1
|
McDaniel SL, Shuster LI, Kennedy MRT. Clock Drawing Test Performance of Young Adults Based on a One-Shot Case Study. Arch Clin Neuropsychol 2024; 39:175-185. [PMID: 37565493 DOI: 10.1093/arclin/acad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE The clock drawing test (CDT) is being used regularly by medical professionals in a variety of settings to aid in assessing cognitive functioning in adults of all ages. As our technological environment has changed significantly, because of the inception of this measure, the use of and exposure to the analog clock have diminished. We investigated whether young adults, who have grown up in a mainly digital world, can draw and tell time on an analog clock. METHOD Participants aged 18-30 years (N = 80, Mage = 24.2, SD = 3.93), who self-identified as having normal cognition, completed the CDT, as well as setting hands on a pre-drawn clock and identifying analog clock times. RESULTS About 25% of participants received a CDT score below the expected range. There was a moderate, positive correlation between analog clock hand setting and time identification in the group who scored below the expected range on the CDT only (rs(16) = 0.472, p = .048). Most participants reported not wearing an analog watch. CONCLUSIONS Based on these findings, the CDT should be used with caution to screen cognitive functioning in young adults (i.e., aged 18-30 years). Consideration of an alternative approach to screening cognition and modifying cognitive assessments in which the CDT is embedded is recommended for this population. These findings warrant further investigation into CDT performance in the young adult population.
Collapse
Affiliation(s)
- Samantha L McDaniel
- Department of Health and Human Services, Interdisciplinary Health Sciences, Western Michigan University, Kalamazoo, MI 49008, USA
- Georgia Southern University, Communication Sciences and Disorders Program, Savannah, GA 31419, USA
| | - Linda I Shuster
- Department of Speech, Language and Hearing Sciences, Western Michigan University, Kalamazoo, MI 49008, USA
| | - Mary R T Kennedy
- Department of Communication Sciences and Disorders, Chapman University, Irvine, CA 92618, USA
| |
Collapse
|
2
|
Medina LD, Henry S, Torres S, MacDonald B, Strutt AM. The Measurement of Acculturation in Neuropsychological Evaluations of Hispanic/Latino Individuals across the Lifespan: A Scoping Review of the Literature. Arch Clin Neuropsychol 2023; 38:365-386. [PMID: 36988392 PMCID: PMC10132785 DOI: 10.1093/arclin/acac114] [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] [Accepted: 12/27/2022] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE Acculturation has been linked to health outcomes in Hispanics/Latinos (H/Ls). However, there is equivocal evidence of a relationship between acculturation and neuropsychological outcomes. Various factors limit the ability to subject the evidence to systematic/meta-analytic review. We sought to examine the current state of the literature in the context of H/Ls and neuropsychology and describe the various limitations of measuring acculturation across the lifespan. METHOD Applying a scoping review approach, we identified unique stand-alone (e.g., questionnaires) measures of acculturation. We focused on psychometric (e.g., internal consistency) and other characteristics (e.g., language, structure/format) and description of the validation samples (e.g., cultural background/country of origin). RESULTS A total of 40 unique acculturation measures were identified. Measures spanned various domains (e.g., language proficiency, food preference, music choice), and relied heavily on linguistic behavioral characteristics. Internal consistency varied from unacceptable to clinically acceptable ranges. Variable approaches to development and validation were reported. Validation samples varied from 22 to 2,048 respondents (median = 380), most of which represented a general adult population. Only eight measures were validated for use in pediatric populations; none were developed specifically for use with older adults. CONCLUSIONS Published measures are outdated, evidence highly variable psychometric and methodological weaknesses, and lack a lifespan perspective. Several themes in the types of items considered elemental to the acculturative process are revealed and findings are summarized via an "ABC" framework, categorizing items as antecedents, behaviors, and consequent acculturative changes, that lends itself to clinical and research settings.
Collapse
Affiliation(s)
- Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Samantha Henry
- Department of Neurology, Section of Neuropsychology, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie Torres
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, TX, USA
| | - Beatriz MacDonald
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX, USA
| | - Adriana M Strutt
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Neurology, Section of Neuropsychology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
3
|
Abstract
OBJECTIVE Dementia among migrants is an emerging phenomenon worldwide and the development of neuropsychological tests sensitive to cultural differences is increasingly regarded as a priority. The Clock Drawing Test (CDT) is one of the most used screening tools for the detection of cognitive decline. Nevertheless, there is still a debate about its adoption as a cross-cultural assessment. METHODS To identify cultural variables influencing performance at CDT, we performed a systematic review of literature on three databases of all studies considering the role of at least one of the following: (1) language; (2) education; (3) literacy; (4) acculturation; and (5) ethnicity. RESULTS We extrapolated 160 analyses from 105 studies. Overall, an influence of cultural determinants on performance at CDT was found in 127 analyses (79.4%). Regarding specific cultural factors, 22 analyses investigated the effect of ethnicity on CDT scores, reporting conflicting results. Only two scoring systems turned out to be sufficiently accurate in a multicultural population. Language influenced performance in only 1 out of 8 analyses. A higher level of education positively influenced test performance in 118 out of 154 analyses (76.6%), and a better quality of education in 1 analysis out of 2. A negative influence of illiteracy on CDT performance emerged in 9 out of 10 analyses. Acculturation affected performances at CDT in 1 out of 2 studies. CONCLUSIONS Based on the present findings, caution is needed when using CDT in a multicultural context, even if it requires limited linguistic competence.
Collapse
|
4
|
Alam RB, Singleton CR, Aguiñaga S, Chodzko-Zajko W, Jahan NA, Oke A, Schwingel A. Is Acculturation Associated with the Cognitive Performance of Older Hispanics? J Alzheimers Dis 2021; 85:535-544. [PMID: 34842186 DOI: 10.3233/jad-210502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Hispanics in the United Statues are disproportionately affected by Alzheimer's disease and related dementias. Little is known about the impact of acculturation on cognitive performance. OBJECTIVE This study examined the association between acculturation and cognitive performance among older Hispanics. METHODS We analyzed cross-sectional data of 616 Hispanic participants in the National Health and Nutrition Examination Survey (NHANES) 2011-2014 [average age = 67.15 years, %Female = 51.46, %less than high-school graduate = 52.60]. Cognitive performance was measured by two neuropsychological tests: Animal Fluency Test (AFT) and Digit Symbol Substitution Test (DSST). We used two single-item proxy measures to quantify acculturation: nativity status (non-US-born residing < 15 years in the US (low acculturation), non-US-born residing ≥15 years in the US, and US-born (high acculturation)); and language acculturation (only/mostly Spanish (low acculturation), Spanish and English, only/mostly English (high acculturation)). We used adjusted linear regression to evaluate associations between acculturation and cognitive performance. RESULTS Results indicated poorer cognitive performance among the low-acculturated groups for both nativity and linguistic measures. Participants who were non-US-born living ≥15 years (p = 0.02) and speaking only/mostly Spanish or Spanish and English (p = 0.01 and 0.006 respectively) had significantly lower AFT scores compared to US-born and only/mostly English-speaking groups. Participants who were non-US-born living < 15 years (p < 0.0001) or non-US-born living ≥15 years (p < 0.0001) and speaking only/mostly Spanish (p = 0.0008) scored lower on the DSST than the US-born and only/mostly English-speaking participants. CONCLUSION In summary, low acculturation is associated with poorer cognitive performance among older Hispanics. Acculturation might be an important attribute to help understand cognitive decline and dementias among Hispanics.
Collapse
Affiliation(s)
- Rifat B Alam
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Chelsea R Singleton
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Susan Aguiñaga
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Wojtek Chodzko-Zajko
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Nilufer A Jahan
- Department of Organic and Geriatric Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | - Adeyosola Oke
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Andiara Schwingel
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| |
Collapse
|
5
|
Gasquoine PG, Weimer AA, Estevis E, Perez E. Survey of Spanish Language Neuropsychological Test Use in the Assessment of Hispanic Americans/Latino/as/x. Arch Clin Neuropsychol 2021; 36:1350-1360. [PMID: 33522567 DOI: 10.1093/arclin/acaa131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/31/2020] [Accepted: 12/27/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To identify the Spanish language neuropsychological tests most frequently used in the evaluation of Hispanic Americans/Latino/as/x across eight neuropsychological domains. To compare these with previously surveyed most frequently used English language tests in the US/Canada. To describe the norms used with Spanish language tests. METHOD An anonymous, uncompensated, 12-min survey was emailed to 169 members of the American Academy of Clinical Neuropsychology, Hispanic Neuropsychological Society, and National Academy of Neuropsychology who self-identified as providing neuropsychological evaluations in Spanish via organizational websites. RESULTS The response rate was 36%. Respondents were all licensed U.S. psychologists with the majority fluent in Spanish, conducting less than half their evaluations in Spanish. There was an overlap between the versions of the three most frequently used Spanish versus English neuropsychological tests, but it varied by domain with 3/3 similar for visual-spatial/visuoconstructional skills and sensory/motor functioning domains and 2/3 similar for all other domains except memory (0/3). English language norm use predominated within the mood/personality and sensory/motor functioning domains. In all other domains, Spanish language norms collected in the continental US were preferred to those from foreign Spanish-speaking countries. The most frequently used foreign norms were from Mexico. CONCLUSION Except for the memory domain, there was a sizeable overlap between the three most frequently used Spanish and English language neuropsychological tests in the US. Spanish language tests are primarily interpreted with Spanish norms collected in the continental US except within the mood/personality and sensory/motor functioning domains where English language norms predominate.
Collapse
Affiliation(s)
- Philip Gerard Gasquoine
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Amy A Weimer
- School of Family & Consumer Sciences, Texas State University, San Marcos, TX, USA
| | | | - Eros Perez
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, TX, USA
| |
Collapse
|
6
|
Hall JR, Johnson LA, Peterson M, Julovich D, Como T, O'Bryant SE. Relationship of Neurofilament Light (NfL) and Cognitive Performance in a Sample of Mexican Americans with Normal Cognition, Mild Cognitive Impairment and Dementia. Curr Alzheimer Res 2021; 17:1214-1220. [PMID: 33605860 DOI: 10.2174/1567205018666210219105949] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 11/20/2020] [Accepted: 01/05/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION This study characterized the relationship between plasma NfL and cognition in a community-based sample of older Mexican Americans. METHODS 544 participants completed a battery of neuropsychological tests and were diagnosed using clinical criteria. NfL was assayed using Simoa. NfL levels across groups and tests were analyzed. RESULTS Difference in NfL was found between normal and impaired groups and was related to global cognition, processing speed, executive functions and a list of learning tasks with a significant negative effect for all diagnostic groups. NfL had a negative impact on processing speed, attention, executive functions and delayed and recognition memory for both normal and MCI groups. CONCLUSION The research supports plasma NfL as a marker of cognitive impairment related to neurodegenerative processes in Mexican Americans and may be a marker of early changes in cognition in those with normal cognition and at risk for developing MCI.
Collapse
Affiliation(s)
- James R Hall
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Leigh A Johnson
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Melissa Peterson
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - David Julovich
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Tori Como
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Sid E O'Bryant
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
| |
Collapse
|
7
|
Tan YW, Burgess GH, Green RJ. The effects of acculturation on neuropsychological test performance: A systematic literature review. Clin Neuropsychol 2020; 35:541-571. [DOI: 10.1080/13854046.2020.1714740] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Yi Wen Tan
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Gerald H. Burgess
- Salomons Institute for Applied Psychology Canterbury, Christ Church University, Canterbury, United Kingdom
| | - Robin J. Green
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
8
|
Caballero J, Ownby RL, Jacobs RJ, Pandya N, Hardigan PC, Ricabal LC. Predicting medication adherence in older Hispanic patients with type 2 diabetes. Am J Health Syst Pharm 2019; 75:e194-e201. [PMID: 29691262 DOI: 10.2146/ajhp170067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Potential cognitive and demographic correlates of medication nonadherence in older Hispanic adults with type 2 diabetes were investigated. METHODS Forty community-dwelling participants 65 years of age or older were recruited. Executive control function (ECF) was assessed using the executive clock drawing task (CLOX 1) test and the 25-item Executive Interview. Self-reported medication adherence was measured on a visual analog scale (VAS); measures of glycemic control included glycosylated hemoglobin (HbA1c) concentration. The primary objective was to determine if ECF performance correlated with medication adherence or glycemic control. RESULTS Participants' mean ± S.D. age was 74.95 ± 7.07 years, and 73% (n = 29) were female. Lower VAS scores correlated with worse CLOX 1 performance (r = 0.38, p = 0.02) and worse HbA1c status (r = -0.42, p = 0.007). Linear regression modeling indicated significant associations between VAS scores and both CLOX 1 results (beta coefficient [β] = 0.41, p = 0.01) and educational level (β = 0.345, p = 0.03). Receiver operating characteristic analysis of CLOX 1 scores (scoring range, 0-15; lower scores indicate greater impairment) showed that a highly sensitive cutoff score for predicting adherence of <90% would be 7, but a cutoff of 10 would provide more specificity. CONCLUSION Results of an evaluation of a small sample of Hispanic older adults with type 2 diabetes demonstrated a relationship between ECF, as measured by the CLOX 1 instrument, and self-reported medication adherence.
Collapse
Affiliation(s)
- Joshua Caballero
- Department of Clinical and Administrative Sciences, College of Pharmacy, Larkin University, Miami, FL
| | - Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
| | | | - Naushira Pandya
- Department of Geriatrics, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
| | | | - Lazara C Ricabal
- Department of Pharmacy Practice, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL
| |
Collapse
|
9
|
Hall JR, Wiechmann A, Johnson LA, Edwards M, O'Bryant SE. Characteristics of Cognitively Normal Mexican-Americans with Cognitive Complaints. J Alzheimers Dis 2019; 61:1485-1492. [PMID: 29376872 DOI: 10.3233/jad-170836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Subjective cognitive complaints in cognitively normal adults have been linked to later cognitive decline and dementia. Research on the characteristics of this group has been conducted on a variety of clinical and community-based populations. The current study focuses on the rapidly expanding population of Mexican-American elders. OBJECTIVE The objective of the study is the determination of characteristics of cognitively normal Mexican-Americans with cognitive complaints. METHODS Data on 319 cognitively normal participants in a large-scale community-based study of elderly Mexican-Americans (HABLE) were analyzed comparing those with cognitive complaints with those without on clinical characteristics, affective status, neuropsychological functioning, and proteomic markers. RESULTS Those expressing concern about cognitive decline scored lower on the MMSE, were more likely to have significantly more affective symptoms, higher levels of diabetic markers, poorer performance on attention and executive functioning, and a different pattern of inflammatory markers. CONCLUSION Although longitudinal research is needed to determine the impact of these differences on later cognition, possible targets for early intervention with Mexican-Americans were identified.
Collapse
Affiliation(s)
- James R Hall
- Center for Alzheimer's and Neurodegenerative Disease Research, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - April Wiechmann
- Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Leigh A Johnson
- Institute for Health Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Melissa Edwards
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Sid E O'Bryant
- Institute for Health Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| |
Collapse
|
10
|
O’Bryant SE, Edwards M, Johnson L, Hall J, Gamboa A, O’Jile J. Texas Mexican American adult normative studies: Normative data for commonly used clinical neuropsychological measures for English- and Spanish-speakers. Dev Neuropsychol 2018; 43:1-26. [PMID: 29190120 PMCID: PMC5875704 DOI: 10.1080/87565641.2017.1401628] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study aimed to provide normative references for Mexican Americans on neuropsychological measures of cognitive functioning. Data were analyzed from a total of 797 Mexican-Americans recruited across three Texas-based studies with approximately one-half of the participants tested in Spanish. Normative tables include: MMSE, AMNART, WMS-III (Logical Memory I, II; Visual Reproduction I, II; Digit Span), CERAD, RAVLT, Exit25, CLOX 1 & 2, Trail Making Test- A&B, BNT, COWA, and Animal Naming. The norms were stratified by education then age. Normative references were generated for Texas-based Mexican Americans and data may be limited to the population sampled.
Collapse
Affiliation(s)
- Sid E. O’Bryant
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth Texas 76107, USA
| | - Melissa Edwards
- Department of Psychology, University of North Texas, Denton, Texas 76203, USA
| | - Leigh Johnson
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth Texas 76107, USA
| | - James Hall
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth Texas 76107, USA
| | - Adriana Gamboa
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth Texas 76107, USA
| | - Judith O’Jile
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth Texas 76107, USA
| |
Collapse
|
11
|
Villarreal AE, Grajales S, O'Bryant SE, Edwards M, López L, Montalván A, Britton GB. Characterization of Alzheimer's Disease and Mild Cognitive Impairment in Older Adults in Panama. J Alzheimers Dis 2016; 54:897-901. [PMID: 27567849 DOI: 10.3233/jad-160402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Research on age-related cognitive impairment is scarce in Central America. We report factors associated with cognitive impairment among a sample of older adults in Panama diagnosed with Alzheimer's disease (AD, n = 31), mild cognitive impairment (MCI, n = 43), or no cognitive impairment (controls, n = 185). Apolipoprotein E (ApoE) genotype was assessed in a subset of cases (n = 135). Age (OR = 2.53, 95% CI = 1.03-6.17) and ApoE ɛ4 (OR = 5.14, 95% CI = 2.11-12.52) were significantly related to cognitive impairment (AD/MCI combined). Results underscore the potential of genetic screening in Panama for identifying those at risk of dementia.
Collapse
Affiliation(s)
- Alcibiades E Villarreal
- Centro de Neurociencias y Unidad de Investigación Clínica, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Clayton, Apartado Postal 0843-01103, Panamá.,Department of Biotechnology, Acharya Nagarjuna University, Guntur 522 510, India
| | - Shantal Grajales
- Centro de Neurociencias y Unidad de Investigación Clínica, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Clayton, Apartado Postal 0843-01103, Panamá
| | - Sid E O'Bryant
- Institute for Healthy Aging, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Melissa Edwards
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX, 76203, USA
| | - Lineth López
- Department of Hematology, Social Security Hospital, Calle José de Fábrega, Vía Simón Bolivar, Panamá
| | - Astevia Montalván
- Department of Psychiatry, Social Security Hospital, Calle José de Fábrega, Vía Simón Bolivar, Panamá
| | - Gabrielle B Britton
- Centro de Neurociencias y Unidad de Investigación Clínica, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Clayton, Apartado Postal 0843-01103, Panamá
| | | |
Collapse
|
12
|
Evans BC, Coon DW, Belyea MJ, Ume E. Collective Care: Multiple Caregivers and Multiple Care Recipients in Mexican American Families. J Transcult Nurs 2016; 28:398-407. [PMID: 27389911 DOI: 10.1177/1043659616657878] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Specific stressors associated with caregiving in Mexican American (MA) families are not well documented, yet caregiving issues are paramount because informal care for parents is central to their culture. Although MA families who band together to provide care for one member are not unique, the literature does not describe the phenomenon of collective caregiving, which may be widespread but unrecognized. This article describes these understudied families who are poorly served by contemporary health systems because their characteristics are unknown. DESIGN Descriptive, multisite, longitudinal mixed-methods study of MA caregiving families. FINDINGS We identified three types of collective caregivers: those providing care for multiple family members simultaneously, those providing care successively to several family members, and/or those needing care themselves during their caregiving of others. DISCUSSION AND CONCLUSIONS Collective caregiving of MA elders warrants further investigation. IMPLICATIONS FOR PRACTICE Exploration of collective caregiving may provide a foundation for tailored family interventions.
Collapse
Affiliation(s)
- Bronwynne C Evans
- 1 Arizona State University College of Nursing and Health Innovation, Phoenix, AZ, USA
| | - David W Coon
- 1 Arizona State University College of Nursing and Health Innovation, Phoenix, AZ, USA
| | - Michael J Belyea
- 1 Arizona State University College of Nursing and Health Innovation, Phoenix, AZ, USA
| | - Ebere Ume
- 2 Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| |
Collapse
|
13
|
Vahia IV, Ng B, Camacho A, Cardenas V, Cherner M, Depp CA, Palmer BW, Jeste DV, Agha Z. Telepsychiatry for Neurocognitive Testing in Older Rural Latino Adults. Am J Geriatr Psychiatry 2015; 23:666-70. [PMID: 25708655 PMCID: PMC4363076 DOI: 10.1016/j.jagp.2014.08.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 01/17/2023]
Abstract
As the population of older Latinos in the U.S. increases, availability of culturally adapted geriatric psychiatry services is becoming a growing concern. This issue is exacerbated for rural Latino populations. In this study, we assessed whether neurocognitive assessment via telepsychiatry (TP) using a Spanish-language battery would be comparable to in-person (IP) testing using the same battery in a sample of Spanish-speaking older adults in a rural setting. Patients (N = 22) received IP and TP testing 2 weeks apart. The order of IP and TP test administrations in individual subjects was determined randomly. Comparison of scores indicated that there were no significant differences between IP and TP test performance though both groups scored non-significantly higher at the second visit. This study demonstrates feasibility and utility of neurocognitive testing in Spanish using TP among older rural Latinos.
Collapse
Affiliation(s)
- Ipsit V Vahia
- Department of Psychiatry, University of California, San Diego, CA; Sam and Rose Stein Institute for Research in Aging, University of California, San Diego, CA.
| | - Bernardo Ng
- Department of Psychiatry, University of California, San Diego, CA; Sun Valley Behavioral & Research Center, Imperial, CA; Department of Psychology, San Diego State University, San Diego, CA
| | - Alvaro Camacho
- Department of Psychiatry, University of California, San Diego, CA; Sun Valley Behavioral & Research Center, Imperial, CA; Department of Psychology, San Diego State University, San Diego, CA
| | - Veronica Cardenas
- Department of Psychiatry, University of California, San Diego, CA; Sam and Rose Stein Institute for Research in Aging, University of California, San Diego, CA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, CA; HIV Neurobehavioral Research Program, University of California, San Diego, CA
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, CA; Sam and Rose Stein Institute for Research in Aging, University of California, San Diego, CA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, CA; Sam and Rose Stein Institute for Research in Aging, University of California, San Diego, CA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, CA; Sam and Rose Stein Institute for Research in Aging, University of California, San Diego, CA
| | - Zia Agha
- Department of Veterans Affairs, University of California, San Diego, CA; Department of Medicine, University of California, San Diego, CA
| |
Collapse
|
14
|
Japanese versions of the executive interview (J-EXIT25) and the executive clock drawing task (J-CLOX) for older people. Int Psychogeriatr 2014; 26:1387-97. [PMID: 24832196 DOI: 10.1017/s104161021400088x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of the study was to develop the Japanese versions of Executive Interview (J-EXIT25) and Executive Clock Drawing Task (J-CLOX) and to evaluate the aspects of executive function that these two tests will be examining. METHODS The concurrent validity and reliability of J-EXIT25 and J-CLOX were first examined in all participants (n = 201). Next, the relationship between the two tests was examined using receiver operating characteristic (ROC), correlation, and regression analyses in healthy participants (n = 45) and participants with mild cognitive impairment (n = 36) and dementia (n = 95). RESULTS Satisfactory concurrent validity and reliability of J-EXIT25 and J-CLOX were shown. ROC analysis indicated that J-EXIT25 and J-CLOX1 were superior to the Frontal Assessment Battery, but inferior to the Mini-Mental State Examination (MMSE), in discriminating between non-dementia and dementia. J-EXIT25, J-CLOX1, and J-CLOX2 scores were significantly correlated with age, scores on the MMSE, Instrumental Activities of Daily Living (IADL) and Physical Self-Maintenance Scale (PSMS), and care level. In stepwise regression analyses of IADL scores, MMSE and J-EXIT25 were significantly independent predictors in men, and MMSE, age, and J-CLOX1 were significantly independent predictors in women. J-EXIT25, MMSE, and J-CLOX1 were significantly independent predictors in stepwise regression analysis of PSMS scores, and J-EXIT25 was the only significantly independent predictor in stepwise regression analysis of care level. CONCLUSIONS J-EXIT25 and J-CLOX are valid and reliable instruments for assessment of executive function in older people. The present results suggest that these tests have common and distinct psychometric properties in the assessment of executive function.
Collapse
|
15
|
Evans BC, Coon DW, Belyea MJ. Worry Among Mexican American Caregivers of Community-Dwelling Elders. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2014; 36:344-365. [PMID: 27228120 DOI: 10.1177/0739986314536684] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This mixed methods, multi-site, National Institute of Nursing Research (NINR)-funded, interdisciplinary, descriptive study aimed to identify expressions of worry in qualitative data obtained from caregiving Mexican American (MA) families assisting older adults. The purpose of this portion of the inquiry was to determine how worry is expressed, what happens to caregivers when they worry, and what adaptive strategies they used. We examined semi-structured interviews completed during six in-home visits with 116 caregivers. We identified 366 worry quotations from 639 primary documents in ATLAS.ti, entered them into matrices, and organized findings under thematic statements. Caregivers expressed cultural and contextual worries, worried about transitions and turning points in care, and identified adaptive strategies. Despite these strategies, worry persisted. Constant worry may be an allied, important aspect of caregiver burden. We need additional longitudinal research to better understand the experience of MA caregivers for older adults and to provide empirically supported interventions, programs, and services that reduce worry.
Collapse
Affiliation(s)
- Bronwynne C Evans
- Arizona State University College of Nursing and Health Innovation, Phoenix, USA
| | - David W Coon
- Arizona State University College of Nursing and Health Innovation, Phoenix, USA
| | - Michael J Belyea
- Arizona State University College of Nursing and Health Innovation, Phoenix, USA
| |
Collapse
|
16
|
Runzer-Colmenares FM, Samper-Ternent R, Al Snih S, Ottenbacher KJ, Parodi JF, Wong R. Prevalence and factors associated with frailty among Peruvian older adults. Arch Gerontol Geriatr 2013; 58:69-73. [PMID: 23978328 DOI: 10.1016/j.archger.2013.07.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 07/17/2013] [Accepted: 07/30/2013] [Indexed: 12/17/2022]
Abstract
The objective of this study is to examine the prevalence and factors associated with frailty in Peruvian Navy Veteran's older adults and family members. A total of 311 non-institutionalized men and women aged 60 years and older, from the Geriatrics Service of the Peruvian Navy Medical Center (Centro Médico Naval "Cirujano Mayor Santiago Távara") were assessed between May and October 2010. Frailty was defined as having two or more of the following components: (1) unintentional weight-loss, (2) weakness (lowest 20% in grip-strength), (3) self-reported exhaustion, and (4) slow walking speed (lowest 20% 8-m walk-time in seconds). Additionally, information on socio-demographic factors, medical conditions, depressive symptoms, disability, and cognitive function were obtained. Of the 311 participants, 78 (25.1%) were not frail, 147 (47.3%) were pre-frail, and 86 (27.8%) were frail. Using logistic regression analysis, we found that older age, being married, falls in the last year and disability were factors significantly associated with being frail. We conclude that prevalence of pre-frail and frail status in Peruvian Navy Veterans and family members is high. Our data reports risk factors for frailty that have been reported in the past in other population groups. A larger sample and longitudinal follow-up are needed to design and implement comprehensive geriatric interventions that can benefit Peruvian Navy Veteran's older adults at risk of becoming frail.
Collapse
Affiliation(s)
- Fernando M Runzer-Colmenares
- Aging Investigation Center, Universidad de San Martin de Porres, Peru; Peruvian Naval Medical Center, Callao, Peru.
| | | | | | | | | | | |
Collapse
|
17
|
Juarez-Cedillo T, Sanchez-Arenas R, Sanchez-Garcia S, Garcia-Peña C, Hsiung GYR, Sepehry AA, Beattie BL, Jacova C. Prevalence of mild cognitive impairment and its subtypes in the Mexican population. Dement Geriatr Cogn Disord 2013. [PMID: 23207978 DOI: 10.1159/000345251] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM To estimate the prevalence of mild cognitive impairment (MCI) and its subtypes, taking into account education and health status. METHODS This is the first report of our Study on Aging and Dementia in Mexico. This study included 2,944 elderly individuals 60 years old or more with in-home assessment for cognitive impairment. The prevalence of MCI was based on Petersen criteria. MCI was classified as amnestic of single domain (a-MCI-s) or multiple domain (a-MCI-md) or nonamnestic of single domain (na-MCI-s) or multiple domain (na-MCI-md). In addition to a battery of neuropsychological measures, a self-report depression measure and a medical history including history of stroke, heart disease and other health conditions were recorded. RESULTS The global estimated prevalence of MCI in the Mexican population was 6.45%. Of these subjects, 2.41% met criteria for a-MCI-s, 2.56% for a-MCI-md, 1.18% for na-MCI-s and 0.30% for na-MCl-md. Women showed a higher prevalence of MCI than men (63.7 vs. 36.3%, respectively). The analysis showed that heart disease [odds ratio (OR) 1.5], stroke (OR 1.2) and depression (OR 2.1) were associated with an increased risk of MCI. CONCLUSIONS The prevalence of MCI in Mexico is similar to that in other countries. The results suggest that stroke, heart disease and depression may have an important role in the etiology of MCI.
Collapse
Affiliation(s)
- Teresa Juarez-Cedillo
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área de Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, Mexico.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Menon CV, Jahn DR, Mauer CB, O'Bryant SE. Executive functioning as a mediator of the relationship between premorbid verbal intelligence and health risk behaviors in a rural-dwelling cohort: a Project FRONTIER study. Arch Clin Neuropsychol 2013; 28:169-79. [PMID: 23192834 PMCID: PMC3569949 DOI: 10.1093/arclin/acs102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 12/23/2022] Open
Abstract
Limited research is available regarding the impact of neuropsychological functioning on health risk behaviors in rural-dwelling elderly populations. This cross-sectional study examined the relationships between estimated premorbid verbal IQ (AMNART), executive functioning impairment (EXIT25), and health risk behaviors including alcohol use (AUDIT), smoking, compliance with recommended cancer screenings, and obesity (BMI). The total sample included 456 English-speaking adults and older adults of non-Hispanic White and Hispanic origin seen as part of an ongoing study of rural cognitive aging, Project FRONTIER. Regression analyses revealed significant independent effects of AMNART and EXIT25 on most health risk behaviors, and supported the hypothesized mediating role of EXIT25 on the relationships between AMNART and smoking, cancer screenings, and BMI in both cognitively impaired and healthy subgroups. This study clarifies the relationships between executive functioning, premorbid IQ, and health risk behaviors in diverse groups, and confirms that premorbid IQ represents an important determinant of health behaviors and neurocognitive outcomes.
Collapse
Affiliation(s)
- Chloe V. Menon
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Danielle R. Jahn
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Cortney B. Mauer
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Sid E. O'Bryant
- Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
- Institute for Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, TX, USA
| |
Collapse
|
19
|
Evans BC, Belyea MJ, Coon DW, Ume E. Activities of daily living in Mexican American caregivers: the key to continuing informal care. JOURNAL OF FAMILY NURSING 2012; 18:439-466. [PMID: 22740307 PMCID: PMC3739688 DOI: 10.1177/1074840712450210] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
La familia drives elder care in Mexican-American (MA) families, but nursing home placement can result from day-to-day caregiving demands that increase caregiver difficulty with activities of daily living (ADLs). Using life course perspective, this article describes the initial data wave of 31 MA caregivers from a descriptive, longitudinal, mixed-methods study of 110 MA caregivers and care recipients over 15 months in their caregiving trajectories. Fifteen of 31 caregivers consistently indicated "no help needed" on the Katz ADL, whereas all but one reported "help needed" during semistructured interviews with cultural brokers. In addition to the discrepancy between results on the Katz ADL and interviews, findings include consideration of nursing home placement by moderately acculturated caregivers and minimization of their illnesses by caregivers. Additional methods of MA caregiver assessment may be needed due to the questionable accuracy of the Katz ADL; additional research should explore minimization and acculturation in MA caregivers.
Collapse
Affiliation(s)
- Bronwynne C Evans
- Arizona State University College of Nursing and Health Innovation, Phoenix, AZ, USA.
| | | | | | | |
Collapse
|
20
|
Menon C, Hall J, Hobson V, Johnson L, O’Bryant SE. Normative performance on the executive clock drawing task in a multi-ethnic bilingual cohort: a project FRONTIER study. Int J Geriatr Psychiatry 2012; 27:959-66. [PMID: 22052628 PMCID: PMC4142441 DOI: 10.1002/gps.2810] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 09/12/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND The executive clock drawing task (CLOX) test is a neuropsychological measure intended to aid in the assessment and detection of dementia in older populations. Few studies have provided normative data for this measure, with even less research available regarding the impact of sociodemographic factors on test scores. This study presents normative data for the CLOX in a sample of English and Spanish-speaking Hispanic and non-Hispanic Whites. METHODS The total sample included 445 cognitively healthy older adults seen as part of an ongoing study of rural cognitive aging, project FRONTIER. Unlike previous studies, criteria for "normality" (i.e., unimpaired) for CLOX1 and CLOX2 were based not merely on global impairment, but also on domain-specific impairment of executive functioning on the Executive Interview 25-item Examination and/or Trail Making Test B, or visuospatial/constructional impairment on the Line Orientation and Figure Copy subtests of the Repeatable Battery for the Assessment of Neuropsychological Status, respectively. RESULTS Hierarchical regression analyses revealed that CLOX1 scores require adjustment by Age across ethnicities, whereas Education and Gender are necessary stratification markers for CLOX1 performance only in non-Hispanic Whites. None of the demographic variables were valid predictors of CLOX2 performance, negating the need for such adjustments. CONCLUSION In addition to being the first study to provide separate normative data for CLOX performance in Hispanic and non-Hispanic White samples, the current study offers a novel approach to defining "normal" by cognitive domain. We also highlight the need to directly examine the impact of sociodemographic factors before applying normative corrections based on factors that have negligible impact on test scores.
Collapse
Affiliation(s)
- Chloe Menon
- Department of Psychology, Texas Tech University, Lubbock, TX, U.S.A
| | - James Hall
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Sciences Center, Fort Worth, TX, U.S.A
- Department of Psychiatry and Neuroscience, University of North Texas Health Sciences Center, Fort Worth, TX, U.S.A
| | - Valerie Hobson
- Department of Psychology, Texas Tech University, Lubbock, TX, U.S.A
| | - Leigh Johnson
- Laura W. Bush Institute for Women’s Health, Texas Tech University Health Sciences Center, Amarillo, TX, U.S.A
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, U.S.A
| | - Sid E. O’Bryant
- F. Marie Hall Institute for Rural & Community Health, Texas Tech University Health Science Center, Lubbock, TX, U.S.A
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, U.S.A
| |
Collapse
|
21
|
Evans BC, Belyea MJ, Ume E. Mexican-American Males Providing Personal Care for their Mothers. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2011; 33:234-260. [PMID: 21643486 DOI: 10.1177/0739986311398615] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We know little about Mexican-American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a female relative. The cases are selected from a federally-funded, descriptive, longitudinal, mixed methods study of 110 MA caregivers and their care recipients. In case-oriented research, investigators can generate propositions (connected sets of statements) that reflect their findings and conclusions, and can be tested against subsequent cases: Caregiving strain and burden in MA males may have more to do with physical and emotional costs than financial ones; MA males providing personal care for their mothers adopt a matter-of-fact approach as they act "against taboo"; and this approach is a new way to fulfill family obligations.
Collapse
Affiliation(s)
- Bronwynne C Evans
- Arizona State University College of Nursing and Health Innovation, 500 N. 3rd Street, Phoenix, Arizona 85004, Office Phone 602-496-0766, Fax 602-496-0886
| | | | | |
Collapse
|
22
|
Kim SH. The global security perspective on the effects of executive cognitive function on complex behavioral screening intervention and HIV/AIDS. SOCIAL WORK IN PUBLIC HEALTH 2010; 25:591-608. [PMID: 21058216 DOI: 10.1080/19371910903127083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of this quantitative study is to understand the global security perspective on the effects of executive cognitive function (ECF) on Complex Behavioral Screening Intervention and HIV/AIDS. The HIV/AIDS pandemic is as much a social, political, economic, and cultural problem as a biomedical one. HIV/AIDS is associated centrally with the collapse not just of communities and families but potentially of states, with some of the largest public health interventions ever and enormous questions about governance, a huge population of orphans, and deep questions about intergenerational relations and cultural transmission. This study also is to develop a screening instrument that improves quality of life for individuals with executive cognitive impairments and behavior problems in our communities and the global society.
Collapse
Affiliation(s)
- Suk-Hee Kim
- The Ethelyn R. Strong School of Social Work, Norfolk State University, Norfolk, Virginia, USA.
| |
Collapse
|
23
|
Crowe M, Allman RM, Triebel K, Sawyer P, Martin RC. Normative performance on an executive clock drawing task (CLOX) in a community-dwelling sample of older adults. Arch Clin Neuropsychol 2010; 25:610-7. [PMID: 20601672 PMCID: PMC2957959 DOI: 10.1093/arclin/acq047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2010] [Indexed: 11/13/2022] Open
Abstract
The CLOX is a clock drawing test used to screen for cognitive impairment in older adults, but there is limited normative data for this measure. This study presents normative data for the CLOX derived from a diverse sample of 585 community-dwelling older adults with complete cognitive data at baseline and 4-year follow-up. Participants with evidence of baseline impairment or substantial 4-year decline on the Mini-Mental State Examination were excluded from the normative sample. Spontaneous clock drawing (CLOX1) and copy (CLOX2) performances were stratified by age group and reading ability from the Wide Range Achievement Test, 3rd edition (WRAT-3). Lowest mean CLOX scores were observed for the oldest age group (75+ years old) with the lowest WRAT-3 reading scores. For all groups, average scores were higher for CLOX2 than CLOX1. These normative data may be helpful to clinicians and researchers for interpreting CLOX performance in older adults with diverse levels of reading ability.
Collapse
Affiliation(s)
- Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, USA.
| | | | | | | | | |
Collapse
|
24
|
Evans BC, Crogan NL, Greenberg E. Lessons Learned in Clinical Research: Using the MMSE With Older Mexican American Nursing Home Residents. J Am Psychiatr Nurses Assoc 2008; 14:373-8. [PMID: 21665780 DOI: 10.1177/1078390308325197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This authors examined the utility of the Mini-Mental State Examination (MMSE) in a pilot study to measure cognitive function in older Mexican American nursing home residents. Many of the lessons learned are transferable to the community: Cognitive screening instruments must be carefully examined for validity and utility, they may need to be administered in Spanish, certain items may need alteration in the questions or expected responses, phrases to be repeated must be culturally appropriate, cutoff scores may need adjustment, "serial sevens" must be used, and education and socioeconomic status must be considered in interpretation of results. Consequently, the MMSE may not be an appropriate measure to use to assess cognitive functioning in older Hispanic populations whose educational levels or literacy is low or unknown. Instead, clinicians should seek other ways to assess mental status, such as other instruments normed for those populations or measures that do not require literacy. J Am Psychiatr Nurses Assoc, 2008; 14(5), 373-378.
Collapse
Affiliation(s)
- Bronwynne C Evans
- Arizona State University College of Nursing & Healthcare Innovation, Phoenix, AZ,
| | | | | |
Collapse
|
25
|
Royall DR, Palmer RF, Chiodo LK, Polk MJ, Markides KS, Hazuda H. Clock-drawing potentially mediates the effect of depression on mortality: replication in three cohorts. Int J Geriatr Psychiatry 2008; 23:821-9. [PMID: 18302318 PMCID: PMC4476511 DOI: 10.1002/gps.1990] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previously studies have associated visuospatial tasks, particularly 'clock-drawing', with mortality. We sought to determine whether clock-drawing also mediates the association between depressive symptoms and mortality. PARTICIPANTS Non-institutionalized Hispanic and non-Hispanic White elderly volunteers. MEASUREMENTS Survival curves were generated as a function of baseline depressive symptom ratings. Significant models were adjusted for CLOX performance. CLOX is divided into CLOX1, a measure of executive control, and CLOX2, a measure of visuospatial skills. DESIGN Retrospective analysis of three longitudinal cohorts. RESULTS CLOX2 and depressive symptoms were both associated with mortality in unadjusted models. CLOX2 predicted survival independently of CLOX1 in all three cohorts. CLOX2 also attenuated, and/or mediated the association between depressive symptoms and mortality. These results withstood adjustment for age and education in all three cohorts. CONCLUSION Regardless of the sample examined, or the measure of depressive symptoms applied, the association between depressive symptoms and mortality appears to be at least partially mediated by visuospatial skills. This finding supports our hypothesis that right hemisphere structural brain disease, particularly that involving the insula, may mediate depression's effects on mortality.
Collapse
Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, the South Texas Veterans’ Health System Audie L. Murphy Division GRECC and the University of Texas Health Science Center, San Antonio, TX, Department of Medicine, the South Texas Veterans’ Health System Audie L. Murphy Division GRECC and the University of Texas Health Science Center, San Antonio, TX, Department of Pharmacology, the South Texas Veterans’ Health System Audie L. Murphy Division GRECC and the University of Texas Health Science Center, San Antonio, TX
| | - Raymond F. Palmer
- Department of Family and Community Medicine, the South Texas Veterans’ Health System Audie L. Murphy Division GRECC and the University of Texas Health Science Center, San Antonio, TX
| | - Laura K. Chiodo
- Department of Medicine, the South Texas Veterans’ Health System Audie L. Murphy Division GRECC and the University of Texas Health Science Center, San Antonio, TX
| | - Marsha J. Polk
- Department of Psychiatry, the South Texas Veterans’ Health System Audie L. Murphy Division GRECC and the University of Texas Health Science Center, San Antonio, TX
| | - Kyriakos S. Markides
- Department Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Helen Hazuda
- Department of Medicine, the South Texas Veterans’ Health System Audie L. Murphy Division GRECC and the University of Texas Health Science Center, San Antonio, TX
| |
Collapse
|
26
|
Schillerstrom JE, Sawyer Baker P, Allman RM, Rungruang B, Zamrini E, Royall DR. Clock drawing phenotypes in community-dwelling African Americans and Caucasians: results from the University of Alabama at Birmingham study of aging. Neuroepidemiology 2007; 28:175-80. [PMID: 17579283 DOI: 10.1159/000104095] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Two dementia patterns have been described: 'type 1' dementia is characterized by executive function impairment and posterior cortical impairment, and 'type 2' dementia is characterized by executive impairment and relatively preserved posterior cortical function. The Executive Clock Drawing Task (CLOX) has been used to discriminate between type 1, type 2, and normal cognitive phenotypes. The aim of this study was to describe the prevalence of these phenotypes in community-dwelling African American and Caucasian elders. METHODS 433 African Americans and 477 Caucasians over the age of 65 were recruited. Executive function was assessed using CLOX1, a command-directed clock drawing task. Posterior cortical impairment was assessed using CLOX2, a clock copy task. CLOX scores were combined to estimate the prevalence of type 1 phenotype (those with poor CLOX1 and CLOX2 performance) versus type 2 phenotype (those with only poor CLOX1 performance). RESULTS 351 (39%) subjects had poor executive performance. Three hundred (33%) subjects had a type 1 phenotype and this pattern was 2.5 times more common among African Americans than Caucasians. One hundred and thirty-seven (15%) subjects had a type 2 phenotype with no significant difference between African Americans and Caucasians. African American ethnicity was independently associated with poor CLOX1 performance after adjusting for sociodemographic factors, posterior cortical function, and global cognition. CLOX2 performance was not associated with ethnicity. CONCLUSION The prevalence of poor executive performance in community-dwelling elders is high. African Americans were more likely to have a type 1 phenotype and these ethnic differences were not explained by sociodemographic variables alone.
Collapse
Affiliation(s)
- Jason E Schillerstrom
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Gaestel Y, Amieva H, Letenneur L, Dartigues JF, Fabrigoule C. Cube drawing performances in normal ageing and Alzheimer's disease: data from the PAQUID elderly population-based cohort. Dement Geriatr Cogn Disord 2006; 21:22-32. [PMID: 16254427 DOI: 10.1159/000089216] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2005] [Indexed: 11/19/2022] Open
Abstract
To assess the influence of age and other sociodemographical variables, depressive symptomatology and the occurrence of Alzheimer's disease (AD) on cube drawing, we examined the performance of 858 normal subjects and 17 incident AD patients in the PAQUID population-based study. Cube drawing was first performed on verbal command and, in case of failure, a model of a cube was given to the subjects to copy. Normal subjects had some difficulties in drawing a cube on verbal command, evidenced by 40% failure in the drawing-to-command condition, while only 17% still failed in the drawing-to-copy condition. Multivariate logistic regressions showed that age, gender, and educational level were associated with cube drawing failure in both conditions, but depressive symptomatology was only associated with persistent failure in the drawing-to-copy condition. Seventy-six point five percent of incident AD subjects failed in the drawing-to-command condition and 64.7% did not benefit from the presentation of the model. Analysis showed that persistent failure in the copy condition was the best level of differentiation between normal and AD subjects.
Collapse
Affiliation(s)
- Yann Gaestel
- INSERM U 593, University Victor Segalen Bordeaux 2, Bordeaux, France.
| | | | | | | | | |
Collapse
|
28
|
Barrington L, Yoder-Wise PS. Executive Control Function: A Clinically Practical Assessment. J Gerontol Nurs 2006; 32:28-34; quiz 35-6. [PMID: 16502759 DOI: 10.3928/0098-9134-20060201-08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Intact executive control function is emerging as a determinant of functional status and independent living. Multiple causes of impaired executive control function including subclinical impairments exist. Integration of bedside executive control function assessment into routine nursing assessment and documentation provides a quantitative measure of an individual's ability to provide self-care.
Collapse
|
29
|
Royall DR, Chiodo LK, Polk MJ. An empiric approach to level of care determinations: the importance of executive measures. J Gerontol A Biol Sci Med Sci 2005; 60:1059-64. [PMID: 16127113 DOI: 10.1093/gerona/60.8.1059] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The ability to predict the level of care received by elderly retirees was compared in a discriminant model and using a classification tree derived from cognitive and noncognitive variables. Methods. Participants were 193 residents (mean age, 79.1+/-5.1 years) of a single, 1,500-bed, continuing care retirement community. They were given a battery of cognitive measures that included tests of general cognition, memory, and executive control function. A multivariate discriminant model of level of care was compared with a classification tree. RESULTS Residents in congregate high-rises (n=115) differed significantly from those in apartment settings (n=78) with respect to age, Executive Interview (EXIT 25), and the Executive Clock-Drawing Task (CLOX). Only age and executive control function measures (CLOX1, EXIT 25, and Trail Making Test Part B [Trails B]) contributed independently to a discriminant model of level of care (Wilke's lambda=0.92; F [df 4,170]=3.48; p <.01). Sixty-three percent of participants were correctly classified. A classification tree derived from the same variable set was more accurate (75% correctly classified). Age, CLOX1, and EXIT 25 made the most important contributions to the model. The EXIT 25 and CLOX1 thresholds empirically derived from this model coincide with the fifth percentiles for these instruments in a young adult sample. CONCLUSIONS Executive control function appears to be most responsible for the effect of cognition on level of care. Young adult norms may be most relevant when the effects of cognitive impairment on functional status are assessed.
Collapse
Affiliation(s)
- Donald R Royall
- Department of Psychiatry, University of Texas Health Science, San Antonio, TX 78229-3900, USA
| | | | | |
Collapse
|
30
|
Schillerstrom JE, Horton MS, Schillerstrom TL, Joshi KG, Earthman BS, Velez AM, Royall DR. Prevalence, Course, and Risk Factors for Executive Impairment in Patients Hospitalized on a General Medicine Service. PSYCHOSOMATICS 2005; 46:411-7. [PMID: 16145185 DOI: 10.1176/appi.psy.46.5.411] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to determine the prevalence, course, and risk factors for executive impairment in patients hospitalized on a general medicine service. One hundred patients were administered the Executive Interview (EXIT25), the Executive Clock Drawing Task (CLOX), and the Mini-Mental State Examination at admission and discharge. Fifty-two percent of the patients at admission and 56% at discharge had scores indicating impairment on at least one measure of executive function. Median scores on every measure improved during hospitalization. Older patients and those with a cardiac or gastrointestinal disorder were more likely to have executive impairment. The prevalence of executive impairment on general medicine services is high. Although improvement in executive function occurs during hospitalization, many patients remained impaired.
Collapse
Affiliation(s)
- Jason E Schillerstrom
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
| | | | | | | | | | | | | |
Collapse
|
31
|
|
32
|
Royall DR, Chiodo LK, Polk MJ. Misclassification Is Likely in the Assessment of Mild Cognitive Impairment. Neuroepidemiology 2004; 23:185-91. [PMID: 15272221 DOI: 10.1159/000078504] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We estimated the relative frequency of isolated memory impairment versus isolated and comorbid impairment in executive control function (ECF). One hundred and ninety-three noninstitutionalized residents of a single Comprehensive Care Retirement Community (mean age 79.2 years) were investigated. The subjects were tested with multiple measures of memory and ECF. Test scores were standardized to minimize scaling effects. 'Impairment' was defined as performance < or =1.5 standard deviations below the mean for the entire sample (i.e., a z score < or =-1.5). Disability was estimated as the sum of self-reported activities of daily living and instrumental activities of daily living. The cognitive test performance was significantly associated with functional impairment, independently of age. ECF and memory measures were significantly intercorrelated. Both were significantly and independently associated with disability ratings. 6-10% of the subjects had memory impairment; 25-35% of the memory-impaired subjects had comorbid ECF impairments. An additional 4-7% of the subjects had isolated ECF impairment. A significant fraction of the cases otherwise meeting the criteria for 'mild cognitive impairment' may have comorbid ECF impairment. This raises the issue of whether they might be more properly classified as 'demented'. In addition, isolated ECF impairment may affect almost as many persons as isolated memory impairment. Isolated ECF impairment is not consistent with the natural history of preclinical Alzheimer's disease, suggests other conditions, and can be disabling, independently of age and/or memory loss.
Collapse
Affiliation(s)
- Donald R Royall
- Department of Psychiatry, South Texas Veterans' Health System Audie L. Murphy Division GRECC and University of Texas Health Science Center, San Antonio, TX 78284, USA.
| | | | | |
Collapse
|
33
|
Wong A, Mok VCT, Yim P, Fu M, Lam WWM, Yau C, Chan AS, Wong KS. The executive clock drawing task (CLOX) is a poor screening test for executive dysfunction in Chinese elderly patients with subcortical ischemic vascular disease. J Clin Neurosci 2004; 11:493-7. [PMID: 15177391 DOI: 10.1016/j.jocn.2004.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2003] [Indexed: 11/19/2022]
Abstract
Executive dysfunction (ED) is a prominent feature of subcortical ischemic vascular disease. A screening test for ED is lacking among Chinese. The objective of the study is to investigate the validity and reliability of a Chinese version of the Executive clock drawing task (CLOX) in screening ED among Chinese elderly patients with small subcortical infarct (SSI). The Chinese version of CLOX correlated with MMSE, CDRS I/P, and WCST perseverative errors. However, multivariate regression analysis showed that only education (R(2) change=0.22, p < 0.001 ) and MMSE (R(2) change=0.35, p < 0.001), but none of the standard executive function tests, significantly accounted for the variance in the CLOX. Test-retest (r=0.84) and inter-rater reliability (r=0.84) were high for the CLOX. Conclusions. Although the CLOX is reliable, it is not valid in detecting ED in Chinese elderly patients with SSI.
Collapse
Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | | | | | | | | | | |
Collapse
|