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Nielsen TR, Franzen S, Watermeyer T, Jiang J, Calia C, Kjærgaard D, Bothe S, Mukadam N. Interpreter-mediated neuropsychological assessment: Clinical considerations and recommendations from the European Consortium on Cross-Cultural Neuropsychology (ECCroN). Clin Neuropsychol 2024:1-31. [PMID: 38588670 DOI: 10.1080/13854046.2024.2335113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE With increasing international migration, societies have become increasingly diverse worldwide. Although neuropsychological assessment is influenced by several diversity characteristics, language barriers have repeatedly been identified as one of the main challenges to cross-cultural neuropsychological assessment in migrant populations. Importantly, neuropsychologists are often required to conduct interpreter-mediated neuropsychological assessments without any graduate training or continuing education on the topic. To address this gap, the objective of this paper is to provide guidelines for interpreter-mediated neuropsychological assessment. METHOD A European Consortium on Cross-Cultural Neuropsychology (ECCroN) task force conducted a conceptual literature review and provided recommendations for good practice and working principles to inform the preparation and administration of interpreter-mediated assessments. RESULTS ECCroN takes the position that it is the responsibility of neuropsychologists, as well as the institutions or organizations that employ them, to ensure effective communication between themselves and their patients. This may be accomplished by preparing for an interpreter-mediated assessment by engaging an appropriate interpreter, which in most circumstances will be a professional in-person interpreter speaking the same language(s) or dialect(s) as the patient, and considering practical, language, and cross-cultural issues. During the assessment, reasonable steps should be taken to proactively manage the proceedings and adopt a communication style that facilitates effective patient-directed communication, and when interpreting test data and determining formulations and diagnoses, the limitations of interpreter-mediated assessment should be carefully considered. CONCLUSION Adhering to the provided recommendations and working principles may help neuropsychologists provide competent interpreter-mediated neuropsychological assessments to linguistically diverse patients.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sanne Franzen
- Department of Neurology & Alzheimer Center, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tamlyn Watermeyer
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Clara Calia
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Daniel Kjærgaard
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Søren Bothe
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- DIGNITY - Danish Institute Against Torture, Copenhagen, Denmark
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Chithiramohan T, Santhosh S, Threlfall G, Hull L, Mukaetova-Ladinska EB, Subramaniam H, Beishon L. Culture-Fair Cognitive Screening Tools for Assessment of Cognitive Impairment: A Systematic Review. J Alzheimers Dis Rep 2024; 8:289-306. [PMID: 38405352 PMCID: PMC10894602 DOI: 10.3233/adr-230194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Background Cognitive screening tools are important in the detection of dementia, including Alzheimer's disease; however, they may contain cultural biases. Objective This review examines culture-fair cognitive screening tools and evaluates their screening accuracy, strengths, and limitations. Methods Medline, Embase, PsychINFO and CINAHL were searched. The protocol was registered on PROSPERO (CRD42021288776). Included studies used a culture-fair tool to assess cognition in older adults from varying ethnicities. Narrative synthesis was conducted. Results 28 studies were included assessing eleven different tools. The Rowland Universal Dementia Assessment Scale (RUDAS) was as accurate as the Mini-Mental State Examination (MMSE) (AUC 0.62-0.93), with a similar sensitivity (52-94%) and better specificity (70-98%), and the Multicultural Cognitive Examination (MCE) had improved screening accuracy (AUC 0.99) compared to RUDAS (AUC 0.92). The Visual Cognitive Assessment Test (VCAT) was equivalent to MMSE (AUC 0.84-0.91). The Kimberley Indigenous Cognitive Assessment tool (KICA) had AUC of 0.93-0.95; sensitivity of 90.6%, specificity 92.6%. Conclusions The RUDAS, KICA and VCAT were superior to MMSE for screening dementia in ethnic minorities. Other tools also showed good screening accuracy. Further research should be done to validate tools in different populations.
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Affiliation(s)
| | | | | | - Louise Hull
- Library and Information Service, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Elizabeta B. Mukaetova-Ladinska
- Leicestershire Partnership NHS Trust, Leicester UK
- Department of Psychology and Visual Sciences, University of Leicester, Leicester, UK
| | | | - Lucy Beishon
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK
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Henderson R, Furlano JA, Claringbold SS, Cornect-Benoit A, Ly A, Walker J, Zaretsky L, Roach P. Colonial drivers and cultural protectors of brain health among Indigenous peoples internationally. Front Public Health 2024; 12:1346753. [PMID: 38425465 PMCID: PMC10903363 DOI: 10.3389/fpubh.2024.1346753] [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: 12/04/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This synthesis of 23 sources includes health communication about dementia, health provider knowledge about Indigenous health, culturally relevant screening and assessment tools, and culturally grounded care models. Much of the focus is currently still on modifiable risk factors that reside at individual factors, whereas attention to wider social factors that impact populations is needed, as stressors through isolation, discrimination, and unequal care are widely reported. Going forward, identifying structural barriers to living well and recognizing the importance of connection to culture will benefit both Indigenous and non-Indigenous understandings of brain health.
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Affiliation(s)
- Rita Henderson
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Joyla A. Furlano
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | | | | | - Anh Ly
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jennifer Walker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Lisa Zaretsky
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Pamela Roach
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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4
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Tureson KN, Beam CR, Medina LD, Segal-Gidan F, D'Orazio LM, Chui H, Torres M, Varma R, Ringman JM. Use of the Spanish English Neuropsychological Assessment Scale in older adult Latines and those at risk for autosomal dominant Alzheimer's disease. J Clin Exp Neuropsychol 2023; 45:553-569. [PMID: 37990912 PMCID: PMC10926998 DOI: 10.1080/13803395.2023.2284971] [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: 05/07/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE The Spanish English Neuropsychological Assessment Scale (SENAS) is a cognitive battery with English and Spanish versions for use with persons for whom either language is predominant. Few studies have examined its utility outside the normative sample. The current study examined SENAS performance in samples of older adult Latines and Latines with or at risk for autosomal dominant Alzheimer's disease (ADAD) mutations. METHOD The SENAS was administered to 202 older adults from the Los Angeles Latino Eye Study (LALES) and 29 adults with (carriers) or without (non-carriers) mutations causing ADAD. We examined associations between SENAS, age, education, and language (LALES) and between SENAS, estimated years from familial age of dementia diagnosis, education, language, and acculturation (ADAD). Partial correlations were used to examine differences in correlational strength between estimated years from familial age of dementia diagnosis and SENAS scores among ADAD carriers compared to chronological age and SENAS in the LALES sample. Exploratory t-tests were performed to examine SENAS performance differences between ADAD carriers and non-carriers. RESULTS In an older adult sample (LALES), increased age correlated with worse verbal delayed recall; English fluency and higher education correlated with better naming and visuospatial subtest performance. Among ADAD carriers, verbal and nonverbal delayed recall and object naming subtest performance worsened as they approached their familial age of dementia diagnosis. English fluency and higher U.S.-acculturation were related to better SENAS performance among carriers and non-carriers. Tests of verbal delayed recall and object naming best distinguished ADAD carriers from their familial non-carrier counterparts. CONCLUSIONS Verbal delayed recall and object naming measures appear to be most sensitive to age-related changes in older adult samples and mutation-related changes in distinguishing ADAD carriers from non-carriers. Future research should examine the sensitivity of SENAS in other samples, such as larger samples of symptomatic ADAD carriers and other AD subtypes.
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Affiliation(s)
- Kayla N Tureson
- Alzheimer's Disease Research Center, Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Christopher R Beam
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
- USC Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Freddi Segal-Gidan
- Alzheimer's Disease Research Center, Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Lina M D'Orazio
- Alzheimer's Disease Research Center, Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Helena Chui
- Alzheimer's Disease Research Center, Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Mina Torres
- CHA Hollywood Presbyterian Medical Center, Southern California Eye Institute, Los Angeles, CA, USA
| | - Rohit Varma
- CHA Hollywood Presbyterian Medical Center, Southern California Eye Institute, Los Angeles, CA, USA
| | - John M Ringman
- Alzheimer's Disease Research Center, Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
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Wei H, Masurkar AV, Razavian N. On gaps of clinical diagnosis of dementia subtypes: A study of Alzheimer's disease and Lewy body disease. Front Aging Neurosci 2023; 15:1149036. [PMID: 37025965 PMCID: PMC10070837 DOI: 10.3389/fnagi.2023.1149036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction Alzheimer's disease (AD) and Lewy body disease (LBD) are the two most common neurodegenerative dementias and can occur in combination (AD+LBD). Due to overlapping biomarkers and symptoms, clinical differentiation of these subtypes could be difficult. However, it is unclear how the magnitude of diagnostic uncertainty varies across dementia spectra and demographic variables. We aimed to compare clinical diagnosis and post-mortem autopsy-confirmed pathological results to assess the clinical subtype diagnosis quality across these factors. Methods We studied data of 1,920 participants recorded by the National Alzheimer's Coordinating Center from 2005 to 2019. Selection criteria included autopsy-based neuropathological assessments for AD and LBD, and the initial visit with Clinical Dementia Rating (CDR) stage of normal, mild cognitive impairment, or mild dementia. Longitudinally, we analyzed the first visit at each subsequent CDR stage. This analysis included positive predictive values, specificity, sensitivity and false negative rates of clinical diagnosis, as well as disparities by sex, race, age, and education. If autopsy-confirmed AD and/or LBD was missed in the clinic, the alternative clinical diagnosis was analyzed. Findings In our findings, clinical diagnosis of AD+LBD had poor sensitivities. Over 61% of participants with autopsy-confirmed AD+LBD were diagnosed clinically as AD. Clinical diagnosis of AD had a low sensitivity at the early dementia stage and low specificities at all stages. Among participants diagnosed as AD in the clinic, over 32% had concurrent LBD neuropathology at autopsy. Among participants diagnosed as LBD, 32% to 54% revealed concurrent autopsy-confirmed AD pathology. When three subtypes were missed by clinicians, "No cognitive impairment" and "primary progressive aphasia or behavioral variant frontotemporal dementia" were the leading primary etiologic clinical diagnoses. With increasing dementia stages, the clinical diagnosis accuracy of black participants became significantly worse than other races, and diagnosis quality significantly improved for males but not females. Discussion These findings demonstrate that clinical diagnosis of AD, LBD, and AD+LBD are inaccurate and suffer from significant disparities on race and sex. They provide important implications for clinical management, anticipatory guidance, trial enrollment and applicability of potential therapies for AD, and promote research into better biomarker-based assessment of LBD pathology.
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Affiliation(s)
- Hui Wei
- Manning College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Arjun V. Masurkar
- Center for Cognitive Neurology, Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
- Neuroscience Institute, NYU Grossman School of Medicine, New York, NY, United States
| | - Narges Razavian
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States
- Center for Data Science, New York University, New York, NY, United States
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Franzen S, van den Berg E, Bossenbroek W, Kranenburg J, Scheffers EA, van Hout M, van de Wiel L, Goudsmit M, van Bruchem-Visser RL, van Hemmen J, Jiskoot LC, Papma JM. Neuropsychological assessment in the multicultural memory clinic: Development and feasibility of the TULIPA battery. Clin Neuropsychol 2023; 37:60-80. [PMID: 35225154 DOI: 10.1080/13854046.2022.2043447] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neuropsychological assessment of culturally diverse populations is hindered by barriers in language, culture, education, and a lack of suitable tests. Furthermore, individuals from diverse backgrounds are often unfamiliar with being cognitively tested. The aim of this study was to develop a new neuropsychological test battery and study its feasibility in multicultural memory clinics. Composition of the TULIPA battery (Towards a Universal Language: Intervention and Psychodiagnostic Assessment) entailed a literature review and consultation with experts and individuals from diverse backgrounds. Feasibility was investigated by examining administration and completion rates and the frequency of factors complicating neuropsychological assessment in 345 patients from 37 countries visiting four multicultural memory clinics in the Netherlands. The test battery included existing tests such as the Cross-Cultural Dementia screening (CCD), Rowland Universal Dementia Assessment Scale (RUDAS), tests from the European Cross-Cultural Neuropsychological Test Battery, and newly developed tests. Completion rates for the test battery were generally high (82%-100%), except for CCD Dots subtest B (58%). Although tests of the "core" TULIPA battery were administered often (median: 6 of 7, IQR: 5-7), supplementary tests were administered less frequently (median: 1 of 9; IQR: 0-3). The number of administered tests correlated with disease severity (RUDAS, ρ=.33, adjusted p < .001), but not with other patient characteristics. Complicating factors were observed frequently, e.g. suboptimal effort (29%-50%), fatigue (29%), depression (37%-57%). The TULIPA test battery is a promising new battery to assess culturally diverse populations in a feasible way, provided that complicating factors are taken into account. Supplemental data for this article is available online at https://doi.org/10.1080/13854046.2022.2043447 .
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Affiliation(s)
- Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Willemijn Bossenbroek
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Medical Psychology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Judi Kranenburg
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Esther A Scheffers
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Moniek van Hout
- Department of Medical Psychology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Lotte van de Wiel
- Department of Medical Psychology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Miriam Goudsmit
- Department of Psychiatry and Medical Psychology, OLVG, Amsterdam, The Netherlands
| | | | - Judy van Hemmen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lize C Jiskoot
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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7
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Mendez MF. Can Speaking More Than One Language Help Prevent Alzheimer's Disease? J Alzheimers Dis 2023; 95:363-377. [PMID: 37545240 DOI: 10.3233/jad-230285] [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] [Indexed: 08/08/2023]
Abstract
Alzheimer's disease (AD) is an age-related neurocognitive disorder that is epidemic in the elderly population. Currently, there are limited pharmacological interventions, and this has heightened the urgency to identify potential preventable or modifiable risk factors that promote resilience to the neuropathological effects of AD. The regular use of two or more languages is one such factor that may increases cognitive reserve through the long-standing executive control involved in managing multiple languages in the brain. There is also evidence that bilingualism is associated with increased brain reserve or maintenance, particularly in frontal-executive structures and networks. This review examines the current, sometimes conflicting literature on bi/multilingualism and AD. These studies have confounding variations in the assessment of age of second language onset, language proficiency, language usage, and whether determining incidence of AD or age of symptom onset. Despite these limitations, most publications support the presence of increased frontal-executive reserve that compensates for the development of AD neuropathology and, thereby, delays the emergence of clinical symptoms of dementia by about 4-5 years. Although regularly speaking more than one language does not protect against AD neuropathology, the delay in its clinical expression has a potentially significant impact on the lifelong morbidity from this age-related disease. Learning other languages may be an important modifiable factor for delaying the clinical expression of AD in later life.
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Affiliation(s)
- Mario F Mendez
- Departments of Neurology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, and Neurology Service, Neurobehavior Unit, U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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8
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Zhu CW, Neugroschl J, Barnes LL, Sano M. Racial/ethnic disparities in initiation and persistent use of anti-dementia medications. Alzheimers Dement 2022; 18:2582-2592. [PMID: 35218291 PMCID: PMC9402814 DOI: 10.1002/alz.12623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/23/2021] [Accepted: 01/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Racial/ethnic disparities in anti-dementia medications use in longitudinally followed research participants are unclear. METHODS The study included initially untreated participants followed in National Alzheimer's Coordinating Center Uniform Data Set who were ≥65 at baseline with Alzheimer's disease dementia. OUTCOMES Outcomes for acetylcholinesterase inhibitor (AChEI) treatment included (1) any new AChEI treatment during follow-up, and (2) persistence of treatment during follow-up categorized into: intermittent treatment (< 50% follow-ups reporting treatment), persistent (≥50% follow-ups), and always treated. Outcomes for memantine treatment were similarly constructed. RESULTS Controlling for participant characteristics, Black and Hispanic participants remained less likely than White participants to report any new AChEI or memantine treatment during follow-up. Among those who reported new treatment during follow-up, both Black and Hispanic participants were less likely than White participants to be persistently treated with AChEI and memantine. DISCUSSION Substantial racial/ethnic treatment disparities remain in controlled settings of longitudinal research in which participants have access to dementia experts, suggesting wider disparities in the larger community.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
- James J Peters VA Medical Center, Bronx, NY
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Judith Neugroschl
- James J Peters VA Medical Center, Bronx, NY
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lisa L Barnes
- Rush Alzheimer’s Disease Center and Department of Neurological Sciences, Chicago, IL.Rush University Medical Center, Chicago, IL
| | - Mary Sano
- James J Peters VA Medical Center, Bronx, NY
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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Noren Hooten N, Pacheco NL, Smith JT, Evans MK. The accelerated aging phenotype: The role of race and social determinants of health on aging. Ageing Res Rev 2022; 73:101536. [PMID: 34883202 PMCID: PMC10862389 DOI: 10.1016/j.arr.2021.101536] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/12/2021] [Accepted: 12/03/2021] [Indexed: 02/06/2023]
Abstract
The pursuit to discover the fundamental biology and mechanisms of aging within the context of the physical and social environment is critical to designing interventions to prevent and treat its complex phenotypes. Aging research is critically linked to understanding health disparities because these inequities shape minority aging, which may proceed on a different trajectory than the overall population. Health disparities are characteristically seen in commonly occurring age-associated diseases such as cardiovascular and cerebrovascular disease as well as diabetes mellitus and cancer. The early appearance and increased severity of age-associated disease among African American and low socioeconomic status (SES) individuals suggests that the factors contributing to the emergence of health disparities may also induce a phenotype of 'premature aging' or 'accelerated aging' or 'weathering'. In marginalized and low SES populations with high rates of early onset age-associated disease the interaction of biologic, psychosocial, socioeconomic and environmental factors may result in a phenotype of accelerated aging biologically similar to premature aging syndromes with increased susceptibility to oxidative stress, premature accumulation of oxidative DNA damage, defects in DNA repair and higher levels of biomarkers of oxidative stress and inflammation. Health disparities, therefore, may be the end product of this complex interaction in populations at high risk. This review will examine the factors that drive both health disparities and the accelerated aging phenotype that ultimately contributes to premature mortality.
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Affiliation(s)
- Nicole Noren Hooten
- Laboratory of Epidemiology and Population Science, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Baltimore, MD 21224, USA
| | - Natasha L Pacheco
- Laboratory of Epidemiology and Population Science, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Baltimore, MD 21224, USA
| | - Jessica T Smith
- Laboratory of Epidemiology and Population Science, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Baltimore, MD 21224, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Science, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Baltimore, MD 21224, USA.
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10
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Franzen S, Papma JM, van den Berg E, Nielsen TR. Cross-cultural neuropsychological assessment in the European Union: a Delphi expert study. Arch Clin Neuropsychol 2021; 36:815-830. [PMID: 33043958 PMCID: PMC8292927 DOI: 10.1093/arclin/acaa083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/06/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The increasing ethnic diversity in the European Union (EU) calls for adaptations to neuropsychological assessment practices. The aims of this study were to examine the current state of cross-cultural neuropsychological assessment in EU-15 countries and to provide recommendations for researchers and policy makers. METHOD Twelve experts from nine EU-15 countries participated in a Delphi consensus study involving two sequential rounds of web-based questionnaires and an in-person consensus meeting. The experts individually rated Delphi topics on the basis of importance (scale 1-10). The degree of consensus was determined by assessing first and third quartiles (Q1 and Q3) and medians. RESULTS Consensus outcomes showed the following priorities: (a) the development of tests (median importance rating 10, Q1-Q3: 9-10), (b) the collection of normative data (median importance rating 9, Q1-Q3: 8-10), and (c) more training, awareness, and knowledge regarding cross-cultural assessment among neuropsychologists in the EU (median importance rating 9, Q1-Q3: 8-10). Whereas memory tests were often available, tests measuring social cognition (median 9, Q1-Q3: 8-10) and language (median 9, Q1-Q3: 7-10) are particularly lacking. Recommendations were made regarding essential skills and knowledge necessary for cross-cultural neuropsychological assessment. CONCLUSIONS This study in a small group of experts suggests that the development and availability of cross-cultural tests and normative data should be prioritized, as well as the development and implementation of training initiatives. Furthermore, EU guidelines could be established for working with interpreters during neuropsychological assessment. Before implementing these recommendations, follow-up studies are recommended that include more minority neuropsychologists and community stakeholders.
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Affiliation(s)
- Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
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11
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Bulic D, Bennett M, Georgousopoulou EN, Shehabi Y, Pham T, Looi JCL, van Haren FMP. Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium. Ann Intensive Care 2020; 10:104. [PMID: 32748298 PMCID: PMC7399009 DOI: 10.1186/s13613-020-00723-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/28/2020] [Indexed: 01/02/2023] Open
Abstract
Objective Delirium is common in intensive care patients and is associated with short- and long-term adverse outcomes. We investigated the long-term risk of cognitive impairment and post-traumatic stress disorder (PTSD) in intensive care patients with and without delirium. Methods This is a prospective cohort study in ICUs in two Australian university-affiliated hospitals. Patients were eligible if they were older than 18 years, mechanically ventilated for more than 24 h and did not meet exclusion criteria. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Variables assessing cognitive function and PTSD symptoms were collected at ICU discharge, after 6 and 12 months: Mini-Mental State Examination, Telephone Interview for Cognitive Status, Impact of Events Scale-Revised and Informant Questionnaire for Cognitive Decline (caregiver). Results 103 participants were included of which 36% developed delirium in ICU. Patients with delirium were sicker and had longer duration of mechanical ventilation and ICU length of stay. After 12 months, 41/60 (68.3%) evaluable patients were cognitively impaired, with 11.6% representing the presence of symptoms consistent with dementia. When evaluated by the patient’s caregiver, the patient’s cognitive function was found to be severely impaired in a larger proportion of patients (14/60, 23.3%). Delirium was associated with worse cognitive function at ICU discharge, but not with long-term cognitive function. IES-R scores, measuring PTSD symptoms, were significantly higher in patients who had delirium compared to patients without delirium. In regression analysis, delirium was independently associated with cognitive function at ICU discharge and PTSD symptoms at 12 months. Conclusions Intensive care survivors have significant rates of long-term cognitive decline and PTSD symptoms. Delirium in ICU was independently associated with short-term but not long-term cognitive function, and with long-term PTSD symptoms. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616001116415, 15/8/2016 retrospectively registered, https://www.anzctr.org.au
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Affiliation(s)
- Daniella Bulic
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Michael Bennett
- Prince of Wales Clinical School of Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ekavi N Georgousopoulou
- Australian National University Medical School, Canberra, Australia.,Centre for Health and Medical Research, ACT Health Directorate, Canberra, Australia
| | - Yahya Shehabi
- Prince of Wales Clinical School of Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Monash Health and Monash University, Melbourne, Australia
| | - Tai Pham
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Service de Médecine Intensive-Réanimation, APHP, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra, Australia
| | - Frank M P van Haren
- Australian National University Medical School, Canberra, Australia. .,ICU, Canberra Hospital, Canberra, Australia.
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Cognitive and neuropsychological examination of the elderly. HANDBOOK OF CLINICAL NEUROLOGY 2020. [PMID: 31753159 DOI: 10.1016/b978-0-12-804766-8.00006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Neuropsychological assessment plays a prominent role in the evaluation and care of patients with neurodegenerative diseases throughout the dynamic course of disease. As a biomarker of disease, neuropsychological measurement can distinguish normal from pathologic aging processes. Further, neuropsychological data can help distinguish and classify underlying pathologies in dementing diseases, augmenting imaging and biofluid markers in this area. Neuropsychological data can predict increased or reduced risk for dementia conferred by multiple factors, and describe disease trajectory in affected individuals. Cognitive evaluation can also estimate and address functional outcomes that are most important to patients and their loved ones and that are clinically relevant to diagnostic staging. In informing intervention and patient care needs, areas of cognitive weakness highlight targets for support/intervention, while areas of cognitive strength can be capitalized upon to modify the clinical course of disease. These functions can be accomplished through the complementary use of brief screening tools and comprehensive test batteries. However, for neuropsychological data to serve these functions, it is critical to understand neuropsychological test properties and nondisease factors that can account for variance in test performance. This chapter concludes with directions for future research.
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Construct validity of the Visual Cognitive Assessment Test (VCAT)-a cross-cultural language-neutral cognitive screening tool. Int Psychogeriatr 2020; 32:141-149. [PMID: 31111797 DOI: 10.1017/s1041610219000504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Visual Cognitive Assessment Test (VCAT) is a language-neutral cognitive screening tool designed for use in culturally diverse populations without the need for translations or adaptations. While it has been established to be language-neutral, the VCAT's construct validity has not been investigated. METHODS 471 participants were recruited, comprising 233 healthy comparisons, 117 mild cognitive impairment (MCI), and 121 mild Alzheimer's disease (AD) patients. VCAT and domain-specific neuropsychological tests were administered in the same sitting. Construct validity was assessed by analyzing domain-specific associations between the VCAT and well-established cognitive assessments. Reliability (internal consistency) was measured by Cronbach's alpha. Diagnostic ability (area under the curve) and recommended cutoffs were determined by receiver operating characteristic (ROC) analysis. RESULTS The VCAT and its subdomains demonstrated good construct validity in terms of both convergent and divergent validity and good internal consistency (α = .74). ROC analysis found that the VCAT was on par with the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at distinguishing between healthy comparisons, MCI, and mild AD. Consistent with previous studies, VCAT scores were not affected by language of administration or ethnicity in our cohort. Findings suggest the following cutoffs: Dementia 0-19, MCI 20-24, Normal 25-30. CONCLUSION This study established the construct validity of the VCAT, which is vital to ensure its subdomains effectively measure the cognitive processes they were designed to. The VCAT is capable of detecting early cognitive impairments and allows for meaningful cross-cultural comparisons, especially useful for international collaborations and clinical trials, and for clinical use in diverse multiethnic populations.
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Arévalo SP, Kress J, Rodriguez FS. Validity of Cognitive Assessment Tools for Older Adult Hispanics: A Systematic Review. J Am Geriatr Soc 2019; 68:882-888. [DOI: 10.1111/jgs.16300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Sandra P. Arévalo
- California State University, Long Beach, Department of Human Development Long Beach California
- USC Edward R. Roybal Institute on Aging University of Southern California Los Angeles California
| | - Jennifer Kress
- USC Edward R. Roybal Institute on Aging University of Southern California Los Angeles California
- Darmstadt University of Applied Science Darmstadt Germany
| | - Francisca S. Rodriguez
- USC Edward R. Roybal Institute on Aging University of Southern California Los Angeles California
- German Center for Neurodegenerative Diseases (DZNE) Greifswald Germany
- Center for Cognitive Science University of Kaiserslautern Kaiserslautern Germany
- Institute of Social Medicine, Occupational Health and Public Health (ISAP) University of Leipzig Leipzig Germany
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Racial disparities and temporal trends in dementia misdiagnosis risk in the United States. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:891-898. [PMID: 31890853 PMCID: PMC6926355 DOI: 10.1016/j.trci.2019.11.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Systematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to 2010. Methods We linked fee-for-service Medicare claims to participants aged ≥70 from the nationally representative Health and Retirement Study. We classified dementia status using an algorithm with similar sensitivity and specificity across racial/ethnic groups and assigned clinical dementia diagnosis status using ICD-9-CM codes from Medicare claims. Multinomial logit models were used to estimate relative risks of clinical under- and overdiagnosis between groups and over time. Results Non-Hispanic blacks had roughly double the risk of underdiagnosis as non-Hispanic whites. While primary analyses suggested a shrinking disparity over time, this was not robust to sensitivity analyses or adjustment for covariates. Risk of overdiagnosis increased over time in both groups. Discussion Our results suggest that efforts to reduce racial disparities in underdiagnosis are warranted.
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Mendez MF. Bilingualism and Dementia: Cognitive Reserve to Linguistic Competency. J Alzheimers Dis 2019; 71:377-388. [DOI: 10.3233/jad-190397] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Mario F. Mendez
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Departments of Neurology and Psychiatry & Biobehavioral Sciences, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California at Los Angeles, CA, USA
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Mendez MF, Chavez D, Akhlaghipour G. Bilingualism Delays Expression of Alzheimer's Clinical Syndrome. Dement Geriatr Cogn Disord 2019; 48:281-289. [PMID: 32045913 PMCID: PMC7195235 DOI: 10.1159/000505872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/10/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To evaluate the effects of bilingualism on the emergence of Alzheimer's clinical syndrome. BACKGROUND Studies have proposed an increase in cognitive and neural reserve from the management and control of two languages, with a consequent delayed expression of dementia. METHODS In a clinic with a large immigrant population, we identified 253 patients with probable Alzheimer's disease (AD) with intermediate or high evidence of AD pathophysiological process. These patients were reviewed for demographic variables, native language (L1) other than English, ages of onset and presentation, Mini-Mental State Examination (MMSE), digit spans, word fluencies, naming, and memory. RESULTS Among these patients, 74 (29.2%) were bilinguals with various L1s (Farsi, Spanish, Chinese, Tagalog, Arabic, others). When compared to the 179 monolingual AD patients, those who were bilingual had significant delays in ages of onset and presentation of approximately 4 years (p = 0.003). These delays persisted despite bilinguals having worse MMSE scores on presentation. There were no significant group differences on other variables except for worse naming in English among bilinguals versus monolinguals. Caregiver/informants reported that 66 (89.2%) of the 74 bilingual AD patients had gradually regressed to the predominant use of their L1. CONCLUSIONS In line with published reports worldwide, we found that bilingualism delays the expression of Alzheimer's clinical syndrome. We also found frequent reversion to the first learned language. These findings suggest that, among bilinguals, the availability of an L1 "back-up" either facilitates compensation or masks emergence of the early symptoms of dementia.
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Affiliation(s)
- Mario F. Mendez
- V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA,Departments of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA,Psychiatry & Biobehavioral Sciences, and Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Diana Chavez
- Departments of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Golnoush Akhlaghipour
- Departments of Neurology, David Geffen School of Medicine, University of California at Los Angeles, CA, USA
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Barrie ES, Lee S, Frater JT, Kataki M, Scharre DW, Sadee W. Alpha-synuclein mRNA isoform formation and translation affected by polymorphism in the human SNCA 3'UTR. Mol Genet Genomic Med 2018; 6:565-574. [PMID: 29730891 PMCID: PMC6081226 DOI: 10.1002/mgg3.407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/02/2018] [Accepted: 04/05/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Multiple variants in SNCA, encoding alpha-synuclein, a main component of Lewy bodies, are implicated in Parkinson's disease. METHODS We searched for cis-acting SNCA variants using allelic mRNA ratios in human brain tissues. In a SNCA 3'UTR (2,520 bp) luciferase reporter gene assay, translation in SH-SY5Y cells in the presence of the rs17016074 G/A alleles was measured. To assess clinical impact, we queried neurocognitive genome-wide association studies. RESULTS Allelic ratios deviated up to twofold, measured at a marker SNP in the middle of a long 3' untranslated region (3'UTR), but not at a marker at its start, suggesting regulation of 3'UTR processing. 3'UTR SNP rs17016074 G/A, minor allele frequency (MAF) <1% in Caucasians, 13% in Africans, strongly associates with large allelic mRNA expression imbalance (AEI), resulting in reduced expression of long 3'UTR isoforms. A second 3'UTR SNP (rs356165) associates with moderate AEI and enhances SNCA mRNA expression. The rs17016074 A allele reduces overall 3'UTR expression in luciferase reporter gene assays but supports more efficient translation, resolving previous contradictory results. We failed to detect significant genome-wide associations for rs17016074, possibly a result of low MAF in Caucasians or its absence from most genotyping panels. In the "Genome Wide Association Study of Yoruba in Nigeria," rs356165 was associated with reduced memory performance. CONCLUSIONS Here, we identify two cis-acting regulatory variants affecting SNCA mRNA expression, measured by allelic ratios in the 3'UTR. The rs17016074 minor A allele is associated with higher expression of luciferase protein activity. Resolving the genetic influence of SNCA polymorphisms requires study of the interactions between multiple regulatory variants with distinct frequencies among populations.
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Affiliation(s)
- Elizabeth S. Barrie
- Institute for Genomic MedicineNationwide Children's HospitalColumbusOhio
- Center for PharmacogenomicsDepartment of Cancer Biology and GeneticsCollege of MedicineThe Ohio State UniversityColumbusOhio
| | - Sung‐Ha Lee
- Center for PharmacogenomicsDepartment of Cancer Biology and GeneticsCollege of MedicineThe Ohio State UniversityColumbusOhio
| | - John T. Frater
- Center for PharmacogenomicsDepartment of Cancer Biology and GeneticsCollege of MedicineThe Ohio State UniversityColumbusOhio
| | - Maria Kataki
- Division of Cognitive NeurologyDepartment of NeurologyThe Ohio State University Wexner Medical CenterColumbusOhio
| | - Douglas W. Scharre
- Division of Cognitive NeurologyDepartment of NeurologyThe Ohio State University Wexner Medical CenterColumbusOhio
| | - Wolfgang Sadee
- Center for PharmacogenomicsDepartment of Cancer Biology and GeneticsCollege of MedicineThe Ohio State UniversityColumbusOhio
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Bellaj T, Ben Jemaa S, Khelifa M, Ben Djebara M, Gouider R, Le Gall D. The Development of the Dementia Screening Battery-100: Instrument Presentation, Reliability, and Construct Validity. Dement Geriatr Cogn Dis Extra 2017; 7:215-229. [PMID: 28690635 PMCID: PMC5498961 DOI: 10.1159/000477437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/02/2017] [Indexed: 12/02/2022] Open
Abstract
Background/Aim The screening of dementia in non-Westerners has so far relied on translations and adaptations of reputed instruments. Other efforts focused on developing culturally appropriate tests or tests in touch with new developments in the field. This study presents the rationale behind the construction of a new dementia screening test: the Dementia Screening Battery-100 (DSB-100). Methods The DSB-100 was administered to 46 demented individuals and 159 healthy matched controls. All demented participants met the DSM-IV criteria for dementia. The healthy controls showed no cognitive impairment and were independent in activities of daily living. The DSB-100 was administered as part of a larger neuropsychological assessment to collect additional indices on the severity of patients' dementia, depression, and frontal dysfunctions. The same information was used for comparisons with DSB-100 scores. Results Multiple regression analysis suggested that age and education, but not the variable sex, are essential in predicting cognitive performance. Construct validation yielded 4 factors, namely attention-visuospatial factors, memory, language, and executive functions. The results showed that the DSB-100 has a high interrater reliability and an acceptable overall internal homogeneity. Conclusion These results validate the DSB-100 and suggest its appropriateness for dementia screening in Tunisian elderly and possibly elderly people from other cultures with modifications to some subscales.
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Affiliation(s)
- Tarek Bellaj
- Psychology Program, Department of Social Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Sonia Ben Jemaa
- Faculty of Human and Social Sciences of Tunis, Tunis University, Tunis, Tunisia
| | - Maher Khelifa
- Psychology Program, Department of Social Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | | | | | - Didier Le Gall
- Laboratoire de Psychologie des Pays de la Loire, University of Angers, Bretagne-Loire University, Angers, France
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Bulic D, Bennett M, Rodgers H, Nourse M, Rubie P, Looi JC, Van Haren F. Delirium After Mechanical Ventilation in Intensive Care Units: The Cognitive and Psychosocial Assessment (CAPA) Study Protocol. JMIR Res Protoc 2017; 6:e31. [PMID: 28246074 PMCID: PMC5426842 DOI: 10.2196/resprot.6660] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 11/13/2022] Open
Abstract
Background In the intensive care unit (ICU), critical illness delirium occurs in the context of multiple comorbidities, multi-organ failure, and invasive management techniques, such as mechanical ventilation, sedation, and lack of sleep. Delirium is characterized by an acute confusional state defined by fluctuating mental status, inattention, and either disorganized thinking or an altered level of consciousness. The long-term cognitive and psychosocial function of patients that experience delirium in the ICU is of crucial interest because preliminary data suggest a strong association between ICU-related delirium and long-term cognitive impairment. Objective The aim of this study is to explore the relationship between delirium in the ICU and adverse outcomes by following mechanically ventilated patients for one year following their discharge from the ICU and collecting data on their long-term cognition and psychosocial function. Methods This study will be conducted by enrolling patients in two tertiary ICUs in Australia. We aim to recruit 200 patients who have been mechanically ventilated for more than 24 hours. Data will be collected at the following three time points: (1) at discharge where they will be administered the Mini-Mental State Examination (MMSE); (2) at 6 months after discharge from the ICU discharge where the Impact of Events Scale Revised (IES-R) and the Telephone Inventory for Cognitive Status (TICS) tests will be administered; and (3) at 12 months after discharge from the ICU where the patients will be administered the TICS and IES-R tests, as well as the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). The IQCODE will be administered to their “person responsible” or the significant other of the patient. Results Long-term cognition and psychosocial function will be the primary outcome of this study. Mortality will also be investigated as a secondary outcome. Active enrollment will take place until the end of September 2016 and data collection will conclude at the end of September 2017. The analysis and results are expected to be available by March 2018. Conclusion Delirium during mechanical ventilation has been linked to longer ICU and hospital stays, higher financial burdens, increased risks of long-term cognitive impairment (ie, dementia), poor functional outcomes and quality of life, and decreased survival. However, delirium during mechanical ventilation in the ICU is not well understood. This study will advance our knowledge of the comprehensive, long-term effects of delirium on cognitive and psychosocial function. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616001116415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371216 (Archived by WebCite at http://www.webcitation.org/ 6nfDkGTcW)
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Affiliation(s)
- Daniella Bulic
- University of New South Wales, Faculty of Medicine, University of New South Wales, Randwick, Australia
| | - Michael Bennett
- University of New South Wales, Faculty of Medicine, University of New South Wales, Randwick, Australia.,Prince of Wales Hospital, Anaesthetic Department, Prince of Wales Hospital, Randwick, Australia
| | - Helen Rodgers
- Canberra Hospital, Intensive Care Research Department, Canberra Hospital, Garran, Australia
| | - Mary Nourse
- Canberra Hospital, Intensive Care Research Department, Canberra Hospital, Garran, Australia
| | - Patrick Rubie
- Prince of Wales Hospital, Anaesthetic Department, Prince of Wales Hospital, Randwick, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, Medical School, Australian National University, Canberra, Australia.,Faculty of Medicine, Melbourne Neuropsychiatry Centre, Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Frank Van Haren
- Canberra Hospital, Intensive Care Research Department, Canberra Hospital, Garran, Australia.,Medical School, College of Medicine, Biology & Environment, Australian National University, Canberra, Australia
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Goudsmit M, Uysal-Bozkir Ö, Parlevliet JL, van Campen JP, de Rooij SE, Schmand B. The Cross-Cultural Dementia Screening (CCD): A new neuropsychological screening instrument for dementia in elderly immigrants. J Clin Exp Neuropsychol 2016; 39:163-172. [DOI: 10.1080/13803395.2016.1209464] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Sayegh P. Neuropsychological Language Tests in Dementia Diagnosis in English-Speaking Hispanic and Non-Hispanic White Outpatients. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 22:435-44. [PMID: 25909144 DOI: 10.1080/23279095.2014.978451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neuropsychological language tests have limitations (e.g., unrepresentative norms) when applied to "Hispanics" and clinicians are likely aware that these tests may lead to inaccurate dementia diagnoses. Therefore, it was hypothesized that language tests would be weaker diagnostic predictors in Hispanics versus "Non-Hispanic Whites." Participants included 436 English-speaking Hispanic and 436 Non-Hispanic White (randomly selected from 10,937) outpatients classified as having dementia or normal cognition at initial evaluation. When covarying for age, sex, education, and functional abilities, vegetable fluency significantly predicted diagnosis among Non-Hispanic Whites (odds ratio = 0.80, 95% confidence interval [0.69, 0.94], p < .01). Animal fluency and an abbreviated (30-item) Boston Naming Test (BNT) comparably predicted diagnosis across groups. Results remained similar when covarying for primary language among Hispanics. Findings suggest that vegetable fluency, but not animal fluency, was relatively unimportant in diagnosis for the English-speaking Hispanics in this study possibly because of cultural influences on the familiarity, salience, and relevance of this category's items. Additionally, clinicians may have informally adjusted Hispanics' 30-item BNT and animal fluency scores and discounted vegetable fluency to account for their limitations. Animal fluency and BNT may be preferable language tests when assessing dementia in English across groups, as they comparably predicted diagnosis in both groups.
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Affiliation(s)
- Philip Sayegh
- a Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine , University of California , Los Angeles , Los Angeles , California
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Vrantsidis F, Logiudice D, Rayner V, Dow B, Antonopoulos S, Runci S, O'Connor DW, Haralambous B. Aged Care Assessment Service practitioners: a review of current practice for assessment of cognition of older people of culturally and linguistically diverse backgrounds in Victoria. Australas J Ageing 2014; 33:E1-6. [PMID: 24520873 DOI: 10.1111/ajag.12056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper describes current practices and gaps identified by Aged Care Assessment Service (ACAS) clinicians in the assessment of cognition of clients of culturally and linguistically diverse (CALD) background in Victoria. METHOD A web-based survey, exploring practices and challenges faced by clinicians in assessing CALD clients and their families, was sent to all Victorian ACAS managers to distribute to their teams. Three focus groups were also conducted with ACAS clinicians to further explore these issues. RESULTS Seventy-nine web-based surveys were returned and 21 ACAS clinicians attended a focus group. Challenges reported included the availability and quality of interpreters, and variability in training received and confidence in assessing cognitive impairment in CALD clients. CONCLUSION ACAS clinicians reported that assessment of cognition for those of CALD background was challenging. Based on this feedback, practice tip sheets were developed as educational aids to assist ACAS staff.
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Affiliation(s)
- Freda Vrantsidis
- National Ageing Research Institute, Melbourne, Victoria, Australia
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Brown CS, Baker TA, Mingo CA, Harden JT, Whitfield K, Aiken-Morgan AT, Phillips KL, Washington T. A review of our roots: blacks in gerontology. THE GERONTOLOGIST 2014; 54:108-16. [PMID: 24022695 PMCID: PMC4064009 DOI: 10.1093/geront/gnt103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 08/04/2013] [Indexed: 11/13/2022] Open
Abstract
The historical underpinnings in the field of gerontology rest on the contributions of scholars across a myriad of racial and ethnic backgrounds. With the increasing diversity of the adult population, there is a need to increase the number of researchers who study older adults from diverse racial and ethnic populations in general and Black elderly people in particular. Furthermore, it is important to document the participation of Black older adults in our earliest and continuing research efforts. Understanding the historical context and the foundational influence of Black scholars in this field is critical. To realize its humble beginnings, one must become aware of the contributions by Black scholars who have a vested interest in the aging process. With universal similarities and unique differences among older adults, there is a need to acknowledge the past and current scholarship of those who study the aging processes of Blacks while marveling over the future possibilities. The purpose of this review is to elucidate the legacy and current contributions, philosophies, and research of Black scholars in the field of gerontology. In addition, exploration of the theoretical and conceptual frameworks used to establish national and organizational initiatives is reviewed. The impetus in initiating and continuing this work requires a "knowledge of our roots" while moving into the future. It is important to learn the history and significance of Black scholars in gerontology, the contributions of older Blacks, and appreciate the resiliency and marveled life course of this unique population.
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Affiliation(s)
- Candace S Brown
- *Address correspondence to Candace S. Brown, MAG, MEd, School of Allied Health Professions, Virginia Commonwealth University, PO Box 980233, Richmond, VA 23298-0233. E-mail:
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Sayegh P, Knight BG. Assessment and diagnosis of dementia in Hispanic and non-Hispanic white outpatients. THE GERONTOLOGIST 2013; 53:760-9. [PMID: 23348889 DOI: 10.1093/geront/gns190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE We examined whether (a) neuropsychological test performance (NP) or (b) informant reports of patients' functional abilities or (c) behavioral and psychological symptoms (BPS) predicted dementia diagnoses to different degrees among Hispanic and non-Hispanic Whites (NHWs). DESIGN AND METHODS Our sample included 444 Hispanic and 444 (randomly selected from 11,081) NHW outpatients diagnosed with normal cognition or dementia at their initial evaluations. We tested for significant ethnic-group differences in dementia diagnosis predictors using NP and the 2 informant reports, covarying for age, sex, and education. RESULTS When using ethnic group-specific norms, NP and functional abilities predicted diagnosis in both groups with no significant differences but BPS was only significant in Hispanics. When using combined ethnic group norms, the only major difference was that BPS approached but did not meet statistical significance in Hispanics. IMPLICATIONS Clinicians may be aware of the limitations of NP and may thus be informally adjusting their overall impressions of patients' NP among Hispanics and weighing certain tests differentially across ethnic groups when assessing dementia. Though these approaches may be aimed at reducing misdiagnosis, their effectiveness is questionable and they may be driving systematic differences in diagnosis within and across ethnicities. In addition, informant-reported functional abilities may be less sensitive to ethnicity-related influences and represent an important, ethnically neutral area in dementia assessment. The predictive value of informant-reported BPS in the diagnostic process across ethnic groups warrants further attention.
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Affiliation(s)
- Philip Sayegh
- Address correspondence to Philip Sayegh, Departments of Psychology and Preventive Medicine, University of Southern California, 3620 S. McClintock Avenue-SGM 501, M/C 1061, Los Angeles, CA 90089-1061. E-mail:
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Dilworth-Anderson P, Pierre G, Hilliard TS. Social justice, health disparities, and culture in the care of the elderly. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2012; 40:26-32. [PMID: 22458459 DOI: 10.1111/j.1748-720x.2012.00642.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Older minority Americans experience worse health outcomes than their white counterparts, exhibiting the need for social justice in all areas of their health care. Justice, fairness, and equity are crucial to minimizing conditions that adversely affect the health of individuals and communities. In this paper, Alzheimer's disease (AD) is used as an example of a health care disparity among elderly Americans that requires social justice interventions. Cultural factors play a crucial role in AD screening, diagnosis, and access to care, and are often a barrier to support and equality for minority communities. The "conundrum of health disparities" refers to the interplay between disparity, social justice, and cultural interpretation, and encourages researchers to understand both (1) disparity caused by economic and structural barriers to access, treatment, and diagnosis, and (2) disparity due to cultural interpretation of disease, in order to effectively address health care issues and concerns among elderly Americans.
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Goudsmit M, Parlevliet JL, van Campen JPCM, Schmand B. [Diagnosis of dementia in non-western elderly migrants in memory clinics: obstacles and solutions]. Tijdschr Gerontol Geriatr 2011; 42:204-214. [PMID: 22470986 DOI: 10.1007/s12439-011-0036-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In the next decade the number of non-western elderly immigrants will double in the Netherlands. Because of specific risk factors (hypertension, diabetes), the number of elderly immigrants with dementia will probably increase. Memory clinics are not well prepared for these patients, because health professionals lack knowledge about important obstacles in intercultural dementia diagnostics. They should consider language barriers, cultural differences, low level of education and illiteracy, as well as ignorance about dementia, shame and special care expectations of patients and their families. We give recommendations to improve communication, (neuropsychological) testing and counseling in clinical practice.
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Robbins RN, Remien RH, Mellins CA, Joska JA, Stein DJ. Screening for HIV-associated dementia in South Africa: potentials and pitfalls of task-shifting. AIDS Patient Care STDS 2011; 25:587-93. [PMID: 21919734 DOI: 10.1089/apc.2011.0154] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There is an urgent need for valid, reliable, and simple-to-use screening tools for HIV-associated dementia (HAD) in South Africa, as little is known about its impact on South Africa's 5.5 million people living with HIV (PLWH). Screening for HAD in South Africa involves several challenges, including few culturally appropriate and validated screening tools, and a shortage of trained personnel to conduct screening. This study examined rates of positive HAD screens as determined by the cutoff score on the International HIV Dementia Scale (IHDS) administered by nonspecialist community health workers (CHWs) in South Africa and examined associations between positive HAD screens and common risk factors for HAD. Sixty-five Xhosa-speaking HIV-positive individuals on antiretroviral therapy (ART) with low CD4 counts and documented ART adherence problems were administered a battery of demographic, psychiatric and neurocognitive screening measures. Positive HAD screens were present in 80% of the sample. Presence of a current alcohol dependence disorder and CD4 counts of 200 or lower were significantly associated with positive HAD screens. HIV-positive South Africans on ART with low CD4 counts and ART adherence problems may be at a very high risk for HAD, highlighting the need for more routine screening and monitoring of neurocognitive functions among South Africa's millions of PLWH on ART. Future research is needed to: (1) validate IHDS performance against a gold standard neurocognitive battery for the detection of HAD among larger samples of Xhosa-speaking South Africans with ART adherence difficulties and (2) compare performance of CHW to expert health care personnel in administering the IHDS.
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Affiliation(s)
- Reuben N. Robbins
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Center, New York, New York
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Center, New York, New York
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Center, New York, New York
| | - John A. Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Connell CM, Roberts JS, McLaughlin SJ, Carpenter BD. Black and white adult family members' attitudes toward a dementia diagnosis. J Am Geriatr Soc 2009; 57:1562-8. [PMID: 19682136 DOI: 10.1111/j.1532-5415.2009.02395.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine potential benefits of and barriers to diagnosis from the perspective of black and white adults directly affected by Alzheimer's disease (AD). DESIGN Telephone survey. SETTING Convenience sample recruited from two U.S. metropolitan areas. PARTICIPANTS One hundred seventy-eight family members of people with AD, including current and former AD caregivers and immediate blood relatives of someone with AD. MEASUREMENTS Respondents were asked to rate the importance of eight benefits of and 16 barriers to obtaining a diagnosis. RESULTS Family members strongly endorse several benefits of obtaining a diagnosis, including getting information, finding out what is wrong with their relative, and prompting future planning. A majority of survey respondents did not endorse any barriers examined. Lack of a cure for AD and the belief that little can be done for someone with AD were the most frequently endorsed barriers. Black respondents endorsed five of the eight benefits more frequently than white respondents. CONCLUSION Black and white adults with a family member who has received an diagnosis of AD perceive a range of benefits and few barriers to the diagnostic process examined in this study. Their positive experiences might be instructive to families considering pursuing a diagnosis and to physicians who may be reluctant to offer screening or referral because of the belief that families have little to gain.
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Affiliation(s)
- Cathleen M Connell
- Department of Health Behavior, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI 48109, USA.
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Basic D, Khoo A, Conforti D, Rowland J, Vrantsidis F, LoGiudice D, Hill K, Harry J, Lucero K, Prowse R. Rowland Universal Dementia Assessment Scale, Mini-Mental State Examination and General Practitioner Assessment of Cognition in a multicultural cohort of community-dwelling older persons with early dementia. AUSTRALIAN PSYCHOLOGIST 2009. [DOI: 10.1080/00050060802593593] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | | | | | | | - Keith Hill
- La Trobe University and Northern Health, Melbourne, Victoria, Australia
| | - Jan Harry
- Royal Adelaide Hospital, Adelaide, South Australia
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Sahadevan S, Saw SM, Gao W, Tan LCS, Chin JJ, Hong CY, Venketasubramanian N. Ethnic differences in Singapore's dementia prevalence: the stroke, Parkinson's disease, epilepsy, and dementia in Singapore study. J Am Geriatr Soc 2008; 56:2061-8. [PMID: 19016940 DOI: 10.1111/j.1532-5415.2008.01992.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To study the prevalence of dementia in Singapore among Chinese, Malays, and Indians. DESIGN A two-phase, cross-sectional study of randomly selected population from central Singapore with disproportionate race stratification. SETTING Community-based study. Subjects screened to have cognitive impairment at phase 1 in their homes were evaluated clinically for dementia at phase 2 in nearby community centers. PARTICIPANTS Fourteen thousand eight hundred seventeen subjects aged 50 and older (67% participation rate). MEASUREMENTS The locally validated Abbreviated Mental Test was used to screen for cognitive impairment at phase 1. Dementia was diagnosed at phase 2 as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Possible Alzheimer's disease (AD) and possible vascular dementia (VD) were diagnosed along the National Institute of Neurological and Communicative Disorders-Alzheimer's Disease and Related Disorders Association and National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neuroscienes criteria, respectively. RESULTS The overall age- and race-standardized dementia prevalence was 1.26% (95% confidence interval (CI)=1.10-1.45). Prevalence (in 5-year age bands) was 0.08% (50-54), 0.08% (55-59), 0.44% (60-64), 1.16% (65-69), 1.84% (70-74), 3.26% (75-79), 8.35% (80-84), and 16.42% (>/=85). From age 50 to 69, 65% of dementia cases were VD; at older ages, 60% were AD. Logistic regression (adjusted for age, sex, education) showed that Malays had twice the risk for AD as Chinese, and Indians had more than twice the risk for AD and VD than Chinese. CONCLUSION Singapore's dementia prevalence, primarily influenced by its Chinese majority, is lower than seen in the West. The striking interethnic differences suggest a need for a dementia incidence study and further investigation of underlying genetic and cultural differences between the three ethnic groups in relation to dementia risk.
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Affiliation(s)
- Suresh Sahadevan
- Department of General Medicine, Tan Tock Seng Hospital, Singapore.
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Zuckerman IH, Ryder PT, Simoni-Wastila L, Shaffer T, Sato M, Zhao L, Stuart B. Racial and ethnic disparities in the treatment of dementia among Medicare beneficiaries. J Gerontol B Psychol Sci Soc Sci 2008; 63:S328-33. [PMID: 18818454 DOI: 10.1093/geronb/63.5.s328] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Numerous studies have documented disparities in health care utilization between non-Hispanic White and minority elders. We investigated differences in anti-dementia medication use between non-Hispanic White and minority community-dwelling Medicare beneficiaries with dementia. METHODS Using multivariate analysis with generalized estimating equations, we estimated prevalence ratios (PRs) for anti-dementia medication use by race/ethnicity for 1,120 beneficiaries with dementia from years 2001 through 2003 of the Medicare Current Beneficiary Survey. RESULTS After adjusting for demographics, socioeconomics, health care access and utilization, comorbidities, and service year, we found that anti-dementia medication use was approximately 30% higher among non-Hispanic Whites compared to other racial/ethnic groups (PR=0.73, 95% confidence interval [CI]=0.59, 0.91). As for individual racial/ethnic groups, prevalence disparities remained significant for non-Hispanic Blacks (PR=0.75, 95% CI=0.57, 0.99) and non-Hispanic others (PR=0.50, 95% CI=0.26, 0.96) but were attenuated for Hispanics (PR=0.84, 95% CI=0.59, 1.20). DISCUSSION Results provide evidence that racial/ethnic disparities in utilization of drugs used to treat dementia exist and are not accounted for by differences in demographic, economic, health status, or health utilization factors. Findings provide a foundation for further research that should use larger numbers of minority patients and consider dementia type and severity, access to specialty dementia care, and cultural factors.
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Affiliation(s)
- Ilene H Zuckerman
- Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD 21201, USA.
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Ortiz F, Fitten LJ, Cummings JL, Hwang S, Fonseca M. Neuropsychiatric and behavioral symptoms in a community sample of Hispanics with Alzheimer's disease. Am J Alzheimers Dis Other Demen 2006; 21:263-73. [PMID: 16948291 PMCID: PMC10833247 DOI: 10.1177/1533317506289350] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to characterize and compare neuropsychiatric symptoms in a sample of 367 community-dwelling subjects: 70 Hispanics and 230 non-Hispanic white patients with Alzheimer's disease, and 22 Hispanics and 45 non-Hispanic white healthy age-matched controls. Neuropsychiatric symptoms were common among all patients with Alzheimer's disease. In the Alzheimer's disease groups, Hispanic subjects presented to the initial assessment with more symptoms than non-Hispanic white subjects did. In comparison to the non-Hispanic white population, the proportion of Hispanics with neuropsychiatric and behavioral symptoms was higher. These findings have implications for differential sociocultural presentations of Alzheimer's disease among ethnic/racial groups.
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Affiliation(s)
- Freddy Ortiz
- The Neuropsychiatry Research Memory Clinic, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA.
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Valle R. Culturally attuned recruitment, retention, and adherence in Alzheimer disease and associated disorders: a best practices working model. Alzheimer Dis Assoc Disord 2006; 19:261-6. [PMID: 16327356 DOI: 10.1097/01.wad.0000190804.05502.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This analysis presents a recruitment, retention, and (treatment and/or research) adherence (RRA) best practices model for targeting Alzheimer disease and associated dementias (ADAD) impacting ethnically diverse populations. RRA practice involves many more factors beyond cultural considerations to be highlighted here. However, it is the cultural dimension where much is at stake, where there is the least comprehensive framework, and where the most ambiguity exists relative to RRA practice. The discussion proceeds on three premises. First, a composite, culturally attuned RRA working model can be assembled from the current literature. Second, culturally speaking, recruitment, retention, and adherence are essentially linked processes. Although each of the components of RRA practice has its own unique set of tasks, culture permeates them all. Third, any RRA practice model that emerges must be tailored to the communities, the specific target populations, and the programmatic circumstances to which the effort is attached.
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Affiliation(s)
- Ramón Valle
- Alzheimer's Cross Cultural Research and Development, San Diego, CA 92119-2823, USA.
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Clark PC, Kutner NG, Goldstein FC, Peterson-Hazen S, Garner V, Zhang R, Bowles T. Impediments to timely diagnosis of Alzheimer's disease in African Americans. J Am Geriatr Soc 2005; 53:2012-7. [PMID: 16274388 DOI: 10.1111/j.1532-5415.2005.53569.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to identify early patterns of care for Alzheimer's disease (AD) in a cohort of African-American patients and their caregivers presenting at an inner city clinic and a suburban memory assessment clinic. Caregivers (N=79) of patients diagnosed with probable AD were interviewed. Data were collected about the delay from noticing first AD signs until recognition that a problem existed and delay from problem recognition until first physician consultation. Patients and caregivers had lower educational status, and patients had been diagnosed more recently at the inner city clinic than at the suburban clinic, although MMSE scores of patients at the two clinics did not differ; median delays in caregivers' recognizing a problem and in consulting a physician were also similar across clinics. Delay was as long as 7 years between noticing symptoms and problem recognition and between problem recognition and physician consultation. Although patients attending the suburban clinic were more likely to have previously seen a physician than those attending the inner city clinic, they were no more likely to have received a prior diagnosis of AD. Lack of physician contact is likely to be widespread in families caring for African Americans with AD. Physician consultation is more characteristic of more highly educated families but may not yield a correct diagnosis for the patient. Intensive efforts are needed to connect African-American families with physicians and to achieve more timely diagnosis of AD to enable families to understand the illness, plan for patient safety, and make long-term plans.
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Affiliation(s)
- Patricia C Clark
- Department of Adult and Elder Health, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia 30322, USA.
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