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Tran T, Finlayson M, Nalder E, Trothen T, Donnelly C. Occupational Therapist-Led Mindfulness Training Program for Older Adults Living with Early Cognitive Decline in Primary Care: A Pilot Randomized Controlled Trial. J Alzheimers Dis Rep 2023; 7:775-790. [PMID: 37662611 PMCID: PMC10473152 DOI: 10.3233/adr-230006] [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: 01/20/2023] [Accepted: 05/25/2023] [Indexed: 09/05/2023] Open
Abstract
Background Community-dwelling older adults with early cognitive deficits experience less efficiency in performing everyday life tasks, resulting in decreased satisfaction and other adverse psychological outcomes. Mindfulness training has been linked to cognitive and psychological improvements and, most recently, has been identified as a potential intervention supporting performance of everyday life activities. Objective This study aimed to evaluate whether mindfulness practice can improve perceived performance and satisfaction with everyday life activity and secondary psychological outcomes. Methods This study is a pilot randomized controlled trial (RCT) in an interprofessional primary care team practice in Toronto, Ontario, Canada. The participants were 27 older adults aged 60 years of age or older living with early cognitive deficits. Participants were randomized into an 8-Week mindfulness training program (n = 14) group or a Wait-List Control (WLC; n = 13) group compared at baseline, post-intervention and 4-weeks follow-up. MANOVAs with post-hoc independent t-tests were used to compare between groups at different time points. Results There was a significant improvement in anxiety for the intervention group compared to the WLC group at post-intervention; Time-2 (mean difference = 3.90; CI = 0.04-7.75; p = 0.04) with large effect size (d = 0.80). Conclusion Mindfulness training significantly improved anxiety scores for patients with early cognitive deficits post-intervention. Further work is required to test the sustainability of reduced anxiety over time, but this study demonstrated that MBSR is a promising primary care intervention for those living with early cognitive deficits. This study warrants the pursuit of a future study in exploring how long the reduced anxiety effects would be sustained.
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Affiliation(s)
- Todd Tran
- Queen’s University, Faculty of Health Sciences, School of Rehabilitation Therapy, Aging & Health, Kingston, ON, Canada
- Clinical Site: Women’s College Hospital, Toronto, ON, Canada
- University of Toronto, Temerty Faculty of Medicine, Department of Occupational Science & Occupational Therapy, Toronto, ON, Canada
| | - Marcia Finlayson
- Queen’s University, Faculty of Health Sciences, School of Rehabilitation Therapy, Aging & Health, Kingston, ON, Canada
| | - Emily Nalder
- University of Toronto, Temerty Faculty of Medicine, Department of Occupational Science & Occupational Therapy, Toronto, ON, Canada
| | - Tracy Trothen
- Queen’s University, Faculty of Health Sciences, School of Rehabilitation Therapy, Aging & Health, Kingston, ON, Canada
- Queen’s University, jointly appointed to the School of Rehabilitation Therapy and School of Religion (Theological Hall), Kingston, ON, Canada
| | - Catherine Donnelly
- Queen’s University, Faculty of Health Sciences, School of Rehabilitation Therapy, Aging & Health, Kingston, ON, Canada
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Tran T, Donnelly C, Nalder EJ, Trothen T, Finlayson M. Occupational therapist-led mindfulness-based stress reduction for older adults living with subjective cognitive decline or mild cognitive impairment in primary care: a feasibility randomised control trial protocol. BMJ Open 2020; 10:e035299. [PMID: 32580984 PMCID: PMC7312340 DOI: 10.1136/bmjopen-2019-035299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Community-dwelling older adults living with subjective cognitive decline or mild cognitive impairment may experience decreased efficiency in their overall functional performance. This decreased cognitive efficiency may result in anxiety, low mood, perceived stress and decreased emotional well-being and quality-of-life. These psychological symptoms may further exacerbate cognitive decline.Exploring non-pharmacological interventions such as mindfulness within primary care is vital in enabling individuals to develop strategies to manage cognitive impairment or psychological symptoms. Mindfulness-based stress reduction (MBSR) is an 8-week programme that is beneficial in alleviating psychological symptoms; however, its impact on perceived satisfaction on overall functional performance with this population has not been evaluated. The primary objective of this study is to explore the feasibility of conducting a randomised controlled trial of an occupational therapist-led MBSR programme within primary care. METHODS Convergent mixed-methods, randomised control feasibility trial with 40 participants from an interprofessional primary care team in Toronto, Ontario. Participants are randomised into the 8-week MBSR group or wait-list control will be compared at baseline, postintervention and 4weeks follow-up. The primary aim is to determine the feasibility of the intervention with this population and setting. The secondary aim is to examine perceived satisfaction with functional performance as measured by the Canadian Occupational Performance Measure. Secondary clinical outcomes include psychological symptoms. ANALYSIS Investigators will analyse the quantitative and qualitative data strands separately. Descriptive statistics, focus group and interviews will then be merged and further analysed to best understand the feasibility and preliminary clinical outcomes from the study. ETHICS AND DISSEMINATION The study is approved by Women's College Hospital (2017-0056-E), and Queen's University, Kingston, Ontario (6026418). The study will follow Standard Protocol Items: Recommendations for Interventional Trials. The results will be published in peer-reviewed academic journals and disseminated to patient organisations and media.Trial registration numberNCT03867474; Pre-results.
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Affiliation(s)
- Todd Tran
- Family Practice, Women's College Hospital, Toronto, Ontario, Canada
- Aging and Health, Queen's University, Kingston, Ontario, Canada
| | - Catherine Donnelly
- Rehabilitation Therapy, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Emily Joan Nalder
- Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Tracy Trothen
- Rehabilitation Therapy, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Marcia Finlayson
- Rehabilitation Therapy, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
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Maia JC, Coutinho JFV, Sousa CRD, Barbosa RGB, Mota FRDN, Marques MB, Silva RDRL, Lima RBDS. Tecnologias assistivas para idosos com demência: revisão sistemática. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Analisar estudos de intervenções com tecnologias assistivas, empregadas no auxílio de idosos com demência, na execução das Atividades Básicas e Instrumentais de Vida Diária. Métodos Realizou-se levantamento, através das bases de dados CINAHL, MEDLINE/PubMed, LILACS, SCOPUS, Scielo, Cochrane e Web of Science . Utilizaram-se os descritores dementia/ demência , aged/ idoso , self-help devices/ equipamentos de autoajuda . Os artigos selecionados foram submetidos à análise de qualidade metodológica, na qual foi utilizada a escala de avaliação da Physiotherapy Evidence Database (PEDro). Resultados Quatro ensaios clínicos foram elencados para a revisão. Os estudos apresentaram classificação de baixa a moderada qualidade metodológica. As tecnologias de sistema de monitoramento noturno e as de comando de voz apresentaram melhor avaliação em relação aos efeitos nas Atividades Básicas e Instrumentais de Vida Diária. Conclusão A aplicação desse aparato tecnológico fornece resultados positivos no apoio a idosos e cuidadores na execução das atividades diárias. As utilizações de comandos verbais simples possuem menor custo, manuseio simples e maior eficiência para execução de Atividades Instrumentais de Vida Diária de idosos com demência.
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Community-based serious illness care for patients with dementia. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:324-325. [PMID: 30094332 PMCID: PMC6071578 DOI: 10.1016/j.trci.2018.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pimouguet C, Le Goff M, Wittwer J, Dartigues JF, Helmer C. Benefits of Occupational Therapy in Dementia Patients: Findings from a Real-World Observational Study. J Alzheimers Dis 2018; 56:509-517. [PMID: 27983551 DOI: 10.3233/jad-160820] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a growing interest in developing non-pharmacological approaches in dementia. Clinical efficacy of occupational therapy (OT) under routine care conditions has not been investigated yet. OBJECTIVE To analyze the short-term effects of OT in patients with dementia; and to identify factors related to greater benefit. METHODS Patients referred to OT were evaluated before starting a 3-month intervention and at 3 and 6 months later. Measures included: Mini-Mental State Examination (MMSE), Disability Assessment in Dementia (DAD), Neuropsychiatric Inventory (NPI) Questionnaire, patients' quality of life (EQ 5D-VAS), caregivers' burden (Zarit scale), and amount of informal care. Linear mixed models were used to analyze trajectories of outcomes. Logistic regressions with stepwise descending selection were used to study factors associated with benefits. RESULTS 421 dementia patients benefited from OT (mean MMSE = 17.3). Patients remained cognitively stable over time. Functional performances also remained stable at 3 months and significantly decreased at 6 months (crude reduction of 2.8 points, p < 0.01). Behavioral troubles were significantly reduced over the intervention period and remained stable after (p < 0.01). Patients' quality of life increased over the 3-month intervention (p = 0.16) and significantly decreased thereafter. Caregivers' burden and informal care significantly decreased over the 3-month intervention and remained stable thereafter. Patients who benefited from OT with regard to function were less educated and had higher cognitive level. CONCLUSION OT may be an effective intervention to maintain cognition and functionality and to reduce psychiatric symptoms in dementia patients. Mild stages of dementia could gain more benefits from OT with regard to functional decline.
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Affiliation(s)
- Clément Pimouguet
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France
| | - Mélanie Le Goff
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France
| | - Jérôme Wittwer
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France
| | - Jean-François Dartigues
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France.,Service de Neurologie, Department of Clinical Neurosciences, CHU Pellegrin, Bordeaux, France
| | - Catherine Helmer
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, Bordeaux, France.,University Bordeaux, Bordeaux, France.,INSERM, Clinical Investigation Center - Clinical Epidemiology 1401, Bordeaux, France
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Van der Roest HG, Wenborn J, Pastink C, Dröes R, Orrell M. Assistive technology for memory support in dementia. Cochrane Database Syst Rev 2017; 6:CD009627. [PMID: 28602027 PMCID: PMC6481376 DOI: 10.1002/14651858.cd009627.pub2] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The sustained interest in electronic assistive technology in dementia care has been fuelled by the urgent need to develop useful approaches to help support people with dementia at home. Also the low costs and wide availability of electronic devices make it more feasible to use electronic devices for the benefit of disabled persons. Information Communication Technology (ICT) devices designed to support people with dementia are usually referred to as Assistive Technology (AT) or Electronic Assistive Technology (EAT). By using AT in this review we refer to electronic assistive devices. A range of AT devices has been developed to support people with dementia and their carers to manage their daily activities and to enhance safety, for example electronic pill boxes, picture phones, or mobile tracking devices. Many are commercially available. However, the usefulness and user-friendliness of these devices are often poorly evaluated. Although reviews of (electronic) memory aids do exist, a systematic review of studies focusing on the efficacy of AT for memory support in people with dementia is lacking. Such a review would guide people with dementia and their informal and professional carers in selecting appropriate AT devices. OBJECTIVES Primary objectiveTo assess the efficacy of AT for memory support in people with dementia in terms of daily performance of personal and instrumental activities of daily living (ADL), level of dependency, and admission to long-term care. Secondary objectiveTo assess the impact of AT on: users (autonomy, usefulness and user-friendliness, adoption of AT); cognitive function and neuropsychiatric symptoms; need for informal and formal care; perceived quality of life; informal carer burden, self-esteem and feelings of competence; formal carer work satisfaction, workload and feelings of competence; and adverse events. SEARCH METHODS We searched ALOIS, the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), on 10 November 2016. ALOIS is maintained by the Information Specialists of the CDCIG and contains studies in the areas of dementia prevention, dementia treatment and cognitive enhancement in healthy people. We also searched the following list of databases, adapting the search strategy as necessary: Centre for Reviews and Dissemination (CRD) Databases, up to May 2016; The Collection of Computer Science Bibliographies; DBLP Computer Science Bibliography; HCI Bibliography: Human-Computer Interaction Resources; and AgeInfo, all to June 2016; PiCarta; Inspec; Springer Link Lecture Notes; Social Care Online; and IEEE Computer Society Digital Library, all to October 2016; J-STAGE: Japan Science and Technology Information Aggregator, Electronic; and Networked Computer Science Technical Reference Library (NCSTRL), both to November 2016; Computing Research Repository (CoRR) up to December 2016; and OT seeker; and ADEAR, both to February 2017. In addition, we searched Google Scholar and OpenSIGLE for grey literature. SELECTION CRITERIA We intended to review randomised controlled trials (RCTs) and clustered randomised trials with blinded assessment of outcomes that evaluated an electronic assistive device used with the single aim of supporting memory function in people diagnosed with dementia. The control interventions could either be 'care (or treatment) as usual' or non-technological psychosocial interventions (including interventions that use non-electronic assistive devices) also specifically aimed at supporting memory. Outcome measures included activities of daily living, level of dependency, clinical and care-related outcomes (for example admission to long-term care), perceived quality of life and well-being, and adverse events resulting from the use of AT; as well as the effects of AT on carers. DATA COLLECTION AND ANALYSIS Two review authors independently screened all titles and abstracts identified by the search. MAIN RESULTS We identified no studies which met the inclusion criteria. AUTHORS' CONCLUSIONS This review highlights the current lack of high-quality evidence to determine whether AT is effective in supporting people with dementia to manage their memory problems.
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Affiliation(s)
- Henriëtte G Van der Roest
- VU University Medical CenterDepartment of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Jennifer Wenborn
- University College LondonDivision of Psychiatryc/o Research & Development, North East London NHS Foundation TrustGoodmayes Hospital, Barley LaneLondonUKIG3 8XJ
| | - Channah Pastink
- VU University Medical CenterDepartment of Psychiatry, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Rose‐Marie Dröes
- VU University Medical CenterDepartment of Psychiatry, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Martin Orrell
- University of NottinghamInstitute of Mental HealthTriumph RoadNottinghamNottinghamshireUK
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Kim H, Kim SJ, Kim MS, Choi JE, Chang SO. Guide Map for Preserving Remaining Ability of Nursing Home Residents With Physical-Cognitive Functional Decline. J Contin Educ Nurs 2017; 48:73-80. [DOI: 10.3928/00220124-20170119-08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/27/2016] [Indexed: 11/20/2022]
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Huang F, Shang Y, Luo Y, Wu P, Huang X, Tan X, Lu X, Zhen L, Hu X. Lower Prevalence of Alzheimer's Disease among Tibetans: Association with Religious and Genetic Factors. J Alzheimers Dis 2016; 50:659-67. [PMID: 26757186 DOI: 10.3233/jad-150697] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prevalence of dementia differs among racial groups, the highest prevalence being in Latin America (8.5%) compared to sub-Saharan African regions (2-4%). The most common type of dementia is Alzheimer's disease (AD). OBJECTIVE To estimate the prevalence of AD in the Qinghai-Tibet plateau and to investigate the related factors. METHODS This was a cross-sectional, multistage cluster sampling design survey. Data was collected from May 2014 to September 2014 from 4,060 Tibetan aged >60 years. Participants underwent clinical examinations and neuropsychological evaluations. MALDI-TOF was used to test the genotypes of CLU, TFAM, TP53INP1, IGHV1-67, CR1, ApoE, and BIN1. Logistic regression models were used to ascertain the associations with AD. RESULTS The prevalence of AD among Tibetan individuals aged >60 years was 1.33% (95% CI: 0.98-1.69). The CLU haplotypes AA+GA (odds ratio (OR) = 4.483; 95% CI: 1.069-18.792) of rs2279590 was correlated with AD. The CLU haplotypes GG+GC (OR = 0.184; 95% CI: 0.038-0.888) of rs9331888 and kowtow (OR = 0.203; 95% CI 0.046-0.896) were negatively correlated with AD. CONCLUSION A low prevalence of AD was found in Tibetans from the Qinghai-Tibet plateau. Multivariate analysis might suggest that regular "mind-body" religious meditative activities may be negatively associated with AD in this population, as well as the CLU genotype at rs9331888.
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Affiliation(s)
- Fukai Huang
- Beijing Tibetan Hospital, China Tibet-ology Research Center, Beijing, P.R. China
| | - Ying Shang
- Beijing Mentougou Hospital of Traditional Chinese Medicine, Beijing, P.R. China
| | - Yuandai Luo
- Beijing Tibetan Hospital, China Tibet-ology Research Center, Beijing, P.R. China
| | - Peng Wu
- Southern Medical University, Guangzhou, P.R. China
| | - Xue Huang
- Southern Medical University, Guangzhou, P.R. China
| | - Xiaohui Tan
- Southern Medical University, Guangzhou, P.R. China
| | - Xingyi Lu
- Beijing Tibetan Hospital, China Tibet-ology Research Center, Beijing, P.R. China
| | - Lifang Zhen
- Beijing Tibetan Hospital, China Tibet-ology Research Center, Beijing, P.R. China
| | - Xianda Hu
- Beijing Tibetan Hospital, China Tibet-ology Research Center, Beijing, P.R. China
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Ciro CA, Stoner J, Prodan C, Hershey L. Skill-building through Task-Oriented Motor Practice (STOMP) intervention for activities of daily living: study protocol for a randomized, single blinded clinical trial. ACTA ACUST UNITED AC 2016; 1:45-50. [PMID: 29071307 DOI: 10.4103/2468-5658.184743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Progressive disability in activities of daily living (ADL) is inevitable for people with Alzheimer's disease and related dementias (ADRD). Attempts to slow or prevent ADL disability have been unsuccessful despite making progress in behavioral training methods. Missing from this research is an emphasis on how we maximize a patient's engagement during training and the rigorous examination of implementation protocols (dosing and training methods) which may advantage learning in people with ADRD. Our team addressed this gap with the development of the STOMP (Skill-building through Task-Oriented Motor Practice) intervention which creates methods for obtaining ADL goals that support "personhood" and tests high-intensity protocols that appear to advantage learning and sustained learning over time. Through this study, we aim to evaluate differential outcomes by dose levels as well as assess the moderating effects of attention to task during training. METHODS/DESIGN Randomized-controlled trial with 32 participants with dementia assigned to either the original, intensive STOMP protocol (3 hours/day, 5 days/week for 2 weeks) or a less-intensive STOMP protocol (1 hour/day, 2 days/week for 2 weeks) delivered by an occupational therapy assistant in the home. ADL training is delivered using motor learning theory techniques of blocked practice, continuous verbal praise, errorless learning and intense dosing schedules. Inclusion criteria: English speaking, adults 50-80 years old that live with a legally-authorized representative that can provide consent, who can follow a one-step command, have three ADL goals they want to address and can participate in an intense therapy protocol. Exclusions include diagnoses of Creutzfeldt-Jakob Dementia, delirium or receptive/global aphasia. Recruitment will occur through direct mailing, physician referral and media/support group presentations. Blinded occupational therapists will complete baseline, post-intervention and 3-month follow-up assessments in the home. Repeated measures ANOVA and graphs will be used to interpret and display results. DISCUSSION Through this protocol, we will examine differential outcomes by dose for the STOMP ADL intervention. Our results will inform dosing parameters for future intervention studies for people with ADRD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02356055. ETHICAL APPROVAL This study protocol was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (#4648) and will be performed in accordance with the Declaration of Helsinki.
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Affiliation(s)
- C A Ciro
- College of Allied Health, 1200 N. Stonewall Ave, OKC, OK 73117
| | - J Stoner
- College of Public Health, 801 NE 13, OKC, OK 73104
| | - C Prodan
- College of Medicine, 1100 N Lindsay, OKC, OK 73104
| | - L Hershey
- College of Medicine, 1100 N Lindsay, OKC, OK 73104
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Ciro CA, Anderson MP, Hershey LA, Prodan CI, Holm MB. Instrumental activities of daily living performance and role satisfaction in people with and without mild cognitive impairment: a pilot project. Am J Occup Ther 2015; 69:6903270020p1-10. [PMID: 25871600 PMCID: PMC4453037 DOI: 10.5014/ajot.2014.015198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We investigated differences in observed performance of instrumental activities of daily living (IADLs) and self-reported satisfaction with social role performance between people with amnestic mild cognitive impairment (a-MCI) and age- and gender-matched control participants. METHOD We measured observed performance of 14 IADLs using the Independence, Safety, and Adequacy domains of the Performance Assessment of Self-Care Skills (PASS) and the Patient-Reported Outcomes Measurement Information Systems (PROMIS) to examine satisfaction with social role performance. RESULTS Total PASS scores were significantly lower in participants with a-MCI (median=40.6) than in control participants (median=44.2; p=.006). Adequacy scores were also significantly lower. No significant differences were found between groups on the PROMIS measures. CONCLUSION IADL differences between groups were related more to errors in adequacy than to safety and independence. Occupational therapy practitioners can play a key role in the diagnosis and treatment of subtle IADL deficits in people with MCI.
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Affiliation(s)
- Carrie A Ciro
- Carrie A. Ciro, PhD, OTR/L, FAOTA, is Assistant Professor, University of Oklahoma Health Sciences Center, Oklahoma City;
| | - Michael P Anderson
- Michael P. Anderson, PhD, is Assistant Professor, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Linda A Hershey
- Linda A. Hershey, MD, PhD, is Professor, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Calin I Prodan
- Calin I. Prodan, MD, is Associate Professor, Veterans Affairs Medical Center, Oklahoma City, OK
| | - Margo B Holm
- Margo B. Holm, PhD, OTR/L, FAOTA, ABDA, is Professor Emerita, University of Pittsburgh, Pittsburgh, PA
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