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Garcia JM, Morales Mejia YL, Ochoa Lopez AP, Woods SP, Valier H, Medina LD. Evidence for the reliability and validity of a Spanish translation of the Medication Management Ability Assessment administered via tele-assessment. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:1192-1204. [PMID: 35998647 DOI: 10.1080/23279095.2022.2114356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We translated the Medication Management Ability Assessment (MMAA) from English to Spanish for use via tele-assessment and examined its reliability and validity. Following International Test Commission Guidelines for Translating and Adapting Tests, we used translation/back-translation and a small focus group (n = 6) to adapt a Spanish version of the MMAA. Eighty-six Spanish-speaking adults completed the adapted MMAA via tele-assessment at baseline and at a two-week follow-up visit. Participants also completed several self-report and performance-based cognitive and functional measures. The internal consistency of the MMAA was excellent (standardized Cronbach's α = 0.90). Performance-based functional assessments (PBFAs) and objective cognition were positively associated with the MMAA at small to medium effect sizes. Self-report measures of daily function and cognition, measures of health literacy, and estimates of premorbid intellectual functioning were not significantly associated with MMAA performance. The test-retest reliability of the MMAA was good (CCC = 0.73, 95% CI [0.62, 0.81]; rs = 0.37, p < 0.001) and demonstrated a small practice effect (Cohen's d = 0.36, p = 0.001). Preliminary evidence for the construct validity of a Spanish-language MMAA administered via tele-assessment further expands the potential clinical utility of PBFAs in culturally diverse, Spanish-speaking populations.
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Affiliation(s)
- Joshua M Garcia
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | | | | | - Helen Valier
- The Honors College, University of Houston, Houston, TX, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
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De Vito AN, Emrani S, Hallowell E, Goldstein A, Davis JD, Margolis SA. Medication management error types: Associations with mild cognitive impairment subtype. Clin Neuropsychol 2024:1-16. [PMID: 38588668 DOI: 10.1080/13854046.2024.2339560] [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: 12/06/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
Objective: Medication management errors are suspected to be prevalent among older adults with mild cognitive impairment (MCI). This study examined types of simulated medication-taking errors in cognitively normal older adults (CN; n = 131), single domain amnestic MCI (sdMCI, n = 91), and multi-domain MCI (mdMCI, n = 44). Errors were measured using the medication management ability assessment (MMAA). Methods: 266 participants seen for neuropsychological evaluation (94.4% White, 57.9% female, average age = 72, average education = 14 years) completed the MMAA (version 4.1), a performance-based task of medication management. Group differences in MMAA total scores, accuracy, and error types were evaluated using Kruskall-Wallis H tests. This study was the first to explore a newly operationalized error, perseverations, caused by taking a specific dose ≥2 times during the simulation. Results: CN and sdMCI groups had higher MMAA total scores than individuals with mdMCI, indicating better overall performance. The mdMCI group made a higher number of omission errors (missed pills) than other groups, but no differences were found for commission errors (extra pills). The sdMCI group made more perseverative errors compared to the CN group. Conclusions: Individuals with mdMCI made more simulated medication management errors than CN and sdMCI groups, indicating that they may be most vulnerable to difficulties in medication management. In contrast, sdMCI individuals were more likely to make perseverative errors, which may reflect a tendency towards overcompensation of memory loss. Future studies should assess whether MMAA performance is associated with patterns of real-world medication-taking in more diverse samples of older adults.
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Affiliation(s)
- Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Sheina Emrani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Hallowell
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Mental Health and Behavioral Science and Services, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Allyson Goldstein
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Jennifer D Davis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Seth A Margolis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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Shaikh KT, Bolton K, Shaikh U, Troyer AK, Rich JB, Vandermorris S. Evaluating functional abilities within the context of memory assessment: A practice survey of neuropsychologists. Clin Neuropsychol 2024; 38:557-587. [PMID: 37649186 DOI: 10.1080/13854046.2023.2249178] [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] [Received: 04/24/2022] [Accepted: 08/12/2023] [Indexed: 09/01/2023]
Abstract
Objective: Functioning in daily life is an important consideration when differentiating between individuals with normal cognition, mild neurocognitive disorder, and major neurocognitive disorder. Despite this, there is no gold standard measurement approach for assessing functional abilities and few guidelines on how to do so. The objective of this study was to examine neuropsychologists' practices regarding the assessment of functional abilities across the spectrum of memory ability. Method: A total of 278 psychologists who routinely conduct neuropsychological assessments completed an online survey (estimated 15% response rate) querying their practices and perspectives with respect to the assessment of functional abilities. Results: Respondents identified that changes to several components of daily functioning, including activities of daily living, were important when evaluating functional abilities. Respondents reported utilizing a variety of instruments to assess functioning, with an overwhelming majority indicating the use of semi-structured interviews. Although most respondents are satisfied with existing tools, a quarter of respondents felt strongly that there was a need for more instruments of everyday functioning. Respondents further indicated that their recommendations to patients, particularly regarding compensatory strategies and follow-up with other professionals, were informed by results of their functional assessment. Conclusions: Overall, our survey results indicate that neuropsychologists perceive multiple factors of daily life to be important considerations when evaluating functioning, use a variety of techniques to assess functioning, and perceive a need for more measures of functional abilities.
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Affiliation(s)
- Komal T Shaikh
- Department of Psychology, York University, Toronto, Canada
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
| | - Kathryn Bolton
- Department of Psychology, York University, Toronto, Canada
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
- Department of Psychology, Toronto Metropolitan University
| | - Umar Shaikh
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
| | - Angela K Troyer
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
| | - Jill B Rich
- Department of Psychology, York University, Toronto, Canada
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
| | - Susan Vandermorris
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Toronto, Canada
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Crook CL, Margolis SA, Goldstein A, Davis JD, Gonzalez JS, Grant AC, Nakhutina L. Medication self-management in predominantly African American and Caribbean American people with epilepsy: The role of medication beliefs and epilepsy knowledge. Epilepsy Behav 2023; 146:109313. [PMID: 37544193 DOI: 10.1016/j.yebeh.2023.109313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Suboptimal medication adherence is common in people with epilepsy (PWE) and disproportionally prevalent among racially/ethnically diverse patients. Understanding reasons and risks of suboptimal adherence is critical to developing interventions that reduce negative health outcomes. This cross-sectional study characterized common barriers to medication self-management, prevalence of negative medication beliefs, and gaps in epilepsy knowledge among predominantly African American and Caribbean American PWE and examined their interrelationships. MATERIALS AND METHODS Sixty-three PWE (Age = 42.1 ± 13.2; 60% female; 79% Black; 19% Hispanic/Latino) completed validated self-report questionnaires about medication self-management, medication beliefs, and epilepsy knowledge. Correlations and t-tests examined interrelationships. RESULTS Four barriers to medication self-management were common, including not taking antiseizure medications at the same time every day, forgetting doses, not planning refills before running out, and spreading out doses when running low. More than half the sample believed medications were overused by prescribers. Nearly one-third believed medications were harmful, and nearly a quarter believed their antiseizure medications were minimally necessary with almost half reporting elevated concerns about negative consequences of antiseizure medications. Poorer medication self-management was associated with stronger beliefs that medications in general are harmful/overused by prescribers. Individuals who were "accepting" of their antiseizure medications (i.e., high perceived necessity, low concerns) were less likely to spread out time between doses when running low compared to non-accepting counterparts. Knowledge gaps related to the cause of seizures/epilepsy, chronicity of epilepsy treatment, and seizure semiology/diagnosis were common. Nevertheless, epilepsy knowledge was unrelated to medication self-management and medication beliefs. CONCLUSIONS In these PWE, the most prevalent reasons for suboptimal medication self-management were behaviorally mediated and potentially modifiable. Negative medication beliefs and misconceptions about epilepsy and its treatment were common. Results further suggest that interventions addressing negative medication beliefs will be more effective than knowledge-based psychoeducation alone to improve medication self-management in this patient population.
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Affiliation(s)
- Cara L Crook
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA; Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
| | - Seth A Margolis
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA; Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA.
| | | | - Jennifer D Davis
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA; Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., Bronx, NY 10461, USA; Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, USA
| | - Arthur C Grant
- SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11203, USA
| | - Luba Nakhutina
- SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11203, USA
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Sumbul-Sekerci B, Hanagasi HA, Bilgic B, Tufekcioglu Z, Gurvit H, Emre M. Medication management and treatment adherence in Parkinson's disease patients with mild cognitive impairment. Acta Neurol Belg 2022:10.1007/s13760-022-01916-1. [PMID: 35325434 DOI: 10.1007/s13760-022-01916-1] [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: 12/07/2021] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The key feature that distinguishes mild cognitive impairment (MCI) from dementia is the absence of significant functional decline because of cognitive impairment. In Parkinson's disease patients (PD) with MCI (PD-MCI), the effect of cognitive impairment on complex instrumental daily activities, such as medication management, is not well established. METHOD 26 patients with PD-MCI (diagnosed to Level 2 Movement Disorders Society diagnostic criteria) and 32 idiopathic PD patients without cognitive impairment participated in the study. A detailed neuropsychological testing battery (including tests for attention and working memory, executive functions, language, visuospatial functions, episodic memory) and various prospective memory tasks were applied to the patients. Medication taking behaviors were evaluated using two different methods based on the performance (medication management ability assessment) and self-reporting (adherence scale). RESULTS The PD-MCI group obtained significantly lower scores in medication management assessment and made more mistakes on following prescription instructions (e.g., they took more or less tablets and did not use medications as instructed with regard to meal times). Cognitive areas predicting success in medication management performance were language, event-based prospective memory and visuospatial functions. There was no significant difference between the two groups' self-reporting of adherence. CONCLUSION Mild cognitive impairment in patients with PD adversely affects medication management. Diagnosing MCI in PD is important to ensure that the appropriate measures can be taken to provide support and improve the medication management process. Adherence assessments based on self-reporting may not provide reliable and sensitive information in patients with PD-MCI.
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Affiliation(s)
- Betul Sumbul-Sekerci
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
- Department of Clinical Pharmacy, Faculty of Pharmacy, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Hasmet A Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Basar Bilgic
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Tufekcioglu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Gurvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Emre
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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von Gaudecker JR, Buelow JM, Miller WR, Tanner AL, Austin JK. Social determinants of health associated with epilepsy treatment adherence in the United States: A scoping review. Epilepsy Behav 2021; 124:108328. [PMID: 34628091 DOI: 10.1016/j.yebeh.2021.108328] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this paper is to share the results of a scoping review in which we examined the social determinants of health (SDoH) that are associated with anti-seizure medication (ASM) treatment adherence among people living with epilepsy in the United States. METHODS Our review was informed by the methods of Arksey and O'Malley for a scoping review. A total of 3,826 articles were identified for reference through a literature search, of which 17 publications were deemed relevant to our scoping review. The final articles were mapped using the Epilepsy SDoH Conceptual Framework to identify gaps. FINDINGS Our review suggests that there are multidimensional associations of SDoH in ASM adherence. The SDoH were interrelated. Race/ethnicity and socioeconomic status appeared to have major associations with ASM adherence. Several gaps in the literature were identified, including inadequately exploring the effect that each SDoH has on treatment adherence, and the methods used for assessment. CONCLUSIONS Future longitudinal research to address the identified gaps would foster interventions that promote ASM adherence among vulnerable populations living with epilepsy.
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Affiliation(s)
| | | | - Wendy R Miller
- Indiana University, 600 Barnhill Drive, Indianapolis, USA
| | | | - Joan K Austin
- Indiana University, 600 Barnhill Drive, Indianapolis, USA
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Gupta SK, Margolis SA, Grant AC, Gonzalez JS, Nakhutina L. Relationships among illness representations and depressive symptom severity in predominantly African-American and Caribbean-American people with epilepsy. Clin Neuropsychol 2021; 36:462-478. [PMID: 34027793 DOI: 10.1080/13854046.2021.1923802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Depression is the most common psychiatric comorbidity among people with epilepsy (PWE) and tends to be more prevalent among people of color (POC) and those with intractable seizures. However, the extent to which illness-related perceptions are associated with depressive symptom severity among POC with intractable seizures is unclear. Method: This cross-sectional study examined relationships among illness representations and self-rated depressive symptoms in 55 PWE (M Age = 41; 61.8% female) with intractable seizures (M seizures per month = 2) who identified as Black/African-American (52.7%), Black/Caribbean-American (27.3%), and/or Hispanic/Latino (21.8%). Epilepsy-related illness perceptions were assessed with the Illness Perception Questionnaire-Revised and depression was measured via the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Results: Nearly half of the sample (41.8%) scored above the NDDI-E depression cut-off. PWE endorsing more severe depressive symptoms indicated that their epilepsy had more negative consequences, was hard to comprehend, was insufficiently controlled by treatment, and had a negative emotional impact (p's ≤ 0.02). Controlling for sex, these four illness representations accounted for 48% of the variance in depression severity. Interestingly, participants with probable major depressive episodes were more likely to endorse several psychological causes of seizures compared to non-depressed PWE. Conclusions: Worse depression symptom severity was associated with negative illness perceptions and a tendency to attribute one's epilepsy to psychological causes. Future research is needed to understand how the relationship between negative illness perceptions and depression symptoms unfold over time and whether interventions aimed at modifying illness representations reduce psychological distress in diverse PWE.
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Affiliation(s)
- Sugandha K Gupta
- Graduate Center, City University of New York, Psychology, New York, NY, USA
| | - Seth A Margolis
- Alpert Medical School, Brown University, Providence, RI, USA
| | - Arthur C Grant
- Downstate Medical Center, State University of New York, New York, NY, USA
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA.,Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Luba Nakhutina
- Downstate Medical Center, State University of New York, New York, NY, USA
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Sumida CA, Lopez FV, Van Etten EJ, Whiteley N, Moore RC, Litvan I, Lessig S, Gilbert PE, Schmitter-Edgecombe M, Filoteo JV, Schiehser DM. Medication Management Performance in Parkinson’s Disease: Examination of Process Errors. Arch Clin Neuropsychol 2021; 36:1307-1315. [DOI: 10.1093/arclin/acab004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Individuals with Parkinson’s disease (PD) are at risk for increased medication mismanagement, which can lead to worse clinical outcomes. However, the nature of the errors (i.e., undertaking or overtaking medications) contributing to mismanagement and their relationship to cognition in PD is unknown. Therefore, this study sought to examine errors committed on the Medication Management Ability Assessment (MMAA) between PD participants with normal cognition (PD-NC) or mild cognitive impairment (PD-MCI) relative to healthy adults (HA).
Method
HA (n = 74), PD-NC (n = 102), and PD-MCI (n = 45) participants were administered the MMAA to assess undertaking, overtaking, and overall errors as well as overall performance (total score). Additionally, participants were administered a comprehensive neuropsychological battery from which cognitive composites of Attention, Learning, Memory, Language, Visuospatial, and Executive Functioning were derived.
Results
Separate negative binomial regression analyses indicated the PD-MCI group performed significantly worse overall on the MMAA (total score) and committed more undertaking and overall errors relative to HA and PD-NC. In the PD-MCI group, poorer MMAA performance was associated with worse delayed memory performance, whereas cognitive performance was not related to MMAA in HA or PC-NC.
Conclusion
Compared to PD and healthy adults with normal cognition, PD-MCI patients exhibited greater difficulty with medication management, particularly with undertaking medications. Poorer medication management in PD-MCI was associated with worse delayed recall. Thus, PD-MCI patients experiencing memory problems may require additional assistance with their medications. Findings have clinical relevance suggesting that objective measures of medication errors may assist clinicians in identifying PD patients needing adherence strategies.
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Affiliation(s)
- Catherine A Sumida
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA
| | - Francesca V Lopez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA
| | - Emily J Van Etten
- Department of Psychology, University of Arizona, Tucson, AZ, 85721, USA
| | - Nicole Whiteley
- Research Service, Veterans Administration San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Stephanie Lessig
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
- Neurology Service, Veterans Administration San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Paul E Gilbert
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, Department of Psychology, San Diego State University, San Diego, CA 92182-4611, USA
| | | | - J Vincent Filoteo
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
- Psychology Service, Veterans Administration San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Dawn M Schiehser
- Research Service, Veterans Administration San Diego Healthcare System, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
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Margolis SA, Hallowell ES, Davis JD, Kenney LE, Tremont GN. The Clinical Utility and Ecological Validity of the Medication Management Ability Assessment in Older Adults with and without Dementia. Arch Clin Neuropsychol 2021; 36:37-50. [PMID: 32808040 DOI: 10.1093/arclin/acaa058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Older adults are susceptible to medication nonadherence, which may signify functional decline. Thus, performance-based proxies of medication-taking behavior may help diagnose dementia. We assessed the Medication Management Ability Assessment's (MMAA) clinical utility and ecological validity. METHOD This was a retrospective chart review of 180 outpatients (age = 72 ± 8 years) who completed the MMAA during clinical evaluations. Forty-seven were cognitively normal (CN), 103 had mild cognitive impairment (MCI), and 30 had dementia. Most (136) were independent in medication management, whereas 28 were assisted and 16 were dependent. Kruskal-Wallis tests assessed whether MMAA scores differed by diagnosis and independence. Receiver operating characteristic (ROC) analyses identified diagnostic cut-offs. Classification accuracy estimates were derived. RESULTS MMAA performance differed across diagnosis as expected (p's < .001). Those who were independent in medication management outperformed assisted and dependent counterparts (p's < .001). Assisted and dependent cases were no different. At a cut-off = 23, the MMAA was good-to-strong in distinguishing dementia from CN cases (Sn = 0.96, Sp = 0.83), dementia from MCI (Sn = 0.70, Sp = 0.83), and dementia from functionally unimpaired cases (Sn = 0.78, Sp = 0.83). At a cut-off = 27, it had good sensitivity but weaker specificity when distinguishing both MCI and all cognitively impaired patients (MCI and dementia) from CN cases (Sn = 0.81, Sp = 0.66 and Sn = 0.81, Sp = 0.72, respectively). CONCLUSIONS The MMAA has ecological validity and clinical utility in identifying dementia. Its inclusion in neuropsychological practice may be especially useful when medication mismanagement is suspected.
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Affiliation(s)
- Seth A Margolis
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Emily S Hallowell
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jennifer D Davis
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Lauren E Kenney
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Geoffrey N Tremont
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Margolis SA, Gonzalez JS, Faria C, Kenney L, Grant AC, Nakhutina L. Anxiety disorders in predominantly African American and Caribbean American adults with intractable epilepsy: The role of perceived epilepsy stigma. Epilepsy Behav 2019; 99:106450. [PMID: 31419635 DOI: 10.1016/j.yebeh.2019.106450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Anxiety disproportionately affects people with epilepsy (PWE) and leads to poor outcomes. Yet, risk factors are not well understood especially among underserved groups. This cross-sectional study aimed to identify epilepsy-specific predictors of anxiety disorders in predominantly African American and Caribbean American PWE. MATERIALS AND METHODS The prevalence of anxiety disorders was established via diagnostic interview (Mini-International Neuropsychiatric Interview (MINI)). We identified the extent to which aspects of seizure burden (seizure frequency, seizure severity, convulsive vs. nonconvulsive seizures), seizure worry, and perceived epilepsy stigma were associated with anxiety disorder diagnosis. Finally, logistic regression assessed the overall and independent contributions of significant risk factors. RESULTS There were 60 participants (62% women, 52% African American, 27% Caribbean American, 20% Hispanic/Latino) with an average of 2 seizures per month. Nearly half of the sample (43%) had ≥1 anxiety disorder, with 62% of affected individuals qualifying for agoraphobia. Those with anxiety disorders tended to have convulsive seizures (p = 0.037) and endorsed greater seizure worry (p = 0.012), more general symptoms of anxiety (p = 0.005), and worse perceived epilepsy stigma (p = 0.003). Logistic regression accounted for 28% to 37.6% of the variance in anxiety disorder diagnostic status and correctly classified 73% of cases; however, only perceived epilepsy stigma made a unique contribution. CONCLUSIONS Anxiety disorders were prevalent in these predominantly African American and Caribbean American PWE. Epilepsy-specific risk factors included convulsive seizures, seizure worry, and perceived epilepsy stigma. Interventions aimed at treating anxiety disorders in diverse PWE may especially benefit from targeting stigma beliefs.
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Affiliation(s)
- Seth A Margolis
- Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA; Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA.
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., Bronx, NY 10461, USA; Albert Einstein College of Medicine, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10461, USA
| | - Caylin Faria
- Bridgewater State University, 131 Summer St., Bridgewater, MA 02324, USA
| | - Lauren Kenney
- Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
| | - Arthur C Grant
- State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA
| | - Luba Nakhutina
- State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA
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