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Yemm H, Peel E, Brooker D. "I guess you can interpret it in a number of ways like kind of a milder or the mildest form of dementia?": Multi-stakeholder perceptions of cognitive impairment. DEMENTIA 2023; 22:1799-1818. [PMID: 37696113 DOI: 10.1177/14713012231201596] [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: 09/13/2023]
Abstract
INTRODUCTION Mild cognitive impairment (MCI) has a high prevalence and is a risk factor for dementia. Furthering understanding of MCI has been identified as a public health priority. This research aimed to explore views about the causes of cognitive impairment and identify associations between cognitive impairment, dementia, and normative ageing. METHOD Semi-structured qualitative interviews were conducted with 22 participants with different stakeholder perspectives on the area of MCI in England, and analysed thematically. RESULTS Our analysis focuses on two main themes: 1) causes of cognitive impairment, and 2) ageing, dementia, and dying. Most participants viewed cognitive impairment as a transitional state between normative ageing and dementia. Participants expressed their fear of cognitive impairment and dementia, and made clear links between cognitive impairment and dying. Participants also showed an awareness of the links between lifestyle factors and cognitive health. However, linkage between lifestyle and cognition was discussed only when explicitly asked, suggesting that this was not especially salient for participants when considering the causes and risk factors for cognitive impairment. CONCLUSION The results of this study highlight key areas for future public health initiatives, such as a focus on the multitude of benefits offered by adopting a healthy diet and physical exercise in reducing risk of cognitive impairment.
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Affiliation(s)
- H Yemm
- Helen McArdle Nursing and Care Research Institute, University of Sunderland, UK; Association for Dementia Studies, University of Worcester, UK
| | - E Peel
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, UK
| | - D Brooker
- Association for Dementia Studies, University of Worcester, UK
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Tan EYL, Janssen N, Handels R, Ramakers IHGB, Verhey FRJ, van der Flier WM, Melis RJF, Olde Rikkert MGM, Schols JMGA, de Vugt ME. Determinants of quality of life in family caregivers in MCI: a comparison with mild dementia. Aging Ment Health 2023; 27:1983-1989. [PMID: 37310855 DOI: 10.1080/13607863.2023.2220274] [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: 07/24/2022] [Accepted: 05/18/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The aim of the current study was to investigate the health-related quality of life (HRQol) of the family caregiver in MCI, explore possible determinants and study possible differences with mild dementia. METHODS This secondary data analysis included 145 persons with MCI and 154 persons with dementia and their family caregivers from two Dutch cohort studies. HRQoL was measured with the VAS of the EuroQol-5D-3L version. Regressions analyses were conducted to examine potential demographic and clinical determinants of the caregiver's HRQoL. RESULTS The mean EQ5D-VAS in family caregivers of persons with MCI was 81.1 (SD 15.7), and did not significantly differ from family caregivers in mild dementia (81.9 (SD 13.0)). In MCI, patient measurements were not significantly associated with caregiver mean EQ5D-VAS. Concerning caregiver characteristics, being a spouse and a lower educational level were associated with a lower mean EQ5D-VAS (in a multiple linear regression model: unstandardized B -8.075, p = 0.013 and unstandardized B -6.162, p = 0.037 resp.). In mild dementia, the NPI item irritability showed an association with caregiver EQ5D-VAS in bivariate linear regression analyses. CONCLUSION Results indicate that especially family caregiver characteristics seem to influence family caregiver HRQoL in MCI. Future research should include other potential determinants such as burden, coping strategies and relationship quality.
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Affiliation(s)
- Eva Y L Tan
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Old Age Psychiatry, Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Niels Janssen
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ron Handels
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Inez H G B Ramakers
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Frans R J Verhey
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - René J F Melis
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Centre for Medical Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos M G A Schols
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Family Medicine and Department of Health Services Research, Caphri, Maastricht, the Netherlands
| | - Marjolein E de Vugt
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Gong B, Li M, Lv W. Machine learning and data analysis-based study on the health issues post-pandemic. Soft comput 2023:1-10. [PMID: 37362289 PMCID: PMC10257175 DOI: 10.1007/s00500-023-08683-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/28/2023]
Abstract
The COVID-19 pandemic has had significant impacts on the health of individuals and communities around the world. While the immediate health impacts of the virus itself are well-known, there are also a number of post-pandemic health issues that have emerged as a result of the pandemic. The pandemic has caused increased levels of anxiety, depression, and other mental health issues among people of all ages. The isolation, uncertainty, and grief caused by the pandemic have taken a toll on people's mental well-being, and there is a growing concern that the long-term effects of the pandemic on mental health could be severe. Many people have delayed or avoided medical care during the pandemic, which could lead to long-term health problems. Additionally, people who have contracted COVID-19 may experience ongoing symptoms, such as fatigue, shortness of breath, and muscle weakness, which could impact their long-term health. Machine learning (ML) can be a powerful tool to analyze the health impact of the post-pandemic period. With the vast amounts of data available from electronic health records, public health databases, and other sources, this article is making use of ML methods which can help identify patterns and insights to conclude the study. The proposed ML models can analyze health data to identify trends and patterns that may indicate future health problems. By monitoring patterns in medical records and public health data, the proposed ML model can help public health officials detect and respond to outbreaks more quickly. The survey outcome reveals that the level of physical activities has been decreased by 22% during COVID-19-outbreak. The variance is shown at 49% during COVID-19 outbreak. The absence of physical activity (PA) and perceived stress (PS) are observed to be suggestively correlated with the QoL (quality of life) of adults. Deteriorated mental health also disrupts the normal lives and impacts the sleeping quality of people. The analysis of the data is performed using statistical analytical tools to depict the consequences of pandemic on the health of individuals aged between 50 to 80 years.
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Affiliation(s)
- Bin Gong
- Faculty of Data Science, City University of Macau, Macau, China
| | - Mingchao Li
- School of Business, Shenzhen Institute of Technology, Shenzhen, China
| | - Wei Lv
- Faculty of Data Science, City University of Macau, Macau, China
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Viscogliosi C, Dame N, Mino-Roy J, Rahimaly S, Breton V, Déry J, Chassé B, Couturier Y, Giroux D, Renaud C, Provencher V. [Trouble neurocognitif majeur et méthodes optimisant l'apprentissage]. Can J Aging 2023; 42:189-198. [PMID: 35971842 DOI: 10.1017/s0714980822000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Les difficultés cognitives consécutives aux troubles neurocognitifs majeurs (TNCM) engendrent des enjeux dans la réalisation d'activités de la vie quotidienne. Ce projet visait à identifier auprès des proches aidants et des intervenants des situations nécessitant des méthodes optimisant l'apprentissage pour faciliter l'engagement de personnes vivant avec un TNCM dans leurs activités de la vie quotidienne. Des entrevues individuelles semi-dirigées, d'une durée de 60 à 90 minutes, ont été menées auprès de proches aidants et d'intervenants. Les résultats montrent que les activités quotidiennes et domestiques sont notamment affectées par les difficultés à repérer ou à utiliser les objets, à garder en tête la tâche en cours, à mettre en séquences des étapes, à ne pas se laisser distraire par autre chose et à constater ses difficultés pour s'y adapter. Les proches aidants souhaitent du soutien dans l'application des méthodes optimisant l'apprentissage pour contribuer au maintien de l'autonomie des personnes vivant avec un TNCM.
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Affiliation(s)
- Chantal Viscogliosi
- Université de Sherbrooke et Centre de recherche sur le vieillissement du CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada
| | - Nathalie Dame
- Université de Sherbrooke et Centre de recherche sur le vieillissement du CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada
| | - Jordan Mino-Roy
- Université de Sherbrooke et Centre de recherche sur le vieillissement du CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada
| | - Sarah Rahimaly
- Université de Sherbrooke et Centre de recherche sur le vieillissement du CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada
| | | | - Jessica Déry
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie et du Centre-du-Québec (CIUSSS MCQ), Bécancour, Québec, Canada
| | - Bernard Chassé
- Société Alzheimer des Maskoutains - Vallée des Patriotes, St-Hilaire, Québec, Canada
| | - Yves Couturier
- Université de Sherbrooke et Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Dominique Giroux
- Université Laval et Centre de recherche en santé durable VITAM, Québec, Québec, Canada
| | | | - Véronique Provencher
- Université de Sherbrooke et Centre de recherche sur le vieillissement du CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada
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Hauber B, Paulsen R, Krasa HB, Vradenburg G, Comer M, Callahan LF, Winfield J, Potashman M, Hartry A, Lee D, Wilson H, Hoffman DL, Wieberg D, Kremer IN, Taylor GA, Taylor JM, Lappin D, Martin AD, Frangiosa T, Biggar V, Slota C, Romano C, DiBenedetti DB. Assessing What Matters to People Affected by Alzheimer's Disease: A Quantitative Analysis. Neurol Ther 2023; 12:505-527. [PMID: 36763306 PMCID: PMC10043143 DOI: 10.1007/s40120-023-00445-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION In this phase of the ongoing What Matters Most study series, designed to evaluate concepts that are meaningful to people affected by Alzheimer's disease (AD), we quantified the importance of symptoms, impacts, and outcomes of AD to people at risk for or with AD and care partners of people with AD. METHODS We administered a web-based survey to individuals at risk for or with AD (Group 1: unimpaired cognition with evidence of AD pathology; Group 2: AD risk factors and subjective cognitive complaints/mild cognitive impairment; Group 3: mild AD) and to care partners of individuals with moderate AD (Group 4) or severe AD (Group 5). Respondents rated the importance of 42 symptoms, impacts, and outcomes on a scale ranging from 1 ("not at all important") to 5 ("extremely important"). RESULTS Among the 274 respondents (70.4% female; 63.1% white), over half of patient respondents rated all 42 items as "very important" or "extremely important," while care partners rated fewer items as "very important" or "extremely important." Among the three patient groups, the minimum (maximum) mean importance rating for any item was 3.4 (4.6), indicating that all items were at least moderately to very important. Among care partners of people with moderate or severe AD, the minimum (maximum) mean importance rating was 2.1 (4.4), indicating that most items were rated as at least moderately important. Overall, taking medications correctly, not feeling down or depressed, and staying safe had the highest importance ratings among both patients and care partners, regardless of AD phase. CONCLUSION Concepts of importance to individuals affected by AD go beyond the common understanding of "cognition" or "function" alone, reflecting a desire to maintain independence, overall physical and mental health, emotional well-being, and safety. Preservation of these attributes may be key to understanding whether interventions deliver clinically meaningful outcomes.
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Affiliation(s)
- Brett Hauber
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Russ Paulsen
- UsAgainstAlzheimer's, Washington, DC, 20043, USA
| | - Holly B Krasa
- Blue Persimmon Group LLC, Washington, DC, 20016, USA
| | | | - Meryl Comer
- UsAgainstAlzheimer's, Washington, DC, 20043, USA
| | | | - John Winfield
- University of North Carolina, Chapel Hill, NC, 27599, USA
| | | | | | - Daniel Lee
- Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ, 08540, USA
| | - Hilary Wilson
- Boehringer Ingelheim, Burlington, ON, L7L 5H4, Canada
| | | | | | - Ian N Kremer
- LEAD Coalition (Leaders Engaged on Alzheimer's Disease), Washington, DC, 20043, USA
| | | | | | - Debra Lappin
- Faegre Drinker Consulting, Washington, DC, 20001, USA
| | | | | | | | - Christina Slota
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Carla Romano
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Dana B DiBenedetti
- RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA.
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Basta M, John Simos N, Zioga M, Zaganas I, Panagiotakis S, Lionis C, Vgontzas AN. Personalized screening and risk profiles for Mild Cognitive Impairment via a Machine Learning Framework: Implications for general practice. Int J Med Inform 2023; 170:104966. [PMID: 36542901 DOI: 10.1016/j.ijmedinf.2022.104966] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Diagnosis of Mild Cognitive Impairment (MCI) requires lengthy diagnostic procedures, typically available at tertiary Health Care Centers (HCC). This prospective study evaluated a flexible Machine Learning (ML) framework toward identifying persons with MCI or dementia based on information that can be readily available in a primary HC setting. METHODS Demographic and clinical data, informant ratings of recent behavioral changes, self-reported anxiety and depression symptoms, subjective cognitive complaints, and Mini Mental State Examination (MMSE) scores were pooled from two aging cohorts from the island of Crete, Greece (N = 763 aged 60-93 years) comprising persons diagnosed with MCI (n = 277) or dementia (n = 153), and cognitively non-impaired persons (CNI, n = 333). A Balanced Random Forest Classifier was used for classification and variable importance-based feature selection in nested cross-validation schemes (CNI vs MCI, CNI vs Dementia, MCI vs Dementia). Global-level model-agnostic analyses identified predictors displaying nonlinear behavior. Local level agnostic analyses pinpointed key predictor variables for a given classification result after statistically controlling for all other predictors in the model. RESULTS Classification of MCI vs CNI was achieved with improved sensitivity (74 %) and comparable specificity (73 %) compared to MMSE alone (37.2 % and 94.3 %, respectively). Additional high-ranking features included age, education, behavioral changes, multicomorbidity and polypharmacy. Higher classification accuracy was achieved for MCI vs Dementia (sensitivity/specificity = 87 %) and CNI vs Dementia (sensitivity/specificity = 94 %) using the same set of variables. Model agnostic analyses revealed notable individual variability in the contribution of specific variables toward a given classification result. CONCLUSIONS Improved capacity to identify elderly with MCI can be achieved by combining demographic and medical information readily available at the PHC setting with MMSE scores, and informant ratings of behavioral changes. Explainability at the patient level may help clinicians identify specific predictor variables and patient scores to a given prediction outcome toward personalized risk assessment.
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Affiliation(s)
- Maria Basta
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Maria Zioga
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Ioannis Zaganas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Simeon Panagiotakis
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Christos Lionis
- School of Medicine, University of Crete, Heraklion, Crete, Greece.
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Current development of a nonpharmacological intervention approach for mild cognitive impairment patients and a clinical trial in China. J Transl Int Med 2022; 10:5-8. [PMID: 35702185 PMCID: PMC8997805 DOI: 10.2478/jtim-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Smith L, Bloska J, Jacob L, Barnett Y, Butler L, Trott M, Odell-Miller H, Veronese N, Kostev K, Bettac EL, Godier-McBard L, Koyanagi A. Is loneliness associated with mild cognitive impairment in low- and middle-income countries? Int J Geriatr Psychiatry 2021; 36:1345-1353. [PMID: 33606886 DOI: 10.1002/gps.5524] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/14/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Loneliness may be a risk factor for mild cognitive impairment but studies on this topic are scarce, particularly from low- and middle-income countries (LMICs). Therefore, the aim of the present study was to investigate the association between loneliness and mild cognitive impairment (MCI) in six LMICs (China, Ghana, India, Mexico, Russia and South Africa). METHODS Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations. RESULTS The final analytical sample consisted of 19,092 and 13,623 individuals aged 50-64 years (middle-aged adults) and ≥65 years (older adults), respectively. Among the middle-aged, overall, loneliness was associated with a non-significant 1.43 (95% confidence interval [CI] = 0.93-2.21) times higher odds for MCI although significant associations were observed in China (OR = 1.51; 95%CI = 1.08-2.09) and South Africa (OR = 3.87; 95%CI = 1.72-8.71). As for older adults, overall, there was a significant association between loneliness and MCI (OR = 1.52; 95%CI = 1.12-2.07). CONCLUSION In this large representative sample of middle-aged and older adults from multiple LMICs, findings suggest that loneliness is associated with MCI. It may be prudent to consider reducing loneliness in low-economic settings to aid in the prevention of MCI and ultimately dementia.
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Affiliation(s)
- Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Jodie Bloska
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, France
| | | | - Laurie Butler
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Mike Trott
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Helen Odell-Miller
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, Geriatric Unit, University of Palermo, Palermo, Italy
| | - Karel Kostev
- Philipps University of Marburg, Marburg, Germany
| | - Erica L Bettac
- Department of Psychology, Washnington State University Vancouver, Vancouver, Washington, USA
| | - Lauren Godier-McBard
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, Chelmsford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain.,ICREA, Pg. Lluis Companys 23, Barcelona, Spain
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Siu MY, Lee DTF. Is Tai Chi an effective intervention for enhancing health-related quality of life in older people with mild cognitive impairment? An interventional study. Int J Older People Nurs 2021; 16:e12400. [PMID: 34254731 DOI: 10.1111/opn.12400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 05/24/2021] [Accepted: 06/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Many neuropsychiatric symptoms in persons of MCI cause negative impacts on their HRQOL. There is limited HRQOL research investigating the effect of Tai Chi on older people with MCI. OBJECTIVE To determine the effectiveness of a Tai Chi program in enhancing health-related quality of life (HRQOL) among community-dwelling older people with mild cognitive impairment (MCI) in Hong Kong. METHODS This was a quasi-experimental study using a nonequivalent control group (CG) design. Four social centres for older people participated in the study, of which two centres were randomised for Tai Chi intervention and the other two were treated as control. Participants in the intervention group (IG) were arranged for a 1-hour Tai Chi class twice weekly for 16 weeks, whereas participants in the CG were advised to join various recreational activities in the social centres as usual. For outcome evaluation, the Chinese version of the Short Form-12 Health Survey-Standard 1 (SF-12) was employed to assess participants' perceived HRQOL. RESULTS One hundred and sixty participants were recruited (IG = 80, CG = 80). Data were collected at baseline (T0) and 16-week post-intervention (T1).The IG reported significant improvement in the physical health component (PCS) (p = .036), the mental health component (MCS) (p = .014), as well as several subscales of SF-12, namely, the role-physical (RP) (p = .044), the bodily pain (BP) (p < .001) and the vitality (VT) (p = .004) subscales, in comparison with the CG. CONCLUSION The current study results extended our knowledge about Tai Chi of which the mind-body exercise could enhance the physical and psychosocial well-being in older people with MCI. IMPLICATIONS FOR PRACTICE The findings have the potential to inform health and social care professionals to promote Tai Chi in community settings, as it may represent a non-intensive and age-fitting strategy to promote HRQOL in older people with MCI. TRIAL REGISTRATION NCT03404765 (Retrospectively registered January 19, 2018).
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Affiliation(s)
- Mei-Yi Siu
- School of Nursing, Union Hospital, Hong Kong SAR, China
| | - Diana T F Lee
- The Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong SAR, China
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Gibson A, Bardach SH, Jicha GA. Identifying Adaptive and Maladaptive Behaviors Following a Diagnosis of Mild Cognitive Impairment. Alzheimer Dis Assoc Disord 2020; 34:262-266. [PMID: 32218064 PMCID: PMC7483717 DOI: 10.1097/wad.0000000000000379] [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] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Individual reactions to a diagnosis of mild cognitive impairment (MCI) can vary in a wide range of both adaptive and maladaptive responses. Understanding such reactions to diagnosis is important to maximize adaptive responses that can promote continued independence. METHODS In this pilot study, the Aging and Memory Quality of Life survey was developed to facilitate an understanding of adaptive and maladaptive behaviors results from a diagnosis of MCI. The Aging and Memory Quality of Life was administered to 45 individuals diagnosed with MCI and 45 cognitively normal participants serving as control subjects matched for age, sex, and education. Study partners were surveyed to collect corroborating and or discrepant observer responses. RESULTS Inconsistent with study partners' reporting, MCI subjects may be underreporting physical limitations, and overreporting medication compliance. MCI subjects identified challenges to managing financial affairs. DISCUSSION Developing strategies to circumvent the development of maladaptive behaviors could significantly reduce morbidity and mortality in MCI patients.
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Affiliation(s)
- Allison Gibson
- University of Kentucky, College of Social Work
- Sanders-Brown Center on Aging, Alzheimer’s Disease Center
| | - Shoshana H. Bardach
- University of Kentucky, College of Public Health, Graduate Center for Gerontology
- Sanders-Brown Center on Aging, Alzheimer’s Disease Center
| | - Gregory A. Jicha
- University of Kentucky, College of Medicine, Department of Neurology
- Sanders-Brown Center on Aging, Alzheimer’s Disease Center
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Dooley J, Bailey C, Xanthopoulou P, Bass N, McCabe R. Communication and understanding of mild cognitive impairment diagnoses. Int J Geriatr Psychiatry 2020; 35:662-670. [PMID: 32103532 DOI: 10.1002/gps.5284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Communication of mild cognitive impairment (MCI) diagnoses is challenging due to its heterogeneity and unclear prognosis. AIM To identify how MCI is communicated and to explore the relationship with patient and companion understanding. METHOD Conversation analysis identified whether MCI was named and explained in 43 video recorded diagnosis feedback meetings. Afterward, patients and companions were asked to name the diagnosis to assess understanding. RESULTS Mild cognitive impairment was not named in 21% meetings. Symptoms were explained as (a) a result of vascular conditions (49%), (b) a stage between normal ageing and dementia (30%), or (c) caused by psychological factors (21%). Fifty-four percentage of prognosis discussions included mention of dementia. There was no association between symptom explanations and whether prognosis discussions included dementia. Fifty-seven percentage patients and 37% companions reported not having or not knowing their diagnosis after the meeting. They were more likely to report MCI when prognosis discussions included dementia. CONCLUSIONS Doctors offer three different explanations of MCI to patients. The increased risk of dementia was not discussed in half the diagnostic feedback meetings. This is likely to reflect the heterogeneity in the definition, cause and likely prognosis of MCI presentations. Clearer and more consistent communication, particularly about the increased risk of dementia, may increase patient understanding and enable lifestyle changes to prevent some people progressing to dementia.
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Affiliation(s)
- Jemima Dooley
- Faculty of Health Sciences, Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | - Nick Bass
- Division of Psychiatry, University College London, London, UK
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12
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Guzmán A, Gillanders D, Stevenson A, Ross K. Psychosocial adjustment to Mild Cognitive Impairment: The role of illness perceptions, cognitive fusion and cognitive impairment. DEMENTIA 2020; 20:464-484. [PMID: 31948271 DOI: 10.1177/1471301219893862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Receiving a Mild Cognitive Impairment diagnosis and adjusting to this condition is challenging, given the uncertain clinical trajectory surrounding progression to dementia. We aimed to explore the influence of illness perceptions and cognitive fusion on coping and emotional responses in a sample of people diagnosed with Mild Cognitive Impairment.Research design and method: A cross-sectional study of 34 participants with Mild Cognitive Impairment (47% female and 53% male; mean age 76.4 years) evaluated the relationships between cognitive impairment, illness perceptions and cognitive fusion on levels of distress and quality of life. Participants completed standardised measures for cognitive assessment, illness perceptions, cognitive fusion, depression, anxiety and quality of life. Relationships between variables were analysed using correlation, regression and conditional process analyses. RESULTS At the group level, illness perceptions were found to be a stronger predictor of depression and quality of life in the current sample than objective cognitive impairment. Illness perceptions did not directly predict anxiety, rather cognitive fusion significantly mediated this relationship. Cognitive fusion also significantly mediated the relationship between illness perceptions and depression. Illness perceptions had a significant, direct effect on quality of life; however, there was no significant indirect effect via cognitive fusion. Greater fusion with threatening illness perceptions was significantly related to increased anxiety and depression.Discussion and implications: Data suggest multiple potential treatment targets in helping people diagnosed with Mild Cognitive Impairment to successfully adapt and adjust. Targeting appraisals (illness perceptions) using Cognitive Therapy is one potential treatment target. In addition, psychological treatments such as Acceptance and Commitment Therapy, which target cognitive fusion, could also warrant further investigation in this population, due to the significant indirect paths from illness perceptions to distress and quality of life, via cognitive fusion.
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Affiliation(s)
| | - David Gillanders
- Department of Clinical Psychology, School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Amanda Stevenson
- Psychological Therapies for Older People, NHS Lanarkshire, Scotland, UK
| | - Kerry Ross
- Older People's Psychology Service, NHS Greater Glasgow and Clyde, Belmont Centre, Stobhill Hospital, Scotland, UK
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Song D, Yu DS, Li PW, He G, Sun Q. Correlates of Health-Related Quality of Life Among Chinese Older Adults with Mild Cognitive Impairment. Clin Interv Aging 2019; 14:2205-2212. [PMID: 31908431 PMCID: PMC6924576 DOI: 10.2147/cia.s227767] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to assess the health-related quality of life (HRQoL) and identify the important correlates of HRQoL in older Chinese adults with mild cognitive impairment (MCI). Patients and methods A cross-sectional study design was adopted. A total of 204 older adults with MCI were enrolled in this study. HRQoL was evaluated by the Quality of Life-Alzheimer's disease. Hierarchical regression analysis was conducted to investigate the sociodemographic, disease-related, psychological, and behavioral factors associated with the HRQoL of individuals with MCI. Results Hierarchical regression analysis indicated that old age (Beta = -0.131, p =0.024), low income (Beta = 0.128, p = 0.032), depressive symptoms (Beta = -0.564, p < 0.001), and poor sleep quality (Beta = -0.169, p =0.004) were significantly associated with the HRQoL of individuals with MCI. Conclusion Caring for older Chinese adults with MCI should focus on sociodemographically disadvantaged groups with advanced age and low income. Rehabilitation programs that effectively alleviate depressive symptoms and improve sleep quality should be applied to older adults with MCI to enhance their HRQoL.
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Affiliation(s)
- Dan Song
- School of Nursing, ZheJiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Doris Sf Yu
- The Nethersole School of Nursing, The Chinese University of Hong Kong, HKSAR
| | - Polly Wc Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, HKSAR
| | - Guijuan He
- School of Nursing, ZheJiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Qiuhua Sun
- School of Nursing, ZheJiang Chinese Medical University, Hangzhou, People's Republic of China
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Larouche E, Hudon C, Goulet S. Mindfulness mechanisms and psychological effects for aMCI patients: A comparison with psychoeducation. Complement Ther Clin Pract 2018; 34:93-104. [PMID: 30712752 DOI: 10.1016/j.ctcp.2018.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/08/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
Amnestic mild cognitive impairment (aMCI), an Alzheimer's disease prodrome, is characterized by cognitive and psychological symptoms, the latter aggravating prognosis. A mindfulness-based intervention (MBI) represents a promising non-pharmacological framework for Alzheimer's disease prevention. The Monitoring + Acceptance Theory (MAT) postulates that MBI improves cognition through monitoring, and psychological well-being, through acceptance. This single-blind preliminary randomized-controlled study investigated the effects of a MBI on anxio-depressive symptoms, quality of life, and memory, compared to a psychoeducation-based intervention in older adults with aMCI. The contribution of MAT components and of ruminations' reduction to intervention efficacy were examined. Participants assigned to both conditions experienced similar benefits regarding anxio-depressive symptoms and aging-related quality of life. General quality of life and memory remained unchanged. A partial support of the MAT and of ruminations reduction to the MBI's efficacy was found. The findings provide new insights on the effects and mechanisms of a MBI on aMCI symptoms.
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Affiliation(s)
- E Larouche
- École de psychologie, Université Laval, Canada; Centre de Recherche CERVO Brain Research Center, Canada
| | - C Hudon
- École de psychologie, Université Laval, Canada; Centre de Recherche CERVO Brain Research Center, Canada
| | - S Goulet
- École de psychologie, Université Laval, Canada; Centre de Recherche CERVO Brain Research Center, Canada.
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Karademas EC, Simos P, Zaganas I, Tziraki S, Panagiotakis S, Basta M, Vgontzas AN. The impact of mild cognitive impairment on the self-regulation process: A comparison study of persons with mild cognitive impairment and cognitively healthy older adults. J Health Psychol 2016; 24:351-361. [PMID: 27777277 DOI: 10.1177/1359105316674270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examined whether mild cognitive impairment affects the associations between personal expectations (i.e. optimism and self-efficacy), illness-related coping, and quality of life. In total, two groups of older adults participated: 127 persons diagnosed with mild cognitive impairment and 225 cognitively healthy older persons (cognitively non-impaired group). Several significant relationships observed in the cognitively non-impaired group did not reach significance among mild cognitive impairment patients, with the opposite trend noted for others (e.g. between palliative coping and physical health). These findings indicate that mild cognitive impairment may lead to problems in the self-regulation process and highlight the significance of the interplay between neurocognitive and psychosocial aspects of self-regulation.
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Pierce S, Lamers C, Salisbury K. Knowingly not wanting to know: Discourses of people diagnosed with mild cognitive impairment. DEMENTIA 2016; 15:1246-59. [DOI: 10.1177/1471301215600895] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mild cognitive impairment is a heterogeneous clinical state whereby assessed cognitive changes over time may progress to dementia, remain stable or revert to back to normal. This study aimed to identify, through discourse analysis, how people with a diagnosis of mild cognitive impairment used language in order to reveal the societal views and shared meanings of the diagnosis, and the positions taken by people. Seven people with mild cognitive impairment were interviewed, and three discourses emerged during analysis. One of the discourses revealed was ‘Not Knowing’ about mild cognitive impairment. Furthermore, in the absence of a coherent discourse related to mild cognitive impairment, participants went on to position themselves between two more familiar discourse; ‘Knowing’ about ageing and dying and ‘Not Wanting to Know’ about dementia. Clinicians must consider how information is presented to people about mild cognitive impairment, including where mild cognitive impairment is positioned in respect to normal ageing and dementia.
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Affiliation(s)
- Sian Pierce
- North Wales Clinical Psychology Programme, Bangor University, Bangor, UK
| | - Carolien Lamers
- North Wales Clinical Psychology Programme, Bangor University, Bangor, UK
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17
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van den Dungen P, Moll van Charante EP, van de Ven PM, van Marwijk HWJ, van der Horst HE, van Hout HPJ. Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care. PLoS One 2016; 11:e0156958. [PMID: 27310616 PMCID: PMC4910994 DOI: 10.1371/journal.pone.0156958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 05/22/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes. METHODS In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual. RESULTS Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326) of persons in the intervention, and in 30.5% (98/321) in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60-3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%), there were no differences in mental health between the intervention and control group. CONCLUSIONS We found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude a clinically relevant effect, a larger study is warranted to replicate ours. TRIAL REGISTRATION Nederlands Trial Register NTR3389.
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Affiliation(s)
- Pim van den Dungen
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Eric P. Moll van Charante
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Harm W. J. van Marwijk
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Primary Care Research Centre, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Henriëtte E. van der Horst
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Hein P. J. van Hout
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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Morley JE, Morris JC, Berg-Weger M, Borson S, Carpenter BD, Del Campo N, Dubois B, Fargo K, Fitten LJ, Flaherty JH, Ganguli M, Grossberg GT, Malmstrom TK, Petersen RD, Rodriguez C, Saykin AJ, Scheltens P, Tangalos EG, Verghese J, Wilcock G, Winblad B, Woo J, Vellas B. Brain health: the importance of recognizing cognitive impairment: an IAGG consensus conference. J Am Med Dir Assoc 2016; 16:731-9. [PMID: 26315321 DOI: 10.1016/j.jamda.2015.06.017] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 06/19/2015] [Indexed: 12/20/2022]
Abstract
Cognitive impairment creates significant challenges for patients, their families and friends, and clinicians who provide their health care. Early recognition allows for diagnosis and appropriate treatment, education, psychosocial support, and engagement in shared decision-making regarding life planning, health care, involvement in research, and financial matters. An IAGG-GARN consensus panel examined the importance of early recognition of impaired cognitive health. Their major conclusion was that case-finding by physicians and health professionals is an important step toward enhancing brain health for aging populations throughout the world. This conclusion is in keeping with the position of the United States' Centers for Medicare and Medicaid Services that reimburses for detection of cognitive impairment as part the of Medicare Annual Wellness Visit and with the international call for early detection of cognitive impairment as a patient's right. The panel agreed on the following specific findings: (1) validated screening tests are available that take 3 to 7 minutes to administer; (2) a combination of patient- and informant-based screens is the most appropriate approach for identifying early cognitive impairment; (3) early cognitive impairment may have treatable components; and (4) emerging data support a combination of medical and lifestyle interventions as a potential way to delay or reduce cognitive decline.
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Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St Louis, MO.
| | - John C Morris
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO
| | - Marla Berg-Weger
- Division of Geriatric Medicine, School of Social Work, Saint Louis University, St Louis, MO
| | - Soo Borson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Brian D Carpenter
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO
| | - Natalia Del Campo
- Institute of Aging, University Hospital of Toulouse, Toulouse, France
| | - Bruno Dubois
- Department of Neurology, Université Pierreet Marie Curie, Salpetriere Hospital, Paris, France
| | - Keith Fargo
- Scientific Programs and Outreach, Alzheimer's Association, Chicago, IL
| | - L Jaime Fitten
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA and Geriatric Psychiatry, Greater Los Angeles VA, Sepulveda Campus, Los Angeles, CA
| | - Joseph H Flaherty
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO
| | - Mary Ganguli
- Departments of Psychiatry, Neurology and Epidemiology, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, PA
| | - George T Grossberg
- Department of Neurology and Psychiatry, Geriatric Psychiatry, Saint Louis University School of Medicine, St Louis, MO
| | - Theodore K Malmstrom
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St Louis, MO
| | - Ronald D Petersen
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Carroll Rodriguez
- Public Policy and Communications, Alzheimer's Association, St Louis, MO
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences and the Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN
| | - Philip Scheltens
- VU University Medical Center, Alzheimer Center, Amsterdam, The Netherlands
| | | | - Joe Verghese
- Division of Geriatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Gordon Wilcock
- Nuffield Department of Clinical Medicine, Oxford Institute of Population Ageing, Oxford, United Kingdom
| | - Bengt Winblad
- Division for Neurogeriatrics, Care Sciences and Society, Department of NVS, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Bruno Vellas
- Department of Geriatrics, CHU Toulouse, Toulouse, France
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Hsiao HT, Li SY, Yang YP, Lin LL, Lin SI, Wang JJ. Cognitive Function and Quality of Life in Community-Dwelling Seniors with Mild Cognitive Impairment in Taiwan. Community Ment Health J 2016; 52:493-8. [PMID: 26993652 DOI: 10.1007/s10597-016-9993-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
Abstract
The aims of this study were to examine the relationships between overall cognitive function and the quality of life (QOL) domains, and to compare the differences in these by age, gender, and educational level in community-dwelling seniors in Taiwan. A cross-sectional study was conducted, with the participants screened and recruited from Southern Tainan. The Saint Louis University Mental Status Examination was used to screen the cognitive status of the participants. A total of 144 seniors participated in this study were assessed using the Taiwanese version of WHOQOL-BREF. The results showed that the participants performed better in the cognitive domains of "figure identification" and "orientation" while they performed poor in "delayed recall" and "immediate paragraph recall". No significant relationship between cognitive function and overall QOL, but a positive relationship between cognitive function and the physical health domain of QOL was found. The findings of this study provide valuable information for community healthcare providers.
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Affiliation(s)
- Hua-Tsen Hsiao
- Institute of Allied Health Science, College of Medicine, National Cheng Kung University, No. 1, Ta-Hsueh Rd., Tainan City, 70101, Taiwan, ROC.,Department of Nursing, School of Nursing, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City, 83102, Taiwan, ROC
| | - Shu-Ying Li
- Taiwan Taipei School for Visually Impaired, No. 1, Ln. 207, Sec. 2, Zhongcheng Rd., Shilin Dist., Taipei City, 111, Taiwan, ROC
| | - Ya-Ping Yang
- Institute of Allied Health Science, College of Medicine, National Cheng Kung University, No. 1, Ta-Hsueh Rd., Tainan City, 70101, Taiwan, ROC
| | - Linda L Lin
- Institute of Pysical Education, Health and Leisure Studies, National Cheng Kung University, No. 1, Ta-Hsueh Rd., Tainan City, 70101, Taiwan, ROC
| | - Sang-I Lin
- Department of Pysical Therapy, College of Medicine, National Cheng Kung University, No. 1, Ta-Hsueh Rd., Tainan City, 70101, Taiwan, ROC
| | - Jing-Jy Wang
- Institute of Allied Health Science, College of Medicine, National Cheng Kung University, No. 1, Ta-Hsueh Rd., Tainan City, 70101, Taiwan, ROC.
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Watermeyer TJ, Brown RG, Sidle KCL, Oliver DJ, Allen C, Karlsson J, Ellis C, Shaw CE, Al-Chalabi A, Goldstein LH. Impact of disease, cognitive and behavioural factors on caregiver outcome in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2015. [DOI: 10.3109/21678421.2015.1051990] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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21
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Fang ML, Coatta K, Badger M, Wu S, Easton M, Nygård L, Astell A, Sixsmith A. Informing Understandings of Mild Cognitive Impairment for Older Adults: Implications From a Scoping Review. J Appl Gerontol 2015; 36:808-839. [PMID: 26092574 DOI: 10.1177/0733464815589987] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The development of effective interventions for mild cognitive impairment (MCI) in older adults has been limited by extensive variability in the conceptualization and definition of MCI, its subtypes, and relevant diagnostic criteria within the neurocultural, pharmaceutical, and gerontological communities. A scoping review was conducted to explore the conceptual development of MCI and identify the resulting ethical, political, and technological implications for the care of older adults with MCI. A comprehensive search was conducted between January and April 2013 to identify English-language peer-reviewed articles published between 1999 and 2013. Our analysis revealed that the MCI conceptual debate remains unresolved, the response to ethical issues is contentious, the policy response is limited, and one-dimensional and technological interventions are scarce. Reflections on the conceptual, ethical, and policy responses in conjunction with the identification of the needs of older adults diagnosed with MCI highlight significant opportunities for technological interventions to effectively reposition MCI in the aging care discourse.
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Affiliation(s)
- Mei Lan Fang
- 1 Simon Fraser University, Vancouver, British Columbia, Canada
| | | | - Melissa Badger
- 1 Simon Fraser University, Vancouver, British Columbia, Canada
| | - Sarah Wu
- 1 Simon Fraser University, Vancouver, British Columbia, Canada
| | - Margaret Easton
- 1 Simon Fraser University, Vancouver, British Columbia, Canada
| | | | | | - Andrew Sixsmith
- 1 Simon Fraser University, Vancouver, British Columbia, Canada
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Paradise M, McCade D, Hickie IB, Diamond K, Lewis SJG, Naismith SL. Caregiver burden in mild cognitive impairment. Aging Ment Health 2015; 19:72-8. [PMID: 24866046 DOI: 10.1080/13607863.2014.915922] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We aimed to compare the rates of burden amongst caregivers of participants with mild cognitive impairment (MCI), compared to a control group. We also aimed to identify factors in both the caregiver and patient that are associated with significant levels of burden. METHOD This was a cross-sectional study. Sixty-four participants with MCI, 36 control-participants and their respective caregivers/informants were recruited to a university research clinic. The proportion of those who showed clinically significant levels of burden was determined by a Zarit Burden Interview score of >21. The associations of burden in MCI-caregivers were calculated in the following categories; participant characteristics (including depressive symptoms, cognition and informant ratings of cognitive and behavioural change); caregiver characteristics; and the caregiving context. Multivariate analyses were performed to examine the relative contribution of individual variables to burden amongst MCI-caregivers. RESULTS We found that 36% of MCI-caregivers reported clinically significant levels of burden, twice that of the control informant group. Participant behavioural problems contribute most to burden, with participant depression and possibly cognition also having a significant association. CONCLUSION Caregiver burden is a considerable problem in MCI and shares some of the same characteristics as caregiver burden in dementia, namely a strong association with challenging behaviours in the patient. This has implications for further research and intervention studies.
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Affiliation(s)
- Matt Paradise
- a Brain & Mind Research Institute, University of Sydney , Camperdown , Australia
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Abstract
ABSTRACTThe purpose of this study is to develop and extend our understanding of dementia care-giving by introducing a typology of informal care-giving across four different diseases. Care-giving factors were examined with respect to specific dementia presentation in mild cognitive impairment, Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease-associated dementia. Informal care-giving literature in the four diseases was systematically searched to identify specific disease symptoms and resultant care-giving strains and outcomes. Key concepts were extracted and grouped thematically. The first classification, ‘role-shift’, reflects care-giving where cognitive deterioration results in changing roles, uncertainty and relational deprivation among married partners. The second classification, ‘consumed by care-giving’, refers to those caring for persons with dementia-motor decline that greatly increases worry and isolation. Finally, in the ‘service use’ classification, formal support is needed to help care-givers cope with daily responsibilities and behaviour changes. In each case, the dementia presentation uniquely impacts care-giver strains. A major conclusion is that the same support to all care-givers under the umbrella term ‘dementia’ is unwarranted; the development of targeted support is required.
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Brooker D, La Fontaine J, Evans S, Bray J, Saad K. Public health guidance to facilitate timely diagnosis of dementia: ALzheimer's COoperative Valuation in Europe recommendations. Int J Geriatr Psychiatry 2014; 29:682-93. [PMID: 24458456 DOI: 10.1002/gps.4066] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 11/26/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE ALzheimer's COoperative Valuation in Europe (ALCOVE) was a Joint Action co-financed by the European Commission to produce a set of evidence-based recommendations for policymakers on dementia. This paper reports on timely diagnosis. METHODS Evidence was reviewed from scientific, policy and qualitative research. An online questionnaire was completed by experts from 24 European Union countries detailing current practice. An iterative process with people with dementia, family carers and professionals was utilised to develop recommendations. RESULTS Advances in the technical aspects of diagnosis have changed what is understood by early diagnosis. Although research into preclinical stages is crucial, diagnosing at these very earliest stages is not recommended as regular practice. On balance, it is suggested that citizens should have access to accurate diagnosis at a time in the disease process when it can be of most benefit to them. The term timely diagnosis is used to reflect this. The diagnosis can help citizens and their families make sense of what is happening and make lifestyle changes and plans for the future. The central principles identified to maximise benefit and to reduce harm associated with diagnosis at an earlier stage included reducing stigma about dementia; respecting the rights of the individual; recognising that how the diagnosis is given will impact on subsequent adjustment and that post diagnostic support are required for the person and their family. Detailed recommendations are provided for timely detection, the diagnostic process, complex diagnoses, response to early cognitive changes and workforce. CONCLUSIONS The recommendations can be utilised at a local, national and European level to benchmark progress.
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Affiliation(s)
- Dawn Brooker
- Association for Dementia Studies, University of Worcester, Worcester, UK
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25
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Berg AI, Wallin A, Nordlund A, Johansson B. Living with stable MCI: experiences among 17 individuals evaluated at a memory clinic. Aging Ment Health 2013; 17:293-9. [PMID: 23323753 DOI: 10.1080/13607863.2012.751582] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Mild cognitive impairment (MCI) is a state of mildly impaired cognitive functioning but with an intact capability of performing basic daily activities. Few studies have targeted personal narratives from persons living with MCI, the major focus in this study is directed to methods for better predictions of the likelihood for conversion to dementia. This study directly explores experiences among individuals who have lived with MCI over seven years without converting to dementia. METHODS Seventeen individuals, who had been diagnosed with MCI across four occasions over a seven-year period at a memory clinic, were interviewed at a single occasion about their experiences of living with MCI, life events, stress, coping, psychosocial resources, and lifestyle behaviors. RESULTS Thematic analysis of the transcripts of the interviews resulted in themes revolving around the life situation and events related to the first visit at the memory clinic, coping with lower cognitive capacity with the aim of enhancing quality of life, and worries about dementia and further cognitive deteriorations. CONCLUSION The participants' experiences of living with MCI indicate that issues and changes in life situations such as long-term stress, retirement, loss of relatives, perceived heritability of dementia, needs to be understood in the context of the individual's understanding and interpretation of their everyday cognitive functioning. Also, supportive long-term contacts with the specialist care unit were vital for creating a personal understanding of MCI. Addressing the intra-personal dynamics of cognitive functioning in the boundary between normal and pathological cognitive aging can also improve diagnostic accuracy.
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