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Su FC, Wei YC, Sun CY, Hsu HJ, Lee CC, Chen YT, Pan HC, Hsu CK, Liu YA, Chen CY. Endocrine-Disrupting Chemicals Exposure and Neurocognitive Function in the General Population: A Community-Based Study. TOXICS 2024; 12:514. [PMID: 39058166 PMCID: PMC11281080 DOI: 10.3390/toxics12070514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Endocrine-disrupting chemicals (EDCs) are pervasive in everyday environments. The impacts of these chemicals, along with EDC-related lifestyle and dietary habits on neurocognitive function, are not well understood. METHODS The Chang Gung Community Medicine Research Center conducted a cross-sectional study involving 887 participants. From this initial cohort, 120 individuals were selected based on their EDC exposure scores for detailed analysis. Among these, 67 participants aged 55 years or older were further chosen to undergo cognitive impairment assessments using the Ascertain Dementia-8 (AD-8) questionnaire. RESULTS These 67 older participants did not significantly differ in age, albuminuria, or estimated glomerular filtration rate compared to those with lower impairment scores. This study revealed that mono-(2-ethylhexyl) phthalate (MEHP) levels (8.511 vs. 6.432 µg/g creatinine, p = 0.038) were associated with greater risk of cognitive impairment (AD-8 ≥ 2). Statistical models adjusting for age, gender, and diabetes indicated that MEHP levels positively correlated with AD-8 scores, achieving statistical significance in more comprehensive models (β ± SE: 0.160 ± 0.076, p = 0.042). Logistic regression analysis underscored a significant positive association between high MEHP levels and higher AD-8 scores (odds ratio: 1.217, p = 0.006). Receiver operating characteristic curves highlighted the association of high MEHP levels and EDC exposure scores for significant cognitive impairment, with areas under the curve of 66.3% and 66.6%, respectively. CONCLUSION Exposure to EDCs, specifically di-(2-ethylhexyl) phthalate, the precursor to MEHP, may be associated with neurocognitive impairment in middle-aged and older adults.
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Affiliation(s)
- Feng-Chieh Su
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (F.-C.S.); (Y.-C.W.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
| | - Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (F.-C.S.); (Y.-C.W.)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chiao-Yin Sun
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Heng-Jung Hsu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chin-Chan Lee
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yih-Ting Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Heng-Chih Pan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Cheng-Kai Hsu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yun-An Liu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chun-Yu Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
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Bayram S, Akkaş ÖA. Adaptation of the Australian National University Alzheimer's Disease Risk Index-Short Form (ANU-ADRI-SF) into Turkish. Int J Older People Nurs 2024; 19:e12608. [PMID: 38509777 DOI: 10.1111/opn.12608] [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: 02/07/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The 'Australian National University Alzheimer's Disease Risk Index' (ANU-ADRI) assesses the risk of developing Alzheimer's disease (AD) and is a potential tool for its prevention. OBJECTIVES The aim of this study is to adapt the ANU-ADRI-SF (the short version of ANU-ADRI) into the Turkish language and Turkish cultural context. METHODS The study was methodological and involved the translation and intercultural adaptation of the ANU-ADRI-SF into the Turkish language. The study included 384 community-based participants from a province in the Western Black Sea Region of Türkiye. Data was collected via an online form prepared using Google Forms. RESULTS The index was translated from its original language, English, into Turkish and then retranslated to English by bilingual translators. It was then reviewed and evaluated for possible issues related to translation and degrees of equivalence. When TR-ANU-ADRI-SF levels were compared according to sex, the mean risk scores were found to be 11.25 ± 7.02 for males and 11.69 ± 7.99 for females. After cross-cultural adaptation, the TR-ANU-ADRI-SF was conceptually intelligible to Turkish adults. CONCLUSIONS The TR-ANU-ADRI-SF is a valid and reliable AD risk assessment tool. IMPLICATIONS FOR PRACTICE Given the increase in AD and its impact on people's health, there is a great need for strategies to be implemented by health professionals to improve the lifestyle of the adult population. For use in conjunction with these strategies, a localised AD risk assessment tool that can be applied by clinicians or by individual patients has been adapted and introduced to the Turkish literature.
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Affiliation(s)
- Serap Bayram
- Elderly Care Program, Vocational School of Health Services, Düzce University, Düzce, Turkey
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Liu Z, Jia C, Yue L, Zhou Y, Wang S, Yao N. Care stressors and perceived stress among family caregivers of Chinese older adults with disabilities: The mediation effect of resilience. Geriatr Nurs 2024; 56:252-258. [PMID: 38387149 DOI: 10.1016/j.gerinurse.2024.02.020] [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: 11/21/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Guided by the Stress Process Model, this study examined the mediating effect of resilience on the relationship between care stressors and perceived caregiving stress. METHODS Data were based on 234 older adults with disabilities and their caregivers from 6 urban districts and 6 rural counties from Jinan, China. Descriptive analysis, analysis of variance, ordinary least squares regression, and mediation analysis were performed. RESULTS Perceived stress among family caregivers of Chinese older adults with disabilities was affected by the physical and mental health of both themselves and the care recipients, as well as care intensity and financial difficulties. Resilience played a partial mediating role in the associations among three stressors (i.e. older adults' disability levels, number of chronic diseases, and caregivers' self-reported mental) and perceived caregiving stress. CONCLUSIONS Enhanced resilience aids caregivers' adaptation to their roles, suggesting the need for societal, spiritual, emotional, and behavioral resilience training.
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Affiliation(s)
- Zeyu Liu
- The First Clinical College of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250012, China
| | - Congxi Jia
- Weifang Health Supervision Institute, Weifang, Shandong, 261000, China
| | - Lirong Yue
- Jinzhong Development and Reform Commission, Jin Zhong, Shanxi, 030600, China
| | - Yuanjin Zhou
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, 78705, USA
| | - Shuangshuang Wang
- School of Public Administration, Southwest Jiaotong University, No. 111, North Section I, Second Ring Road, Chengdu, 610031, China.
| | - Nengliang Yao
- Home Centered Care Institute, Schaumburg, IL, 60173, USA
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Allcock L, Mantzioris E, Villani A. Adherence to a Mediterranean Diet Is Inversely Associated with Anxiety and Stress but Not Depression: A Cross-Sectional Analysis of Community-Dwelling Older Australians. Nutrients 2024; 16:366. [PMID: 38337651 PMCID: PMC10857277 DOI: 10.3390/nu16030366] [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: 11/20/2023] [Revised: 12/07/2023] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Diet quality may be an important modifiable risk factor for mental health disorders. However, these findings have been inconsistent, particularly in older adults. We explored the independent associations between adherence to a Mediterranean diet (MedDiet) and severity of symptoms related to depression, anxiety and stress in older adults from Australia. This was a cross-sectional analysis of older Australians ≥ 60 years. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS), and the Depression, Anxiety and Stress Scale (DASS-21) was used to assess the severity of negative emotional symptoms. A total of n = 294 participants were included in the final analyses (70.4 ± 6.2 years). Adherence to a MedDiet was inversely associated with the severity of anxiety symptoms (β = -0.118; CI: -0.761, -0.012; p = 0.043) independent of age, gender, BMI, physical activity, sleep, cognitive risk and ability to perform activities of daily living. Furthermore, MedDiet adherence was inversely associated with symptoms of stress (β = -0.151; CI: -0.680, -0.073; p = 0.015) independent of age, gender, BMI, physical activity and sleep. However, no relationship between MedDiet adherence and depressive symptoms was observed. We showed that adherence to a MedDiet is inversely associated with the severity of symptoms related to anxiety and stress but not depression. Exploring these findings with the use of longitudinal analyses and robust clinical trials are needed to better elucidate these findings in older adults.
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Affiliation(s)
- Lisa Allcock
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia;
| | - Evangeline Mantzioris
- Clinical and Health Sciences & Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5000, Australia;
| | - Anthony Villani
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia;
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Sandu IA, Ștefăniu R, Alexa-Stratulat T, Ilie AC, Albișteanu SM, Turcu AM, Sandu CA, Alexa AI, Pîslaru AI, Grigoraș G, Ștefănescu C, Alexa ID. Preventing Dementia-A Cross-Sectional Study of Outpatients in a Tertiary Internal Medicine Department. J Pers Med 2023; 13:1630. [PMID: 38138857 PMCID: PMC10744972 DOI: 10.3390/jpm13121630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
Dementia is a significant health problem worldwide, being the seventh leading cause of death (2,382,000 deaths worldwide in 2016). Recent data suggest there are several modifiable risk factors that, if addressed, can decrease dementia risk. Several national dementia screening programs exist; however, limited-income countries do not have the means to implement such measures. We performed a prospective cross-sectional study in an outpatient department to identify individuals at risk for dementia. Patients with no known cognitive dysfunction seeking a medical consult were screened for dementia risk by means of the cardiovascular risk factors, ageing, and dementia (CAIDE) and modified CAIDE tests. Additionally, we collected demographic and clinical data and assessed each participant for depression, mental state, and ability to perform daily activities. Of the 169 patients enrolled, 63.3% were identified as being in the intermediate-risk or high-risk group, scoring more than seven points on the mCAIDE test. Over 40% of the elderly individuals in the study were assessed as "somewhat depressed" or "depressed" on the geriatric depression scale. Almost 10% of the study population was diagnosed de novo with cognitive dysfunction. In conclusion, using a simple questionnaire such as the mCAIDE in a predefined high-risk population is easy and does not represent a major financial burden. At-risk individuals can subsequently benefit from personalized interventions that are more likely to be successful. Limited-resource countries can implement such screening tools in outpatient clinics.
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Affiliation(s)
- Ioana-Alexandra Sandu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
| | - Ramona Ștefăniu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
| | - Teodora Alexa-Stratulat
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
| | - Adina-Carmen Ilie
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
| | - Sabinne-Marie Albișteanu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
| | - Ana-Maria Turcu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
| | - Călina-Anda Sandu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Ophtalmology Department, “St. Spiridon” Hospital, 700111 Iasi, Romania
| | - Anisia-Iuliana Alexa
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Ophtalmology Department, “St. Spiridon” Hospital, 700111 Iasi, Romania
| | - Anca-Iuliana Pîslaru
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
| | - Gabriela Grigoraș
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
| | - Cristinel Ștefănescu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Acute Psychiatry Department, “Socola” Institute of Psychiatry, 700282 Iasi, Romania
| | - Ioana-Dana Alexa
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
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Tanwani R, Danquah MO, Butris N, Saripella A, Yan E, Kapoor P, Englesakis M, Tang-Wai DF, Tartaglia MC, He D, Chung F. Diagnostic accuracy of Ascertain Dementia 8-item Questionnaire by participant and informant-A systematic review and meta-analysis. PLoS One 2023; 18:e0291291. [PMID: 37699028 PMCID: PMC10497164 DOI: 10.1371/journal.pone.0291291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The Ascertain Dementia 8-item Questionnaire (AD8) is a screening tool for cognitive impairment that can be administered to older persons and/or their informants. OBJECTIVES To evaluate the diagnostic accuracy and compare the predictive parameters of the informant and participant-completed Ascertain Dementia 8-item Questionnaire (iAD8 and pAD8, respectively) in older adults with cognitive impairment. METHODS/DESIGN We searched ten electronic databases (including MEDLINE (Ovid), Embase) from tool inception to March 2022. We included studies with patients ≥60 years old that were screened for cognitive impairment using AD8 in any healthcare setting. Predictive parameters were assessed against reference standards to estimate accuracy and diagnostic ability using bivariate random-effects meta-analyses. We used QUADAS-2 criteria to assess risk of bias. RESULTS A cut-off of ≥2/8 was used to classify mild cognitive impairment (MCI), dementia, and cognitive impairment (MCI or dementia). Seven studies using the iAD8 (n = 794) showed a sensitivity of 80% and specificity of 79% to detect MCI. Nine studies using the iAD8 (n = 2393) established 91% sensitivity and 64% specificity to detect dementia. To detect MCI using the pAD8, four studies (n = 836) showed 57% sensitivity and 71% specificity. To detect dementia using the pAD8, four studies (n = 3015) demonstrated 82% sensitivity and 75% specificity. Recurring high or unclear risk of bias was noted in the domains of "Index test" and "reference standard". CONCLUSIONS The diagnostic accuracy of iAD8 is superior to that of pAD8 when screening for cognitive impairment. The AD8 may be an acceptable alternative to screen for cognitive impairment in older adults when there are limitations to formal testing.
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Affiliation(s)
- Rajiv Tanwani
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mercy O. Danquah
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nina Butris
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ellene Yan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Paras Kapoor
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | - David F. Tang-Wai
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David He
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Frances Chung
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Kau YL, Lin IH, Juang CL, Chang CK, Ho WH, Wen HC. Metabolite Variations in the Hippocampus and Corpus Callosum of Patients with Mild Cognitive Impairment Using Magnetic Resonance Spectroscopy with Three-Dimensional Chemical Shift Images. Brain Sci 2023; 13:1244. [PMID: 37759845 PMCID: PMC10526271 DOI: 10.3390/brainsci13091244] [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: 07/13/2023] [Revised: 07/30/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
This study compared the metabolites in the brain regions of hippocampus and corpus callosum between patients with mild cognitive impairment (MCI) and healthy controls using no-radiation and high-sensitivity magnetic resonance spectroscopy (MRS) with three-dimensional chemical shift images (3D-CSI). Twenty volunteers (seven patients with MCI and 13 healthy controls) aged 50-71 years were recruited for this prospective study. MRS with 3D-CSI images of a variety of metabolites was collected from the hippocampus and corpus callosum. Sex and weight showed no significant differences between the two groups. The metabolite levels in the hippocampus and corpus callosum of the MCI group were generally lower than in those of the healthy group, especially for creatine (p < 0.001 in the hippocampus and p = 0.020 in the corpus callosum) and N-acetyl aspartate/creatine (p < 0.001 in the hippocampus and p = 0.020 in the corpus callosum); however, choline/creatine showed a significant difference (p < 0.001) only in the hippocampus, and myo-inositol/creatine showed a significant difference (p < 0.001) only in the corpus callosum. Our study demonstrated that MRS with 3D-CSI can be used to measure these metabolite levels to determine the differences between patients with MCI and healthy individuals. This would aid early diagnosis of MCI in clinical practice, and patients could receive prompt intervention to improve their quality of life.
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Affiliation(s)
- Yen-Lon Kau
- Department of Medical Imaging, Camillian St. Mary’s Hospital, Luodong, Yilan 265502, Taiwan; (Y.-L.K.); (W.-H.H.)
- Department of Medical Imaging and Radiological Sciences, Yuanpei University, Hsinchu 30015, Taiwan;
| | - I-Hung Lin
- Nobel Eye Institute, Taipei 100008, Taiwan;
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chi-Long Juang
- Department of Medical Imaging and Radiological Sciences, Yuanpei University, Hsinchu 30015, Taiwan;
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei 100008, Taiwan;
- Department of Optometry, Yuanpei University, Hsinchu 30015, Taiwan;
| | - Wen-Hsiang Ho
- Department of Medical Imaging, Camillian St. Mary’s Hospital, Luodong, Yilan 265502, Taiwan; (Y.-L.K.); (W.-H.H.)
| | - Hsiao-Chuan Wen
- Department of Pet Healthcare, Yuanpei University, Hsinchu 300, Taiwan
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Rogers CJ, Ayuso J, Hackney ME, Penza C. Alzheimer Disease and Related Cognitive Impairment in Older Adults: A Narrative Review of Screening, Prevention, and Management for Manual Therapy Providers. J Chiropr Med 2023; 22:148-156. [PMID: 37346234 PMCID: PMC10280085 DOI: 10.1016/j.jcm.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/16/2022] [Accepted: 03/08/2023] [Indexed: 06/23/2023] Open
Abstract
Objective The aim of this narrative review was to review literature relevant to manual therapists about cognitive impairment, together with screening, potential treatment, and prevention modalities. Methods A literature search of AMED (Allied and Complementary Medicine Database), CINAHL (Cumulative Index of Nursing and Allied Health Literature), PubMed, and MEDLINE was conducted with the search terms "cognitive decline," "cognitive impairment," "screening," and "prevention." We reviewed current screening practices, including functional exams, imaging, and laboratory testing. We reviewed current potential preventive measures and treatments being implemented in practice. Results We selected 49 resources for this narrative summary. The Montreal Cognitive Assessment and Mini-Mental State Exam are recommended screening tools. Imaging and laboratory testing are not recommended in screening for cognitive decline. Promotion of healthy, active living through physical and mental activities may assist with prevention of cognitive decline. Conclusion Cognitive decline affects a large proportion of the US population. Recognizing signs and symptoms of this condition starts with individuals, caretakers, family members, and health care providers. Health care providers should utilize the most appropriate screening tools to assess the presence of cognitive conditions.
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Affiliation(s)
- Casey J. Rogers
- Veteran's Health Administration Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Birmingham, Alabama
| | - Jaime Ayuso
- Northwestern Health Sciences University, Bloomington, Minnesota
| | - Madeleine E. Hackney
- Veteran's Health Administration Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Birmingham, Alabama
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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9
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Wang Y, Liu T, Cai Y, Wu Y, Nie Y, Kuang W, Qiu P, Wan Y. The Chinese version of informant AD8 for mild cognitive impairment and dementia screening in community-dwelling older adults. Public Health Nurs 2023; 40:258-265. [PMID: 36633577 DOI: 10.1111/phn.13166] [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: 06/29/2022] [Revised: 11/03/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Conducting routine mild cognitive impairment (MCI) and dementia screening for older adults in the community is important, which not only can improve our understanding of these diseases but also can increase early detection and treatment. METHODS To analyze the reliability and validity of the informant AD8 and explore the cut-off values for screening MCI and dementia in the community-dwelling older adults, this study adopted a multi-stage cluster sampling method to recruit 327 participants aged 60 and over in communities. The informant AD8 and Clinical Dementia Rating (CDR) scales were used to evaluate cognitive function of the subjects, and the receiver operating characteristic curves (ROC) was conducted to test the screening efficacy. RESULTS Among the 327 participants, 33.0% of them met the criteria of MCI, and 3.4% of them met the criteria of dementia. The area under the receiver operating characteristic curve (AUC) of the informant AD8 for screening dementia was 0.974, with a screening cut-off of three, sensitivity of 90.9% and specificity of 89.0%. But it has a poor discriminability in MCI screening [AUC = 0.645, 95% confidence interval (CI): 0.578-0.711]. CONCLUSIONS This study suggests that the informant AD8 is an ideal and useful tool for dementia screening in community-dwelling older adults. However, it is less capable to distinguish older adults with MCI from those with normal cognitive function.
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Affiliation(s)
- Yangyang Wang
- Department of Epidemiology and Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tingting Liu
- Shenzhen Futian District Chronic Disease Prevention and Treatment Hospital, Shenzhen, China
| | - Yan Cai
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yue Wu
- Department of Epidemiology and Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yunbo Nie
- School of Medicine and Dentistry, University of Rochester, New York
| | - Weihong Kuang
- Department of Psychiatry and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Peiyuan Qiu
- Department of Epidemiology and Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yang Wan
- Department of Geriatrics, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Chang HT, Chiu PY. Development of a simple screening tool for determining cognitive status in Alzheimer's disease. PLoS One 2023; 18:e0280178. [PMID: 36634049 PMCID: PMC9836308 DOI: 10.1371/journal.pone.0280178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Cognitive screening is often a first step to document cognitive status of patients suspected having Alzheimer's disease (AD). Unfortunately, screening neuropsychological tests are often insensitivity in the detection. The goal of this study was to develop a simple and sensitive screening neuropsychological test to facilitate early detection of AD. This study recruited 761 elderly individuals suspected of having AD and presenting various cognitive statuses (mean age: 77.69 ± 8.45 years; proportion of females: 65%; cognitively unimpaired, CU, n = 133; mild cognitive impairment, MCI, n = 231; dementia of Alzheimer's type, DAT, n = 397). This study developed a novel screening neuropsychological test incorporating assessments of the core memory deficits typical of early AD and an interview on memory function with an informant. The proposed History-based Artificial Intelligence-Show Chwan Assessment of Cognition (HAI-SAC) was assessed in terms of psychometric properties, test time, and discriminative ability. The results were compared with those obtained using other common screening tests, including Cognitive Abilities Screening Instrument (CASI), Montreal Cognitive Assessment (MoCA), and an extracted Mini-Mental State Examination score from CASI. HAI-SAC demonstrated acceptable internal consistency. Factor analysis revealed two factors: memory (semantic and contextual) and cognition-related information from informants. The assessment performance of HAI-SAC was strongly correlated with that of the common screening neuropsychological tests addressed in this study. HAI-SAC outperformed the other tests in differentiating CU individuals from patients with MCI (sensitivity: 0.87; specificity: 0.58; area under the curve [AUC]: 0.78) or DAT (sensitivity: 0.99; specificity: 0.89; AUC: 0.98). Performance of HAI-SAC on differentiating MCI from DAT was on par with performances of other tests (sensitivity: 0.78; specificity: 0.84; AUC: 0.87), while the test time was less than one quarter that of CASI and half that of MoCA. HAI-SAC is psychometrically sound, cost-effective, and sensitive in discriminating the cognitive status of AD.
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Affiliation(s)
- Hsin-Te Chang
- Department of Psychology, College of Science, Chung Yuan Christian University, Taoyuan, Taiwan
- Research Assistance Center, Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua City, Taiwan
- Department of Applied Mathematics, College of Science, Tunghai University, Taichung, Taiwan
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Tsai FJ, Shen SW. Concepts of dementia prevention in the health promotion among older adults: A narrative review. Medicine (Baltimore) 2022; 101:e32172. [PMID: 36550862 PMCID: PMC9771271 DOI: 10.1097/md.0000000000032172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The number of older adults with dementia is predicted to markedly increase in the coming decades. A person suffers from dementia every 3 seconds globally, and one out of every 7 people suffers from dementia in Taiwan. The purpose of this narrative review is to integrate existing concepts of dementia prevention into health promotion and improve older adults' quality of life. This narrative review was performed using the PubMed database by searching for basic research and systematic reviews on dementia prevention and health promotion among older adults. We established a framework for dementia prevention and health promotion with regard to the physical, mental, spiritual, and social health aspects. We identified the following strategies related to older adults towards dementia prevention and health promotion in follows: Physical health promotion: cognitive activities, physical activities, body mass index, balanced diet, rainbow diet, Mediterranean diet, dietary approaches to stop hypertension diet, mind diet, no smoking and drinking, avoiding the "three highs" (i.e., hyperglycemia, hyperlipidemia, and hypertension), and head trauma; Mental health promotion: Positive thinking, Brief Symptom Rating Scale (BSRS-5), depression scale, and ascertained dementia 8 questionnaire (AD8) screening; Spiritual health promotion: religious beliefs, spiritual music, meditative activities, mindfulness, yoga, Qi-gong, Tai-chi, and Baduanjin; and Social health promotion: A supportive family system, socialization, social support, social networks, social interaction, and social participation. The conclusion of this narrative review was to integrate the concepts of dementia prevention and health promotion among older adults.
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Affiliation(s)
- Fu-Ju Tsai
- Department of Nursing, Fooyin University, Taiwan R.O.C
| | - Sheng-Wei Shen
- Department of Neurology, Pingtung Hospital, Ministry of Health and Welfare, Taiwan, R.O.C
- * Correspondence: Sheng-Wei Shen, 270, Ziyou Rd., Pingtung City, Pingtung County 900, Taiwan R.O.C. (e-mail: )
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Allcock L, Mantzioris E, Villani A. Adherence to a Mediterranean Diet is associated with physical and cognitive health: A cross-sectional analysis of community-dwelling older Australians. Front Public Health 2022; 10:1017078. [PMID: 36466491 PMCID: PMC9709195 DOI: 10.3389/fpubh.2022.1017078] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
Poor cognitive function is associated with reduced functional independence, risk of institutionalization and reduced health-related quality of life. The ability to independently perform instrumental activities of daily living (iADLs) is compromised in patients with mild cognitive impairment (MCI) or dementia. Emerging evidence suggests that adherence to a Mediterranean diet (MedDiet), may play an important protective role against cognitive decline and dementia risk, whilst preserving functional status. This cross-sectional study aimed to explore the independent associations between MedDiet adherence, cognitive risk, and functional status in community-dwelling older adults living in Australia. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS); a modified Lawton's iADL scale was used for the assessment of functional status and risk of cognitive impairment was assessed using the AD8 dementia screening intervention. A total of n = 294 participants were included in the final analyses (70.4 ± 6.2 years; Females, n = 201; Males, n = 91; n = 2 unspecified). Adherence to a MedDiet was positively associated with functional ability (β = 0.172; CI: 0.022, 0.132; P = 0.006) independent of age, gender, Body Mass Index (BMI), smoking status, sleep duration, physical activity duration, diabetes status, and level of education. Furthermore, MedDiet adherence was inversely associated with cognitive risk (β = -0.134; CI: -0.198, -0.007; P = 0.035) independent of all covariates. However, our sensitivity analyses further showed that adherence to a MedDiet was not associated with cognitive risk in older adults free from cognitive impairment. We showed that adherence to a MedDiet is associated with healthy physical and cognitive aging. Nevertheless, exploration of these findings in larger cohorts, using longitudinal analyses and controlling for important confounders to ascertain the direction of the relationship is warranted.
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Affiliation(s)
- Lisa Allcock
- School of Health and Behavioral Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Evangeline Mantzioris
- Clinical and Health Sciences and Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Anthony Villani
- School of Health and Behavioral Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
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Thaipisuttikul P, Nakawiro D, Kuladee S, Chittaropas P, Sukying C. Development and validation of the Ascertain Dementia 8 (AD8) Thai version. Psychogeriatrics 2022; 22:795-801. [PMID: 36319270 PMCID: PMC9804864 DOI: 10.1111/psyg.12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/05/2022] [Accepted: 07/22/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The Ascertain Dementia 8 (AD8) is a brief informant-based questionnaire which reliably distinguishes patients with neurocognitive disorder (NCD) and normal cognition. Our objective was to translate the AD8 into Thai and test its validity as a potentially useful measure to detect patients with the mild stage of major NCD due to Alzheimer disease (major NCD-AD). METHODS Evaluations of 144 informant-patient dyads were made. Participants were patients who attended the memory clinic at Ramathibodi Hospital and non-patient volunteers. The AD8-Thai version was administered separately from doctor's interviews and neuropsychological assessments. Diagnostic workups included a complete medical history, physical and neurological examinations, neuropsychological testing, the Clinical Dementia Rating Scale-Sum of Boxes (CDR-SOB), Montreal Cognitive Assessment (MoCA), blood tests and brain imaging, preferably with magnetic resonance imaging. All researchers were blinded to the AD8 results. RESULTS An AD8 score ≥3 had a sensitivity of 95.5%, a specificity of 89.5%, a positive predictive value of 84%, and a negative predictive value of 97.1% for screening major NCD-AD and those with normal cognition. A subgroup analysis with participants aged ≥65 years and with ≥12 years of education revealed comparable ability to the whole group. AD8 scores had a moderate negative relationship with MoCA scores (r = -0.470) and a strong positive relationship with CDR-SOB scores (r = 0.547). The performance of AD8 scores in differentiating mild NCD from normal cognition was not as good as for major NCD-AD. CONCLUSIONS AD8-Thai version is an acceptable screening tool for major NCD-AD. For patients aged 65 years or older, with at least 12 years of education, and with cognitive complaints in memory clinic, an AD8-Thai score of 3 or more would be sufficient to work on major NCD diagnosis. The performance of the AD8-Thai in mild NCD needs further investigation.
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Affiliation(s)
- Papan Thaipisuttikul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Daochompu Nakawiro
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sanchai Kuladee
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pitchayawadee Chittaropas
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chakrit Sukying
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Pourshams M, Galvin JE, Afshar PF, Santos PG, Bazargan-Hejazi S, Kamalzadeh L, Shariati B, Malakouti SK. Validity and reliability of the Farsi version of the ascertain dementia 8-item (AD8-F) informant interview in Iranian patients with mild neurocognitive disorder. BMC Geriatr 2022; 22:801. [PMID: 36241985 PMCID: PMC9569081 DOI: 10.1186/s12877-022-03391-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/17/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND For screening and distinguishing between mild neurocognitive disorder (mNCD) and normal cognitive age-related changes in primary care centers, a simple and practical tool is necessary. Therefore, this study aims to determine the validity and reliability of the Farsi version of the Ascertain Dementia 8-item (AD8-F) informant interview in patients with mNCD. METHODS This is a study of the psychometric properties of the Farsi AD8. The participants include sixty informant-patient dyads with mNCD and sixty controls with normal cognition. The AD8 was compared to the mini-mental state examination (MMSE) and the Mini-Cog. As a gold standard, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for mNCD was used. The reliability was measured using internal consistency and test-retest. Validity was assessed by evaluating the content, concurrent, and construct validity. Data were analyzed via Cronbach's α, Pearson correlation, independent t-test, and analysis of variance (ANOVA) and area under the curve (AUC) by statistical package for the social sciences (SPSS) v.23. RESULTS Cronbach's α was 0.71. Test-retest reproducibility was 0.8. The AD8 had inverse correlations with the Mini-Cog (r = - 0.70, P < 0.01) and MMSE (r = - 0.56, P < 0.01). The area under the curve was 0.88. The optimal cutoff score was > 2. Sensitivity and specificity were 80 and 83%, respectively. The positive predictive value was 83%. The negative predictive value was 81%. CONCLUSION Our results suggest that this tool can be used as a screening tool to detect a mild neurocognitive disorder in primary care centers.
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Affiliation(s)
- Maryam Pourshams
- Department of Psychiatry, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - James E. Galvin
- Department of Integrated Medical Science, Florida Atlantic University FAU, Florida, USA
| | - Pouya Farokhnezhad Afshar
- Department of Gerontology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science & David Geffen School of Medicine, Los Angeles, USA
| | - Leila Kamalzadeh
- Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Shariati
- Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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Ham Y, Bae S, Lee H, Ha Y, Choi H, Park JH, Park HY, Hong I. Item-level psychometrics of the Ascertain Dementia Eight-Item Informant Questionnaire. PLoS One 2022; 17:e0270204. [PMID: 35789335 PMCID: PMC9255723 DOI: 10.1371/journal.pone.0270204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/06/2022] [Indexed: 11/19/2022] Open
Abstract
The aim of this study is to evaluate the item-level psychometrics of the Ascertain Dementia Eight-Item Informant Questionnaire (AD-8) by examining its dimensionality, rating scale integrity, item fit statistics, item difficulty hierarchy, item-person match, and precision. We used confirmatory factor analysis and the Rasch rating scale model for analyzing the data extracted from the proxy versions of the 2019 and 2020 National Health and Aging Trends Study, USA. A total of 403 participants were included in the analysis. The confirmatory factor analysis with a 1-factor model using the robust weighted least squares (WLSMV) estimator indicated a unidimensional measurement structure (χ2 = 41.015, df = 20, p = 0.004; root mean square error of approximation = 0.051; comparative fit index = 0.995; Tucker–Lewis Index = 0.993;). The findings indicated that the AD-8 has no misfitting items and no differential item functioning across sex and gender. The items were evenly distributed in the item difficulty rating (range: −2.30 to 0.98 logits). While there were floor effects, the AD-8 revealed good reliability (Rasch person reliability = 0.67, Cronbach’s alpha = 0.89). The Rasch analysis reveals that the AD-8 has excellent psychometric properties that can be used as a screening assessment tool in clinical settings allowing clinicians to measure dementia both quickly and efficiently. To summarize, the AD-8 could be a useful primary screening tool to be used with additional diagnostic testing, if the patient is accompanied by a reliable informant.
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Affiliation(s)
- Yeajin Ham
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Suyeong Bae
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Heerim Lee
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Yaena Ha
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Heesu Choi
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Ji-Hyuk Park
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Gangwon-do, South Korea
| | - Hae Yean Park
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Gangwon-do, South Korea
| | - Ickpyo Hong
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Gangwon-do, South Korea
- * E-mail:
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Establishing cut-off scores for the self-rating AD8 based on education level. Geriatr Nurs 2021; 42:1093-1098. [PMID: 34274686 DOI: 10.1016/j.gerinurse.2021.06.027] [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: 03/12/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 02/05/2023]
Abstract
This study aimed to explore the threshold of self-rating AD8 in mild cognitive impairment (MCI) and dementia screening among community-dwelling older adults with and without education. 523 participants in Chengdu, China, were recruited: 346 with normal cognitive function, 160 with MCI and 17 with dementia. At the cut-off score of 2, the area under the receiver operator characteristic curves (AUC) of self-rating AD8 for MCI and dementia screening was 0.607 and 0.931 regardless of educational level, respectively. Grouping by educational level, the cut-off in MCI screening was 1 for literate (AUC=0.662) and 2 for illiterate individuals (AUC=0.588). For dementia screening, the cut-off was 2 for illiterate (AUC=0.912) and 4 for literate individuals (AUC=0.963). We concluded that the self-rating AD8 was ideal for dementia screening in community-dwelling older adults, with a cut-off score of 2 for illiterate and 4 for literate people, while its effectiveness for MCI screening required further evaluation.
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Svensson A, Granvik E, Sjögren Forss K. Performance of the Eight-item Informant Interview to Differentiate Aging and Dementia within a context similar to the Swedish primary healthcare sector: a systematic review of diagnostic test accuracy studies. Scand J Prim Health Care 2020; 38:454-463. [PMID: 33216659 PMCID: PMC7782037 DOI: 10.1080/02813432.2020.1844370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Dementia is a common but underdiagnosed health problem. Instruments developed for initial screening exist internationally but are not available within the Swedish primary healthcare sector. This systematic review aimed to evaluate the diagnostic test accuracy of the Eight-item Informant Interview to Differentiate Aging and Dementia in identifying symptomatic dementia within a context similar to the Swedish primary healthcare sector. DESIGN A systematic search was conducted in PubMed, CINAHL, PsycInfo, Cochrane Library and manually via reference lists up to November 2019. Eligibility criteria were the reporting of Diagnostic test accuracy outcomes for the Eight-item Informant Interview to Differentiate Aging and Dementia's ability to identify dementia according to internationally approved criteria. The population of interest was selected within the community or primary care. QUADAS-2 was used for quality assessment, and data were analysed with a narrative approach. RESULTS Five studies with a total of 13,345 participants were included. With sensitivity (88-100%), specificity (67-91%), positive and negative predictive values (28-63%; 96-100%) respectively, the results show that the Eight-item Informant Interview to Differentiate Aging and Dementia has good ability to identify true positives, false negatives and predict low-risk dementia. That is, the Eight-item Informant Interview to Differentiate Aging and Dementia has a greater ability to predict people who are at risk of not having dementia than to correctly identify those at risk of having dementia within the target population. CONCLUSION The results show that the Eight-item Informant Interview to Differentiate Aging and Dementia has the ability to identify persons with symptomatic dementia within the target population. Thus, an evaluation of its potential benefits should be considered and evaluated within the Swedish primary healthcare context. KEY POINTS Dementia is a common but underdiagnosed health problem. Instruments developed for initial screening exist but are not available within the Swedish primary healthcare sector. We found that the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8), has the ability to identify individuals with symptomatic dementia within the target population. The Eight-item Informant Interview to Differentiate Aging and Dementia (AD8), has the potential to increase the possibility for timely detection of individuals with symptomatic dementia.
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Affiliation(s)
- Annsofie Svensson
- Kunskapscentrum demenssjukdomar VE minnessjukdomar Skånes University Hospital Malmö, Sweden
| | - Eva Granvik
- Kunskapscentrum demenssjukdomar VE minnessjukdomar Skånes University Hospital Malmö, Sweden
| | - Katarina Sjögren Forss
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
- CONTACT Katarina Sjögren Forss Faculty of Health and Society, Department of Care Science, Malmö University, Jan Waldenströmsgata 25 SE-205 06, Malmö, Sweden
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