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Misiura MB, Butts B, Hammerschlag B, Munkombwe C, Bird A, Fyffe M, Hemphill A, Dotson VM, Wharton W. Intersectionality in Alzheimer's Disease: The Role of Female Sex and Black American Race in the Development and Prevalence of Alzheimer's Disease. Neurotherapeutics 2023; 20:1019-1036. [PMID: 37490246 PMCID: PMC10457280 DOI: 10.1007/s13311-023-01408-x] [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] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
It is well known that vascular factors and specific social determinants of health contribute to dementia risk and that the prevalence of these risk factors differs according to race and sex. In this review, we discuss the intersection of sex and race, particularly female sex and Black American race. Women, particularly Black women, have been underrepresented in Alzheimer's disease clinical trials and research. However, in recent years, the number of women participating in clinical research has steadily increased. A greater prevalence of vascular risk factors such as hypertension and type 2 diabetes, coupled with unique social and environmental pressures, puts Black American women particularly at risk for the development of Alzheimer's disease and related dementias. Female sex hormones and the use of hormonal birth control may offer some protective benefits, but results are mixed, and studies do not consistently report the demographics of their samples. We argue that as a research community, greater efforts should be made to not only recruit this vulnerable population, but also report the demographic makeup of samples in research to better target those at greatest risk for the disease.
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Affiliation(s)
- Maria B Misiura
- Department of Psychology, Georgia State University, Atlanta, GA, USA.
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.
| | - Brittany Butts
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Bruno Hammerschlag
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Chinkuli Munkombwe
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Arianna Bird
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Mercedes Fyffe
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Asia Hemphill
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Gerontology Institute, Georgia State University, Atlanta, GA, USA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
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Bonds K, Song M, Whitlatch CJ, Lyons KS, Kaye JA, Lee CS. Patterns of Dyadic Appraisal of Decision-Making Involvement of African American Persons Living With Dementia. THE GERONTOLOGIST 2021; 61:383-391. [PMID: 32609831 DOI: 10.1093/geront/gnaa086] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Greater everyday decision-making involvement by persons living with dementia (PLWD) and congruent appraisal between PLWDs and their caregivers have been associated with a better quality of life (QOL) for both members of the dyad. However, no study has examined the association between the appraisals of everyday decision-making involvement of PLWDs and their QOL among African Americans. RESEARCH DESIGN AND METHODS A secondary analysis of cross-sectional data from 62 African American dementia dyads was conducted. Multilevel and latent class mixture modeling was used to characterize dyadic appraisal of the decision-making involvement of African American PLWDs and identify distinct patterns thereof. RESULTS Three distinct patterns were observed. "Incongruent, PLWD Low Involvement" labeled 19.4% of the sample, 53.2% were labeled "Incongruent, PLWD Moderate Involvement," and 27.4% were labeled "Congruent, PLWD High Involvement." The Congruent, PLWD High Involvement pattern consisted of PLWDs who were significantly younger and had significantly less cognitive impairment than PLWDs in the other patterns. In the Incongruent, PLWD Moderate Involvement pattern, PLWDs had significantly better QOL than PLWDs in the Incongruent, PLWD Low Involvement pattern, but QOL did not significantly differ from PLWDs in the Congruent, PLWD High Involvement pattern. DISCUSSION AND IMPLICATIONS There is a need to tailor strategies to optimize QOL in African American dementia dyads. While increasing everyday decision-making involvement for PLWDs in the Incongruent, PLWD Low Involvement pattern is an important goal, other strategies may be needed to improve the QOL of PLWDs in the remaining patterns.
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Affiliation(s)
- Kalisha Bonds
- School of Nursing, Oregon Health & Science University, Portland
| | - MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland
| | - Carol J Whitlatch
- Benjamin Rose Institute on Aging, Center for Research and Education, Cleveland, Ohio
| | - Karen S Lyons
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Jeffrey A Kaye
- Department of Neurology, Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University, Portland
| | - Christopher S Lee
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
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Racial disparities and temporal trends in dementia misdiagnosis risk in the United States. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:891-898. [PMID: 31890853 PMCID: PMC6926355 DOI: 10.1016/j.trci.2019.11.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Systematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to 2010. Methods We linked fee-for-service Medicare claims to participants aged ≥70 from the nationally representative Health and Retirement Study. We classified dementia status using an algorithm with similar sensitivity and specificity across racial/ethnic groups and assigned clinical dementia diagnosis status using ICD-9-CM codes from Medicare claims. Multinomial logit models were used to estimate relative risks of clinical under- and overdiagnosis between groups and over time. Results Non-Hispanic blacks had roughly double the risk of underdiagnosis as non-Hispanic whites. While primary analyses suggested a shrinking disparity over time, this was not robust to sensitivity analyses or adjustment for covariates. Risk of overdiagnosis increased over time in both groups. Discussion Our results suggest that efforts to reduce racial disparities in underdiagnosis are warranted.
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Ho RTH, Fong TCT, Hon T, Chan WC, Kwan JSK, Chiu PKC, Lam LCW. Psychometric validation of Fuld Object Memory Evaluation in older adults with cognitive impairments. Aging Ment Health 2019. [PMID: 29517270 DOI: 10.1080/13607863.2018.1442414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Mild cognitive impairment (MCI) refers to an early but abnormal state of cognitive impairment with minimal functional impairment. The present study aimed to evaluate the validity of Fuld Object Memory Evaluation (FOME) as a measure of episodic memory function. METHOD The study sample included 204 Chinese older adults with cognitive impairments. The participants completed five recall trials and a delayed trial in FOME, neurocognitive measures on digit spans and trail making, and daily functioning. Discriminative power of FOME to differentiate between MCI and dementia was inspected via receiver operating characteristic curve analysis. RESULTS FOME showed good test-retest reliability and convergent validity with digit spans and trail making. Controlling for gender, age, and education, lower levels of FOME total retrieval, verbal fluency, and daily functioning significantly predicted a higher likelihood of dementia compared to MCI. The optimal cut-off scores for total retrieval, verbal fluency, and daily functioning to differentiate dementia were 37/38 (77% sensitivity and 83% specificity), 28/29 (85% sensitivity and 72% specificity), and 14/15 (92% sensitivity and 78% specificity), respectively, in the younger subgroup. The corresponding figures were 34/35 (69% sensitivity and 76% specificity) and 27/28 (92% sensitivity and 62% specificity), and 11/12 (74% sensitivity and 80% specificity), respectively, in the older subgroup. CONCLUSION The findings support the FOME as a valid assessment tool of episodic memory function in older Chinese adults. The combined use of FOME and daily functioning is recommended to distinguish persons with dementia from MCI.
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Affiliation(s)
- Rainbow T H Ho
- a Centre On Behavioral Health , The University of Hong Kong , Hong Kong.,b Department of Social Work & Social Administration , The University of Hong Kong , Hong Kong.,c Sau Po Centre on Aging , The University of Hong Kong , Hong Kong
| | - Ted C T Fong
- a Centre On Behavioral Health , The University of Hong Kong , Hong Kong.,b Department of Social Work & Social Administration , The University of Hong Kong , Hong Kong
| | - Tiffany Hon
- a Centre On Behavioral Health , The University of Hong Kong , Hong Kong
| | - Wai Chi Chan
- d Department of Psychiatry , The University of Hong Kong , Hong Kong
| | - Joseph S K Kwan
- e Department of Medicine , The University of Hong Kong , Hong Kong
| | - Patrick K C Chiu
- e Department of Medicine , The University of Hong Kong , Hong Kong
| | - Linda C W Lam
- f Department of Psychiatry , The Chinese University of Hong Kong , Hong Kong
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Burke SL, Naseh M, Rodriguez MJ, Burgess A, Loewenstein D. Dementia-Related Neuropsychological Testing Considerations in Non-Hispanic White and Latino/Hispanic Populations. PSYCHOLOGY & NEUROSCIENCE 2019; 12:144-168. [PMID: 31649798 PMCID: PMC6812579 DOI: 10.1037/pne0000163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hispanic individuals are at greater risk for health disparities, less than optimal health care, and are diagnosed at later stages of cognitive impairment than white non-Hispanics. Acculturation and different attitudes toward test-taking may result in decrements in performance, especially on unfamiliar measures that emphasize speed and accuracy. Non-Hispanic individuals often outperform Hispanic individuals on cognitive and neuropsychological measures in community and clinical populations. Current neuropsychological testing may not provide accurate data related to monolingual and bilingual individuals of Hispanic descent. Testing instruments were identified by searching academic databases using combinations of relevant search terms. Neuropsychological instruments were included if they were designed to detect cognitive impairment, had an administration time of less than 45 minutes, and were available in English. Validity studies were required to employ gold standard comparison diagnostic criteria. Twenty-nine instruments were evaluated in dementia staging, global cognition, memory, memory and visual abilities, working memory and attention, verbal learning and memory, recall, language, premorbid intelligence, literacy/cognitive reserve, visuospatial, attention, problem-solving, problem solving and perception, functional assessment, and mood/daily functioning domains. Spanish-language neuropsychological instruments need to be made widely available and existing instruments to be normed in Spanish to best serve and assess diverse populations. Psychometric data were reported for neuropsychological instruments, which may be administered to Hispanic older adults presenting for evaluation related to dementia-spectrum disorders. This is one of the few reviews to provide an overview of the sensitivity and specificity of available Spanish translated neuropsychological instruments.
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Affiliation(s)
- Shanna L Burke
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | - Mitra Naseh
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | | | - Aaron Burgess
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University
| | - David Loewenstein
- Center on Aging as the Center for Cognitive Neuroscience and Aging and Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami
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Rosselli M, Tappen RM, Newman D. Semantic Interference Test: Evidence for Culture and Education Fairness from an Ethnically Diverse Sample in the USA. Arch Clin Neuropsychol 2019; 34:337-349. [PMID: 29688251 DOI: 10.1093/arclin/acy037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 03/01/2018] [Accepted: 04/12/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Tests of cognitive abilities are particularly susceptible to culture-based bias because these abilities are culturally bound. The specific purpose of this study was to examine the Semantic Interference Test, a clinical neuropsychological test, for culture bias. METHOD The sample included 415 community-dwelling participants (mean age 74, SD = 8.32; 308 were females) living in South Florida (USA). The sample included 72 African Americans, 93 Afro-Caribbeans, 77 Hispanic Americans, and 173 European Americans. An Item Response Theory analysis of bias was employed using the Differential Item Functioning (DIF) procedure. RESULTS Overall, the items appear to be invariant across gender, ethnicity, and education levels. Although the DIF identified several items that appear to differ across the two latter groupings, the multiple group confirmatory factor analysis (MG-CFA) suggests that these items have low impact on the overall measure. There were however, meaningful differences across age groups in the MG-CFA, suggesting that an age adjustment might be required. CONCLUSION The SIT can be considered a cognitive test that is not significantly affected by the participants' cultural background, at least within the culture range included in this study.
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Affiliation(s)
- Mónica Rosselli
- Department of Psychology, Charles E. Schmidt College of Science, Florida Atlantic University, Davie, FL, USA
| | - Ruth M Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - David Newman
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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Julayanont P, Ruthirago D. The illiterate brain and the neuropsychological assessment: From the past knowledge to the future new instruments. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 25:174-187. [PMID: 27841690 DOI: 10.1080/23279095.2016.1250211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The lifetime learning of illiterate and low-educated individuals shapes their cognitive skills, which are challenging to grade by the current available neuropsychological tools. Eight hundred million of the global population are illiterate. It is very challenging to interpret the cognitive performance of this population by the available formal neuropsychological tests, mainly developed for higher educated people. From extensive literature investigation, we reviewed the cognitive process and performance of illiterate and low-educated population on various cognitive domains including language, executive function, memory, visual-related function, and motor skills. We also suggested the concept in the development of the appropriate tools for the cognitive assessment among this population. Finally, we provide the available cognitive screening tools validated in the illiterate and low-educated subjects within the last three decades.
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Affiliation(s)
- Parunyou Julayanont
- a Department of Neurology , Texas Tech University Health Sciences Center , Lubbock , Texas , USA
| | - Doungporn Ruthirago
- a Department of Neurology , Texas Tech University Health Sciences Center , Lubbock , Texas , USA
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Lichtenberg PA, Ficker L, Rahman-Filipiak A, Tatro R, Farrell C, Speir JJ, Mall SJ, Simasko P, Collens HH, Jackman JD. The Lichtenberg Financial Decision Screening Scale (LFDSS): A new tool for assessing financial decision making and preventing financial exploitation. J Elder Abuse Negl 2016; 28:134-51. [PMID: 27010780 DOI: 10.1080/08946566.2016.1168333] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
One of the challenges in preventing the financial exploitation of older adults is that neither criminal justice nor noncriminal justice professionals are equipped to detect capacity deficits. Because decision-making capacity is a cornerstone assessment in cases of financial exploitation, effective instruments for measuring this capacity are essential. We introduce a new screening scale for financial decision making that can be administered to older adults. To explore the scale's implementation and assess construct validity, we conducted a pilot study of 29 older adults seen by APS (Adult Protective Services) workers and 79 seen by other professionals. Case examples are included.
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Affiliation(s)
- Peter A Lichtenberg
- a Institute of Gerontology , Wayne State University , Detroit , Michigan , USA.,b Department of Psychology , Wayne State University , Detroit , Michigan , USA
| | - Lisa Ficker
- a Institute of Gerontology , Wayne State University , Detroit , Michigan , USA
| | - Analise Rahman-Filipiak
- a Institute of Gerontology , Wayne State University , Detroit , Michigan , USA.,b Department of Psychology , Wayne State University , Detroit , Michigan , USA
| | - Ron Tatro
- c Center for Elder Rights Advocacy , Elder Law of Michigan , Lansing , Michigan , USA
| | - Cynthia Farrell
- d Aging and Adult Services, Adult Protective Services , State of Michigan Department of Health and Human Services , Lansing , Michigan , USA
| | - James J Speir
- e Speir Financial Services , Southfield , Michigan , USA
| | - Sanford J Mall
- f Mall, Malisow and Cooney, PC , Farmington Hills , Michigan , USA
| | - Patrick Simasko
- g Simasko and Simasko Law Firm , Mount Clemens , Michigan , USA
| | - Howard H Collens
- h Galloway and Collens, PLLC , Huntington Woods , Michigan , USA
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Chen CW, Chu H, Tsai CF, Yang HL, Tsai JC, Chung MH, Liao YM, Chi MJ, Chou KR. The reliability, validity, sensitivity, specificity and predictive values of the Chinese version of the Rowland Universal Dementia Assessment Scale. J Clin Nurs 2015; 24:3118-28. [DOI: 10.1111/jocn.12941] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Chia-Wei Chen
- Graduate Institute of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine; School of Medicine; National Defense Medical Center; Taipei Taiwan
- Department of Neurology; Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - Chia-Fen Tsai
- Department of Psychiatry; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Brain Science; National Yang-Ming University Schools of Medicine; Taipei Taiwan
- Faculty of Medicine; National Yang-Ming University Schools of Medicine; Taipei Taiwan
| | - Hui-Ling Yang
- Graduate Institute of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
| | - Jui-Chen Tsai
- Department of Nursing; Taipei Medical University-Shuang Ho Hospital; Taipei Taiwan
| | - Min-Huey Chung
- Graduate Institute of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
| | - Yuan-Mei Liao
- Graduate Institute of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
| | - Mei-ju Chi
- School of Gerontology Health Management; College of Nursing; Taipei Medical University; Taipei Taiwan
- Master Program in Long-term Care; College of Nursing; Taipei Medical University; Taipei Taiwan
| | - Kuei-Ru Chou
- Graduate Institute of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
- Department of Nursing; Taipei Medical University-Shuang Ho Hospital; Taipei Taiwan
- School of Gerontology Health Management; College of Nursing; Taipei Medical University; Taipei Taiwan
- Psychiatric Research Center; Taipei Medical University Hospital; Taipei Taiwan
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Rahman-Filipiak A, Woodard JL, Miller LS, Martin P, Davey A, Poon LW. Octogenarian and centenarian performance on the Fuld Object Memory Evaluation. AGING NEUROPSYCHOLOGY AND COGNITION 2014; 22:438-51. [PMID: 25513737 DOI: 10.1080/13825585.2014.968085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Fuld Object Memory Evaluation (FOME) has considerable utility for cognitive assessment in older adults, but there are few normative data, particularly for the oldest old. In this study, 80 octogenarians and 244 centenarians from the Georgia Centenarian Study completed the FOME. Total and trial-to-trial performance on the storage, retrieval, repeated retrieval, and ineffective reminder indices were assessed. Additional data stratified by age group, education, and cognitive impairment are provided in the Supplemental data. Octogenarians performed significantly better than centenarians on all FOME measures. Neither age group benefitted from additional learning trials beyond Trial 3 for storage and Trial 2 for retention and retrieval. Ineffective reminders showed no change across learning trials for octogenarians, while centenarians improved only between Trials 1 and 2. This minimal improvement past Trial 2 indicates that older adults might benefit from a truncated version of the test that does not include trials three through five, with the added benefit of reducing testing burden in this population.
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Abstract
BACKGROUND As the population ages, it is increasingly important to use effective short cognitive tests for suspected dementia. We aimed to review systematically brief cognitive tests for suspected dementia and report on their validation in different settings, to help clinicians choose rapid and appropriate tests. METHODS Electronic search for face-to-face sensitive and specific cognitive tests for people with suspected dementia, taking ≤ 20 minutes, providing quantitative psychometric data. RESULTS 22 tests fitted criteria. Mini-Mental State Examination (MMSE) and Hopkins Verbal Learning Test (HVLT) had good psychometric properties in primary care. In the secondary care settings, MMSE has considerable data but lacks sensitivity. 6-Item Cognitive Impairment Test (6CIT), Brief Alzheimer's Screen, HVLT, and 7 Minute Screen have good properties for detecting dementia but need further validation. Addenbrooke's Cognitive Examination (ACE) and Montreal Cognitive Assessment are effective to detect dementia with Parkinson's disease and Addenbrooke's Cognitive Examination-Revised (ACE-R) is useful for all dementias when shorter tests are inconclusive. Rowland Universal Dementia Assessment scale (RUDAS) is useful when literacy is low. Tests such as Test for Early Detection of Dementia, Test Your Memory, Cognitive Assessment Screening Test (CAST) and the recently developed ACE-III show promise but need validation in different settings, populations, and dementia subtypes. Validation of tests such as 6CIT, Abbreviated Mental Test is also needed for dementia screening in acute hospital settings. CONCLUSIONS Practitioners should use tests as appropriate to the setting and individual patient. More validation of available tests is needed rather than development of new ones.
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Anderson-Hanley C, Miele AS, Dunnam M. The Fuld Object-Memory Evaluation: Development and Validation of an Alternate Form. APPLIED NEUROPSYCHOLOGY-ADULT 2012; 20:1-6. [DOI: 10.1080/09084282.2012.670156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Andrea S. Miele
- b Department of Psychology , University at Albany , Albany , New York
| | - Mina Dunnam
- c Behavioral Health Care, Albany Stratton VA Medical Center , Albany , New York
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Man DWK, Chung JCC, Lee GYY. Evaluation of a virtual reality-based memory training programme for Hong Kong Chinese older adults with questionable dementia: a pilot study. Int J Geriatr Psychiatry 2012; 27:513-20. [PMID: 21681818 DOI: 10.1002/gps.2746] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 04/18/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Older adults with questionable dementia are at risk of progressing to dementia, and early intervention is considered important. The present study investigated the effectiveness of a virtual reality (VR)-based memory training for older adults with questionable dementia. METHODS A pre-test and post-test design was adopted. Twenty and 24 older adults with questionable dementia were randomly assigned to a VR-based and a therapist-led memory training group, respectively. Primary outcome measures included the Multifactorial Memory Questionnaire and Fuld Object Memory Evaluation. RESULTS Both groups demonstrated positive training effects, with the VR group showing greater improvement in objective memory performance and the non-VR group showing better subjective memory subtest results in the Multifactorial Memory Questionnaire. CONCLUSION The use of VR seems to be acceptable for older adults with questionable dementia. Further study on the effect of educational background and memory training modality (visual, auditory) is warranted.
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Affiliation(s)
- David W K Man
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, People's Republic of China.
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Manly JJ, Smith C, Crystal HA, Richardson J, Golub ET, Greenblatt R, Robison E, Martin EM, Young M. Relationship of ethnicity, age, education, and reading level to speed and executive function among HIV+ and HIV– women: The Women's Interagency HIV Study (WIHS) Neurocognitive Substudy. J Clin Exp Neuropsychol 2011. [DOI: https:/doi.10.1080/13803395.2010.547662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jennifer J. Manly
- a Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, and the Gertrude H. Sergievsky Center , College of Physicians and Surgeons, Columbia University , New York, NY, USA
| | - Clifford Smith
- b Oscar G. Johnson VA Medical Center , Iron Mountain, MI, USA
| | - Howard A. Crystal
- c Department of Neurology , SUNY Downstate Medical Center , Brooklyn, NY, USA
| | - Jean Richardson
- d Keck School of Medicine, University of Southern California , Los Angeles, CA, USA
| | - Elizabeth T. Golub
- e Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | - Ruth Greenblatt
- f Departments of Clinical Pharmacy, Medicine, Epidemiology, and Biostatistics , University of California San Francisco , San Francisco, CA, USA
| | | | - Eileen M. Martin
- h University of Illinois College of Medicine-Chicago , Chicago, IL, USA
| | - Mary Young
- i Department of Medicine , Georgetown University Medical Center , Washington, DC, USA
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Manly JJ, Smith C, Crystal HA, Richardson J, Golub ET, Greenblatt R, Robison E, Martin EM, Young M. Relationship of ethnicity, age, education, and reading level to speed and executive function among HIV+ and HIV- women: the Women's Interagency HIV Study (WIHS) Neurocognitive Substudy. J Clin Exp Neuropsychol 2011; 33:853-63. [PMID: 21950512 PMCID: PMC3383771 DOI: 10.1080/13803395.2010.547662] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Use of neuropsychological tests to identify HIV-associated neurocognitive dysfunction must involve normative standards that are well suited to the population of interest. Norms should be based on a population of HIV-uninfected individuals as closely matched to the HIV-infected group as possible and must include examination of the potential effects of demographic factors on test performance. This is the first study to determine the normal range of scores on measures of psychomotor speed and executive function among a large group of ethnically and educationally diverse HIV-uninfected, high-risk women, as well as their HIV-infected counterparts. Participants (n = 1,653) were administered the Trail Making Test Parts A and B (Trails A and Trails B), the Symbol Digit Modalities Test (SDMT), and the Wide Range Achievement Test-3 (WRAT-3). Among HIV-uninfected women, race/ethnicity accounted for almost 5% of the variance in cognitive test performance. The proportions ofvariance in cognitive test performance accounted for by age (13.8%), years of school (4.1%), and WRAT-3 score (11.5%) were each significant, but did not completely account for the effect of race (3%). HIV-infected women obtained lower scores than HIV-uninfected women on time to complete Trails A and B, SDMT total correct, and SDMT incidental recall score, but after adjustment for age, years of education, racial/ethnic classification, and reading level, only the difference on SDMT total correct remained significant. Results highlight the need to adjust for demographic variables when diagnosing cognitive impairment in HIV-infected women. Advantages of demographically adjusted regression equations developed using data from HIV-uninfected women are discussed.
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Affiliation(s)
- Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, and the Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, USA.
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Klymko KW, Artinian NT, Price JE, Abele C, Washington OGM. Self-care production experiences in elderly African Americans with hypertension and cognitive difficulty. ACTA ACUST UNITED AC 2011; 23:200-8. [DOI: 10.1111/j.1745-7599.2011.00605.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chung JCC, S K Ho W. Validation of Fuld object memory evaluation for the detection of dementia in nursing home residents. Aging Ment Health 2009; 13:274-9. [PMID: 19347694 DOI: 10.1080/13607860802667649] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To examine the psychometric properties of the Fuld Object Memory Evaluation (FOME) as an instrument to detect dementia in nursing home residents. METHOD Ninety-six elderly participants were recruited into a dementia group (n = 30) and a normal control group (n = 66). Forty participants (12 dementia, 28 normal controls) had visual impairment. RESULTS The test-retest reliability and parallel-form reliability of FOME were excellent, with intraclass correlation coefficients of 0.92 and 0.96, respectively. Satisfactory convergent validity of FOME was established with the Cantonese version of Mini-Mental State Examination, and the Memory subscale and the Initiation/Perseveration subscale of the Chinese version of Dementia Rating Scale (r = 0.43 - 0.68; p < 0.01). The FOME total retrieval (TR) score and delayed recall (DR) score showed good discriminative power to screen for dementia. Optimal cutoff scores for TR and DR were suggested as 33 (93% sensitivity, 82% specificity) and 7 (87% sensitivity, 76% specificity) respectively. The performance of FOME was not influenced by age, educational level and visual impairment. CONCLUSION The findings suggest that FOME is a valid assessment to screen for dementia in older nursing home residents and can be used with older individuals with limited education and those with visual impairments.
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Affiliation(s)
- Jenny C C Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
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Chung JCC. Clinical validity of Fuld Object Memory Evaluation to screen for dementia in a Chinese society. Int J Geriatr Psychiatry 2009; 24:156-62. [PMID: 18612999 DOI: 10.1002/gps.2085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Fuld Object Memory Evaluation (FOME) evaluates the episodic memory functions of encoding, storage, and recall across five recall trials and a delayed recall trial. This study examined the clinical validity of FOME as a screening tool for dementia in older Chinese adults. METHOD The psychometric properties and the discriminative power of FOME were examined in a convenience sample of 192 community-dwelling older individuals, of which 57 were diagnosed with dementia. The influence of age and education on the FOME performance was also estimated. RESULTS The test-retest reliability and parallel-form reliability of FOME were excellent, with Intraclass Correlation Coefficients ranging from 0.91-0.96. Good convergent validity of FOME was established with Mini-Mental State Examination (r(p) = 0.69-0.74), and the Memory subscale and the Initiation/Perseveration subscale of Dementia Rating Scale (r(p) = 0.63-0.74). The FOME total retrieval (TR) score and delayed recall (DR) score demonstrated good discriminative power in differentiating dementia from normal cognitive functioning, with area under the curve values of 0.97 and 0.93 respectively. The optimal cut-off scores suggested for TR and DR were 31 (93% sensitivity, 90 specificity) and 7 (91% sensitivity, 82% specificity), respectively. The performance of the FOME was not influenced by the educational level. CONCLUSIONS The results suggest that the FOME is a reliable and valid instrument to screen for dementia in older community-dwelling Chinese adults. The absence of the effects of education on the assessment performance makes FOME a clinically useful instrument for older adults with limited education.
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Affiliation(s)
- Jenny C C Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University Hong Kong.
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Lopez OL, Mackell JA, Sun Y, Kassalow LM, Xu Y, McRae T, Li H. Effectiveness and safety of donepezil in Hispanic patients with Alzheimer's disease: a 12-week open-label study. J Natl Med Assoc 2008; 100:1350-8. [PMID: 19024233 DOI: 10.1016/s0027-9684(15)31515-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hispanics represent 10% of the U.S. population and are the fastest growing group. Studies show a higher prevalence and incidence of Alzheimer's disease (AD) in Hispanics than in the non-Hispanic white population, with an earlier age of onset. Among the currently estimated 200,000 Hispanics with AD, a significant number remain undiagnosed and untreated, and Hispanic participation in AD clinical trials has been historically low. This study evaluated the efficacy and safety of donepezil hydrochloride (donepezil) in Hispanics with mild-to-moderate AD. METHODS In this multicenter, open-label, 12-week study conducted in the United States, subjects were Hispanic men or women aged > or =50 years with a diagnosis of mild-to-moderate AD (DSMV-IV and NINCDS/ADRDA criteria), with Mini-Mental State Examination (MMSE) scores of 10-26 (inclusive) at screening. Subjects were treated with donepezil 5 mg/day for 6 weeks followed by 10 mg/day for 6 weeks. Clinical evaluation was performed at baseline, week 6 and week 12. Cognitive improvement was measured using the MMSE, Fuld Object Memory Evaluation (FOME) and Symbol Digit Modality Test (SDMT). Behavioral symptoms and associated caregiver distress were assessed with the Neuropsychiatric Inventory (NPI). RESULTS One-hundred-six patients with mild-to-moderate AD (mean age 68.6 years) were enrolled (intent to treat, n=97); most chose to have assessments conducted in Spanish. With 12 weeks of treatment, subjects showed statistically significant improvement from baseline on MMSE (P<0.0001), FOME retrieval (P=0.0042), FOME repeated retrieval (P=0.0020) and SDMT correct scores (P<0.0001). The NPI subdomain "apathy/indifference" showed statistically significant improvement (P=0.0010).The NPI Caregiver Distress scale (NPI-D) total score was statistically significantly improved (P=0.0500), suggesting a positive impact on relieving caregivers' burden associated with patient behavior. Most patients tolerated the treatment well, with only 2 discontinuing because of adverse events. The most common (>5%) adverse events were insomnia (9.5%), dizziness (7.6%), diarrhea (5.7%) and nausea (5.7%). CONCLUSION The cognitive improvement and safety results from this study were consistent with those reported for donepezil in the general population. Increased awareness of AD in the Hispanic population will help more Hispanics with AD to benefit from early diagnosis and effective treatment.
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Affiliation(s)
- Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
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Danner DD, Smith CD, Jessa P, Hudson J. African Americans with memory loss: findings from a community clinic in Lexington, Kentucky. Nurs Clin North Am 2008; 43:437-47, ix-x. [PMID: 18674674 DOI: 10.1016/j.cnur.2008.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Kentucky's African-American Dementia Outreach Partnership (AADOP) has shown that African-American patients seek dementia care if a clinic is conveniently located and families are educated about the distinction between normal aging and signs of disease. The early identification of dementia allows African Americans access to pharmaceutic treatments that work best early in the course of the disease and provides the opportunity for the patient to plan future care. In the AADOP model, a conveniently located clinic and access to the patient's home were first steps in achieving equality of care. The trust that was built in the community through collaboration with African-American churches has allowed patients and their families to receive help with memory problems and to feel comfortable in seeking help for other medical problems. Maintaining this involvement and responsiveness to the community over the long term is the next challenge for the program.
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Affiliation(s)
- Deborah D Danner
- Sanders-Brown Center on Aging, Alzheimer's Disease Center, University of Kentucky, Lexington, KY 40536-0230, USA.
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Prigatano GP, Gupta S, Gale S. Fuld Object Memory Evaluation Adapted for School-Age Children. Dev Neuropsychol 2007; 32:757-68. [DOI: 10.1080/87565640701539469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Riudavets MA, Rubio A, Cox C, Rudow G, Fowler D, Troncoso JC. The prevalence of Alzheimer neuropathologic lesions is similar in blacks and whites. J Neuropathol Exp Neurol 2007; 65:1143-8. [PMID: 17146288 DOI: 10.1097/01.jnen.0000248548.20799.a3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Alzheimer disease is the most common dementia in older Americans, but its impact on blacks is not clearly understood. We examined prospectively 200 autopsy brains at the Office of the Chief Medical Examiner in Maryland and compared the frequency and severity of Alzheimer lesions in blacks and whites. Histologic sections of the hippocampus and entorhinal and neocortices were immunostained for Abeta and tau proteins. Subjects were genotyped for ApoE. Abeta deposits were rated as none, sparse, moderate, or frequent; tau lesions were rated into 4 groups corresponding to Braak scores; and Abeta angiopathy was classified as present or absent. Outcome scores were treated as ordinal variables and analyzed by proportional odds logistic regression. Abeta plaques were present in 60% of black males, 58% of white males, 74% of black females, and 74% of white females. Tau lesions were present in 96% of black males, 88% of white males, 96% of black females, and 96% of white females. Neither race nor gender was a significant factor in the frequency or severity of Alzheimer lesions, and ApoE4 increased the risk for Alzheimer lesions similarly in blacks and whites.
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Affiliation(s)
- Miguel A Riudavets
- Department of Neuropathology and Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA
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Mast BT, Allaire JC. Verbal Learning and Everyday Functioning in Dementia: An Application of Latent Variable Growth Curve Modeling. J Gerontol B Psychol Sci Soc Sci 2006; 61:P167-73. [PMID: 16670186 DOI: 10.1093/geronb/61.3.p167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study used latent variable growth curve modeling to identify predictors and correlates of verbal learning over trials on a list-learning task in patients with dementia. Data from 116 patients evaluated at the Detroit satellite of the Michigan Alzheimer's Disease Research Center were incorporated in the present analyses. Patients were administered the Fuld Object Memory Evaluation, examined independently by a geriatrician, and, if appropriate, given a diagnosis of probable Alzheimer's disease according to criteria from the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association. The presence of dementia significantly predicted both the intercept (i.e., level of performance) and the slope (i.e., learning over trials), with dementia patients demonstrating lower overall levels of performance and less verbal learning over trials. Rate of verbal learning over trials was a significant predictor of everyday functioning (instrumental activities of daily living) above and beyond general cognitive impairment and demographics.
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Affiliation(s)
- Benjamin T Mast
- Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA.
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Johnson AS, Flicker LJ, Lichtenberg PA. Reading ability mediates the relationship between education and executive function tasks. J Int Neuropsychol Soc 2006; 12:64-71. [PMID: 16433945 DOI: 10.1017/s1355617706060073] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 10/02/2005] [Accepted: 10/03/2005] [Indexed: 11/08/2022]
Abstract
Neuropsychological test results are affected by multiple factors, but usually age and education are the only variables by which norms are stratified. Some authors have questioned whether these variables alone are sufficient (e.g., Marcopulos et al., 1997; Manly et al., 2002), since such norms have lead to problems, such as poor specificity for African Americans on dementia screening devices (Fillenbaum et al., 1990). Recent research has shown that reading ability, a measure of educational quality, attenuated racial differences in test performance (Manly et al., 2002). We specifically examined whether reading ability would account for a greater amount of variance than education in executive function tests in a population traditionally subject to poor educational quality. Results determined that reading ability accounted for a significantly greater amount of variance than years of education for Letter-Number Sequencing, Similarities, COWA, Trail Making Test, and Coloured Progressive Matrices. Reading ability was found to significantly mediate the relationship between each of these tests and education. Animal naming appears to be least affected by educational quality or quantity. These findings hold implications for the interpretation of neuropsychological test results, especially in those exposed to substandard educational quality, and for the way that test norms are constructed.
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Affiliation(s)
- Jennifer J Manly
- Cognitive Neuroscience Division, GH Sergievsky Center and Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University Health Science Center, 630 West 168th Street, P&S Box 16, New York, NY 10032, USA
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Jackson JS, Antonucci TC, Brown E. A cultural lens on biopsychosocial models of aging. RECENT ADVANCES IN PSYCHOLOGY AND AGING 2003. [DOI: 10.1016/s1566-3124(03)15008-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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