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Lee J, Weerasinghe-Mudiyanselage PDE, Kim B, Kang S, Kim JS, Moon C. Particulate matter exposure and neurodegenerative diseases: A comprehensive update on toxicity and mechanisms. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 266:115565. [PMID: 37832485 DOI: 10.1016/j.ecoenv.2023.115565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/30/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
Exposure to particulate matter (PM) has been associated with a range of health impacts, including neurological abnormalities that affect neurodevelopment, neuroplasticity, and behavior. Recently, there has been growing interest in investigating the possible relationship between PM exposure and the onset and progression of neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, Huntington's disease, and multiple sclerosis. However, the precise mechanism by which PM affects neurodegeneration is still unclear, even though several epidemiological and animal model studies have provided mechanistic insights. This article presents a review of the current research on the neurotoxicity of PM and its impact on neurodegenerative diseases. This review summarizes findings from epidemiological and animal model studies collected through searches in Google Scholar, PubMed, Web of Science, and Scopus. This review paper also discusses the reported effects of PM exposure on the central nervous system and highlights research gaps and future directions. The information presented in this review may inform public health policies aimed at reducing PM exposure and may contribute to the development of new treatments for neurodegenerative diseases. Further mechanistic and therapeutic research will be needed to fully understand the relationship between PM exposure and neurodegenerative diseases.
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Affiliation(s)
- Jeongmin Lee
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju 61186, South Korea
| | - Poornima D E Weerasinghe-Mudiyanselage
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju 61186, South Korea
| | - Bohye Kim
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju 61186, South Korea
| | - Sohi Kang
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju 61186, South Korea
| | - Joong-Sun Kim
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju 61186, South Korea
| | - Changjong Moon
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju 61186, South Korea.
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Bertrand E, Marinho V, Naylor R, Bomilcar I, Laks J, Spector A, Mograbi DC. Metacognitive Improvements Following Cognitive Stimulation Therapy for People with Dementia: Evidence from a Pilot Randomized Controlled Trial. Clin Gerontol 2023; 46:267-276. [PMID: 36482733 DOI: 10.1080/07317115.2022.2155283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Impaired self-awareness is a common feature of dementia, with considerable clinical impact. Some therapeutic strategies such as cognitive stimulation and psychotherapy have been suggested to mitigate loss of awareness. Nevertheless, evidence of intervention improving awareness of deficits is scarce. The present study aims to explore the impact of a Brazilian adapted version of Cognitive Stimulation Therapy (CST-Brasil), an evidence-based psychosocial intervention for people with dementia (PwD), on the level of awareness, reporting here a secondary outcome of a pilot randomized controlled trial. METHODS 47 people with mild to moderate dementia attending an out-patient unit were randomly allocated to CST (n = 23) or treatment as usual (TAU) (n = 24) across 7 weeks, in a pilot randomized controlled trial. Awareness was measured before and after the intervention. RESULTS Results indicated that people in both groups increased in overall awareness of the disease, but only those receiving CST exhibited improvements of awareness of cognitive ability. CONCLUSIONS These findings suggest that CST may also improve metacognitive abilities in PwD, which could potentially be applied to other settings with beneficial effects. CLINICAL IMPLICATIONS Considering the negative impacts of anosognosia, CST-led improvements in awareness have the potential to benefit PwD and their caregivers.
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Affiliation(s)
- Elodie Bertrand
- Laboratoire Mémoire, Cerveau et Cognition (LMC2 UR7536), Institut de Psychologie, Université Paris Cité, Paris, France
| | - Valeska Marinho
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata Naylor
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Iris Bomilcar
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Translational Biomedicine Postgraduate Programme, Universidade do Grande Rio (Unigranrio), Duque de Caxias, Brazil
| | - Aimee Spector
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Daniel C Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
- Psychology & Neuroscience, Institute of Psychiatry, King's College London, London, UK
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Seckin M, Yıldırım E, Demir İ, Orhun Ö, Bülbül E, Velioğlu HA, Öktem Ö, Yeşilot N, Çoban O, Gürvit H. Neuropsychiatric outcomes and caregiver distress in primary progressive aphasia. Psychogeriatrics 2023; 23:52-62. [PMID: 36273493 DOI: 10.1111/psyg.12902] [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: 04/07/2022] [Revised: 09/05/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND In this study, we aimed to outline the neuropsychiatric consequences of primary progressive aphasia (PPA) and to understand how neuropsychiatric symptomatology affects distress in caregivers. METHODS The Neuropsychiatric Inventory (NPI) including the distress index (NPI-Distress) was used. Additional information about the caregiver burden was obtained using Zarit Burden Interview (ZBI). NPI, NPI-Distress, and ZBI data from 17 patients with a clinical diagnosis of PPA were compared with 10 stroke aphasia patients. Neuropsychiatric symptomatology was investigated based on three clusters; Mood, Frontal/Comportmental, and Psychotic/Disruptive. Additionally, the Activities of Daily Living Questionnaire (ADLQ) was used to outline the functional impairment. Twelve healthy controls were included to compare the neurocognitive test scores with PPA and stroke aphasia groups. RESULTS A greater number of neuropsychiatric symptoms were observed in the PPA group compared to the stroke aphasia group. The number of symptoms in Mood, and Frontal/Comportmental clusters were greater than the number of symptoms in Psychotic/Disruptive clusters in the PPA group, whereas no significant relationship between the number of symptoms and symptom clusters was found in the stroke aphasia group. In the PPA group, a strong correlation was found between the NPI-Frequency × Severity scores and the NPI-Distress scores. Moreover, the NPI-Distress scores in the PPA group strongly correlated with the ZBI scores. Scores for anxiety, irritability/lability, and apathy had a stronger correlation with the NPI-Distress scores compared to the other NPI symptoms. The Communication subscale was the most impaired domain in the PPA group. Travel, and Employment and Recreation subscales showed greater functional impairment in the stroke aphasia group compared to the PPA group. CONCLUSIONS Neuropsychiatric symptoms in PPA in our study were more frequent than previously reported. Furthermore, the distress index of the NPI was not only correlated with the severity of the neuropsychiatric symptoms but also reflected the overall burden on the caregivers in the PPA group.
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Affiliation(s)
- Mustafa Seckin
- Department of Neurology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey.,Acıbadem Mehmet Ali Aydınlar University School of Medicine, Alzheimer's Disease and Cognitive Neurology Research Lab, Istanbul, Turkey
| | - Elif Yıldırım
- Faculty of Economics, Administrative and Social Sciences, Department of Psychology, Işık University, Istanbul, Turkey
| | - İlayda Demir
- Department of Neuroscience, Istanbul University Aziz Sancar Institute of Experimental Medicine, Istanbul, Turkey.,Hulusi Behçet Life Sciences Center, Neuroimaging Lab, Istanbul University, Istanbul, Turkey
| | - Ömer Orhun
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, Alzheimer's Disease and Cognitive Neurology Research Lab, Istanbul, Turkey
| | - Ezgi Bülbül
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, Alzheimer's Disease and Cognitive Neurology Research Lab, Istanbul, Turkey
| | - H Aziz Velioğlu
- Health Sciences and Technology Research Institute (SABITA), Regenerative and Restorative Medicine Research Center (REMER), functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Istanbul Medipol University, Istanbul, Turkey
| | - Öget Öktem
- Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Nilüfer Yeşilot
- Department of Neurology, Edip Aktin Stroke Unit, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Oğuzhan Çoban
- Department of Neurology, Edip Aktin Stroke Unit, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Hakan Gürvit
- Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul University Faculty of Medicine, Istanbul, Turkey
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Hergert DC, Cimino CR. Predictors of Caregiver Burden in Huntington's Disease. Arch Clin Neuropsychol 2021; 36:1426–1437. [PMID: 33723593 DOI: 10.1093/arclin/acab009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/19/2020] [Accepted: 02/10/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Huntington's disease (HD) is a genetic neurodegenerative condition that is characterized by cognitive, motor, and psychiatric dysfunction. The purpose of this study was to explore which disease characteristics influence caregiver burden in HD. METHODS Fifty participants with HD and 50 of their caregivers participated in the study at the University of South Florida. Participants were administered a neuropsychological battery, the Unified Huntington's Disease Rating Scale (UHDRS) motor exam, and the Frontal Systems Behavior Scale (FrSBe) self-report. Caregivers completed the Caregiving Appraisal Scale and the FrSBe family-report. RESULTS There were significant correlations between caregiver burden and caregiver age and sex, UHDRS motor scores, cognitive functioning, and self and caregiver-reported FrSBe scores. The significant variables were entered into a regression model and explained 63.1% of the variance in caregiver burden scores. Caregiver age, cognitive functioning, and caregiver-reported FrSBe scores continued to be significant predictors of caregiver burden, whereas the other variables were no longer significant. CONCLUSIONS There were significant relationships between caregiver burden, cognitive functioning, and frontally mediated behaviors, but not motor scores. The results suggest that possible interventions for caregivers may include education to caregivers on how to cope with apathy/executive dysfunction and cognitive decline. Caregiver age was associated with burden, with younger age being associated with increased burden when controlling for symptom severity. This has implications for this population in that HD typically has a younger age of onset than other neurodegenerative diseases and therefore, these caregivers may be particularly at risk for caregiver burden.
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Affiliation(s)
- Danielle C Hergert
- New Mexico Department of Health, Developmental Disabilities Supports Division, Albuquerque, NM, USA
| | - Cynthia R Cimino
- Deparment of Psychology, University of South Florida, Tampa, FL, USA
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Alexander CM, Martyr A, Savage SA, Morris RG, Clare L. Measuring Awareness in People With Dementia: Results of a Systematic Scoping Review. J Geriatr Psychiatry Neurol 2021; 34:335-348. [PMID: 32400259 PMCID: PMC8326902 DOI: 10.1177/0891988720924717] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Awareness of the diagnosis or related changes in functioning varies in people with dementia (PwD), with implications for the well-being of PwD and their carers. Measuring awareness in a clinical setting could facilitate tailored support and optimize involvement in personal health and care decisions. This scoping review aimed to identify validated methods of assessing awareness in dementia and appraise their clinical utility. METHOD A systematic search was conducted of English-language publications that measured awareness in PwD, in 6 electronic databases. Search terms included dement*, Alzheimer*, Pick disease, and awareness, unawareness, anosognosia, insight, denial, metacognit*, or discrepanc*. RESULTS We screened 30,634 articles, finding 345 articles that met our inclusion criteria. We identified 76 measures, most commonly using a discrepancy questionnaire comparing evaluations of function by PwD and an informant. There were 30 awareness measures developed and validated for use in dementia populations but few designed for general clinical use. CONCLUSIONS Although we found a range of clinical indications for measuring awareness, there were few studies investigating clinical applications and few tools designed for clinical purposes. Further investigation and development of a person-centered tool could facilitate health and care choices in mild-to-moderate dementia.
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Affiliation(s)
- Catherine M. Alexander
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom,Catherine M. Alexander, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, United Kingdom.
| | - Anthony Martyr
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom
| | - Sharon A. Savage
- Psychology Department, University of Exeter, Washington Singer Laboratories, Streatham Campus, Exeter, United Kingdom
| | - Robin G. Morris
- King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Linda Clare
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom
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Bertrand E, van Duinkerken E, Laks J, Dourado MCN, Bernardes G, Landeira-Fernandez J, Mograbi DC. Structural Gray and White Matter Correlates of Awareness in Alzheimer's Disease. J Alzheimers Dis 2021; 81:1321-1330. [PMID: 33935073 DOI: 10.3233/jad-201246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Unawareness of disease is a common feature of Alzheimer's disease (AD), but few studies explored its neural correlates. Additionally, neural correlates according to the object of awareness are unexplored. OBJECTIVE To investigate structural brain correlates in relation to different objects of awareness. METHODS 27 people with AD underwent MRI scanning on a 3T Siemens Prisma. T1-MPRAGE was used to investigate cortical thickness and white matter microstructure was defined by DTI as fractional anisotropy, mean, axial, and radial diffusivity. Preprocessing used FreeSurfer6.0, ExploreDTI, and FSL-TBSS. Awareness of disease, cognitive deficits, emotional state, relationships, and functional capacity were assessed with the short version of the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia. Voxel-wise correlations between brain structure and awareness were determined by FSL-PALM. Analyses were corrected for multiple comparisons using Threshold Free Cluster Enhancement and FWE. RESULTS Lower left hemisphere cortical thickness was related to poorer disease awareness uncorrected and corrected for age, sex, and MMSE. In the uncorrected model, mainly right-sided, but also left temporal lower cortical thickness was related to decreased awareness of cognitive deficits. Correcting for age, sex, and MMSE eliminated correlations for the right hemisphere, but extensive correlations in the left hemisphere remained. For white matter integrity, higher right hemisphere MD was related to lower cognitive awareness deficits, and lower FA was related to lower functional capacity awareness. CONCLUSION Findings suggest that extensive regions of the brain are linked to self-awareness, with particular frontal and temporal alterations leading to unawareness, in agreement with theoretical models indicating executive and mnemonic forms of anosognosia in AD.
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Affiliation(s)
- Elodie Bertrand
- MC2Lab (URP 7536), Institut de Psychologie, Université de Paris, Paris, France.,Department of Psychology, Pontifícia Universidade Católica-Rio (PUC-Rio), Rio de Janeiro, Brazil
| | - Eelco van Duinkerken
- Department of Medical Psychology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Center for Epilepsy, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.,Postgraduate Program in Neurology, Hospital Universitário Gaffrée e Guinle -UNIRIO, Rio de Janeiro, Brazil
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychology, Universidade do Grande Rio (Unigranrio), Duque de Caxias, Brazil
| | | | - Gabriel Bernardes
- Department of Psychology, Pontifícia Universidade Católica-Rio (PUC-Rio), Rio de Janeiro, Brazil
| | - Jesus Landeira-Fernandez
- Department of Psychology, Pontifícia Universidade Católica-Rio (PUC-Rio), Rio de Janeiro, Brazil
| | - Daniel C Mograbi
- Department of Psychology, Pontifícia Universidade Católica-Rio (PUC-Rio), Rio de Janeiro, Brazil.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Niermeyer M, Gaudet C, Malloy P, Piryatinsky I, Salloway S, Klinge P, Lee A. Frontal Behavior Syndromes in Idiopathic Normal Pressure Hydrocephalus as a Function of Alzheimer's Disease Biomarker Status. J Int Neuropsychol Soc 2020; 26:883-893. [PMID: 32430087 PMCID: PMC7554119 DOI: 10.1017/s1355617720000387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Cognitive impairment and apathy are well-documented features of idiopathic normal pressure hydrocephalus (iNPH). However, research examining other neuropsychiatric manifestations of iNPH is scant, and it is unknown whether the neuropsychiatric presentation differs for iNPH patients with comorbid Alzheimer's disease (AD) versus iNPH without AD. This study aims to advance our understanding of neuropsychiatric syndromes associated with iNPH. METHODS Fifty patients from Butler Hospital's Normal Pressure Hydrocephalus Clinic met inclusion criteria. Caregiver ratings on the Frontal Systems Behavior Scale (FrSBe) were examined to appraise changes in apathy, executive dysfunction, and disinhibition. Patients also completed cognitive tests of global cognition, psychomotor speed, and executive functioning. AD biomarker status was determined by either amyloid-beta (Aβ) positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) total tau to Aβ-42 ratio. RESULTS Results revealed clinically significant elevations on the FrSBe's apathy and executive dysfunction scales and modest correlations among these scales and cognitive measures. Of the 44 patients with available neuroimaging or CSF draw data, 14 presented with comorbid AD. Relative to the iNPH-only group, the iNPH + AD group showed a larger increase from pre-illness to current informant ratings on the executive dysfunction scale, but not the apathy or disinhibition scales. CONCLUSIONS These results replicate and extend prior research by identifying apathy and executive dysfunction as prominent neuropsychiatric symptoms of iNPH and suggest comorbid AD exacerbates dysexecutive behaviors. Future research is warranted to examine the effects of comorbid AD pathology in response to shunt surgery for iNPH, neuropsychiatric symptom changes, and resultant caregiver burden.
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Affiliation(s)
- Madison Niermeyer
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT
| | - Chad Gaudet
- Department of Psychology, University of Rhode Island, Kingston, RI
| | - Paul Malloy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
- Memory and Aging Program, Butler Hospital, Providence, RI
| | - Irene Piryatinsky
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA
| | - Stephen Salloway
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
- Memory and Aging Program, Butler Hospital, Providence, RI
- Department of Neurology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Petra Klinge
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, RI
- Lifespan Physician Group, Rhode Island Hospital, Providence, RI
| | - Athene Lee
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
- Memory and Aging Program, Butler Hospital, Providence, RI
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Brunet HE, Cummings JL, Banks SJ, Miller JB. Awareness of Psychiatric Symptoms in a Mixed Clinical Sample of Older Adults. J Geriatr Psychiatry Neurol 2020; 33:124-134. [PMID: 31401920 DOI: 10.1177/0891988719868311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examined the neuropsychological correlates and impact on caregiver distress of reduced awareness of mood symptoms in patients with suspected neurodegenerative disease. METHOD Records from a clinical sample of older adults were examined (N = 940). RESULTS More than one-third of patient and caregiver ratings of mood symptoms did not agree (comparing patient and caregiver self-report measures); 27.9% of patients were unaware of depression (UoD) and 16.6% of patients were unaware of anxiety (UoA). The UoD group exhibited poorer verbal memory and executive abilities and the UoA group exhibited poorer verbal memory than those with preserved awareness. Unawareness was not associated with caregiver distress. CONCLUSIONS These findings highlight the importance of capturing informant report in clinical practice with older adults suspected of cognitive impairment. Unawareness of mood symptoms was related to memory dysfunction and-to a lesser extent-to executive abilities and may have implications for addressing patient and caregiver needs for disorders affecting these cognitive systems.
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Affiliation(s)
- Hannah E Brunet
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jeffrey L Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.,School of Allied Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Sarah J Banks
- University of California San Diego, San Diego, CA, USA
| | - Justin B Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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Reduced Awareness of Memory Deficit is Associated With Increased Medicare Home Health Care Use in Dementia. Alzheimer Dis Assoc Disord 2020; 33:62-67. [PMID: 30531365 DOI: 10.1097/wad.0000000000000287] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The objective of this study was to examine whether reduced awareness of memory deficits in individuals with dementia is associated with more frequent need for Medicare home health care services. METHODS Cross-sectional analyses were conducted in a multicenter, clinic-based cohort. In total, 192 participants diagnosed with dementia and their informants were independently asked whether or not the participant demonstrated cognitive symptoms of dementia related to memory and word-finding. Participant self-awareness was measured as the discrepancy between participant and caregiver report of these symptoms. Annual Medicare home health benefit use data was obtained from Medicare claims matched by year to the Predictors study visit. RESULTS Participants that used home health services had lower awareness scores than those who did not. Awareness remained independently associated with home health use in a logistic regression adjusted for age, gender, education, caregiver relationship, global cognition, dementia subtype, and medical comorbidities. IMPLICATIONS Reduced self-awareness of memory deficits in individuals with dementia is associated with more frequent use of Medicare home health services. The disproportionate use of in-home assistance as a function of awareness level may reflect dangers faced by patients, and challenges faced by caregivers, when patients have limited awareness of their memory deficits. Current results have implications for clinical care, caregiver education, and models of health care utilization.
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Factors related to adverse mental health condition of demented family caregivers: A study in West Bengal, India. ANTHROPOLOGICAL REVIEW 2019. [DOI: 10.2478/anre-2019-0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Dementia caregiving is a unique and the caregivers faces extreme challenges which affect care-giver’s mental health adversely. Family caregiving towards elderly individuals with dementia is becoming widespread. The study aims to evaluate the mental health status of dementia family caregivers and some related factors that affect their mental health condition.
Present cross sectional study includes a total of 134 family caregivers. Socio-demographic and caregiving related data were collected using pre-tested questionnaires. Standardized questionnaires were used to collect data on caregivers’ mental health traits (measured in terms of level of stress and anxiety), level of psychosocial distress, support they provided and the care recipient’s behavioural symptoms associated with dementia. Mean age of the caregivers was 61.64 years (SD 13.89) while the care recipients were above 70 years of age. Mean age of care recipients was 75.46±7.26 years. Alzheimer’s type of dementia was the most common type found among them. Higher level of stress and anxiety was prevalent among the caregivers. Level of education, being a spouse, psychological distress has strong relationship with caregivers’ mental health condition. Behavioural abnormalities of care recipients were also responsible for poor mental health conditions of caregivers. Family caregiving is becoming the most suitable option nowadays and it associated with caregivers’ psychological distress and other health issues. Present study also revealed distressed mental health conditions of caregivers. Since care recipients remain dependent mostly on their family care-givers, it is necessary that caregivers should be fit mentally as well as physically. Therefore, proper support and management is needed for caregivers in near future.
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Keszycki RM, Fisher DW, Dong H. The Hyperactivity-Impulsivity-Irritiability-Disinhibition-Aggression-Agitation Domain in Alzheimer's Disease: Current Management and Future Directions. Front Pharmacol 2019; 10:1109. [PMID: 31611794 PMCID: PMC6777414 DOI: 10.3389/fphar.2019.01109] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD) afflict the vast majority of patients with dementia, especially those with Alzheimer's disease (AD). In clinical settings, patients with BPSD most often do not present with just one symptom. Rather, clusters of symptoms commonly co-occur and can, thus, be grouped into behavioral domains that may ultimately be the result of disruptions in overarching neural circuits. One major BPSD domain routinely identified across patients with AD is the hyperactivity-impulsivity-irritiability-disinhibition-aggression-agitation (HIDA) domain. The HIDA domain represents one of the most difficult sets of symptoms to manage in AD and accounts for much of the burden for caregivers and hospital staff. Although many studies recommend non-pharmacological treatments for HIDA domain symptoms as first-line, they demonstrate little consensus as to what these treatments should be and are often difficult to implement clinically. Certain symptoms within the HIDA domain also do not respond adequately to these treatments, putting patients at risk and necessitating adjunct pharmacological intervention. In this review, we summarize the current literature regarding non-pharmacological and pharmacological interventions for the HIDA domain and provide suggestions for improving treatment. As epigenetic changes due to both aging and AD cause dysfunction in drug-targeted receptors, we propose that HIDA domain treatments could be enhanced by adjunct strategies that modify these epigenetic alterations and, thus, increase efficacy and reduce side effects. To improve the implementation of non-pharmacological approaches in clinical settings, we suggest that issues regarding inadequate resources and guidance for implementation should be addressed. Finally, we propose that increased monitoring of symptom and treatment progression via novel sensor technology and the "DICE" (describe, investigate, create, and evaluate) approach may enhance both pharmacological and non-pharmacological interventions for the HIDA domain.
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Affiliation(s)
- Rachel M. Keszycki
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Daniel W. Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, United States
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Hergert DC, Haaland KY, Cimino CR. Evaluation of a performance-rating method to assess awareness of cognitive functioning in Huntington's disease. Clin Neuropsychol 2019; 34:477-497. [PMID: 31322031 DOI: 10.1080/13854046.2019.1640286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Anosognosia, or lack of awareness of symptoms, is commonly observed in Huntington's disease (HD) using patient/informant-report discrepancy methods. The purpose of this study was to examine the utility of a performance-rating method for assessing awareness of cognitive performance in HD.Method: Persons with manifest HD (n = 54) rated their performance on the daily living tests from the Neuropsychological Assessment Battery (NAB) using a bell curve. We also examined patient/informant-report discrepancies of executive functioning (FrSBe) in a subset (n = 47) of patients and their informants.Results: Patients were able to reliably use our method of categorizing their performance as evidenced by significant correlations between verbal descriptions of their performance and the percentile ratings they indicated on the bell curve. Patients across the range of observed Unified HD Rating Scale motor scale scores rated their performance on the NAB tasks significantly higher than actual performance for both pretest prediction and posttest evaluation ratings. Only patients with more severe motor impairment underestimated their problems relative to informant report on the FrSBe.Conclusions: This is the first study to use a performance-rating method for examining awareness in HD. Patients could reliably use this performance-based bell curve method to provide accurate estimations of their performance and as a group they tended to overestimate performance as has been demonstrated in previous studies. Unlike previous studies using self-report methodology, we also demonstrated decreased awareness in the persons with HD with less severe motor impairment using the performance-rating method, suggesting the two methods may measure different constructs of awareness.
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Affiliation(s)
| | - Kathleen Y Haaland
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Cynthia R Cimino
- Department of Psychology, University of South Florida, Tampa, FL, USA
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Ryals AJ, O’Neil JT, Mesulam MM, Weintraub S, Voss JL. Memory awareness disruptions in amnestic mild cognitive impairment: comparison of multiple awareness types for verbal and visuospatial material. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2019; 26:577-598. [PMID: 30080435 PMCID: PMC6453739 DOI: 10.1080/13825585.2018.1503994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022]
Abstract
Successful memory is normally accompanied by explicit awareness of retrieval and confidence in the accuracy of the retrieval product. Prior findings suggest that these features of metamemory can be dissociated from retrieval accuracy in Amnestic Mild Cognitive Impairment (aMCI). However, the literature on this question contains variable and conflicting results, likely because of differences in experimental conditions. We sought to systematically evaluate memory awareness disruptions in aMCI using multiple measures and stimulus formats within the same individuals. Memory awareness was tested with global predictions and postdictions, judgments of learning, confidence level ratings, and modified feeling-of-knowing ratings in tasks of visuospatial and verbal memory. These tests were administered to 14 individuals with aMCI and 15 healthy, age-matched controls. Memory awareness accuracy was calculated as the correspondence between subjective judgments and memory performance.Individuals with aMCI demonstrated impaired global and trial-level retrospective task awareness for visuospatial and verbal stimuli. Additionally, modified feeling-of-knowing awareness was impaired selectively for verbal stimuli. Statistical effect sizes for global awareness impairments were comparable to impairments in several objective neuropsychological memory assessments.Memory awareness (metamemory) disruptions in aMCI were most evident for a subset of subjective judgment types and task input modalities. These findings advance understanding of the nature of memory impairments in aMCI and support the utility of incorporating memory awareness testing to better characterize memory integrity in older adults.
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Affiliation(s)
| | - Jonathan T. O’Neil
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago IL
| | - M.-Marsel Mesulam
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago IL
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Sandra Weintraub
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago IL
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern University Feinberg School of Medicine, Chicago IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Joel L. Voss
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago IL
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago IL
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Bregman N, Kavé G, Shiner T, Biran I. Dissociation in awareness of memory and language decline in Alzheimer's disease. Int J Geriatr Psychiatry 2019; 34:548-554. [PMID: 30548691 DOI: 10.1002/gps.5049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/09/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The aim of this study was to examine awareness of decline in memory and in language in individuals with Alzheimer's disease (AD), by comparing participant and informant ratings, as well as these ratings and actual test performance. METHODS We analyzed data from 149 individuals with AD enrolled in the Alzheimer's Disease Neuroimaging Initiative (ADNI) who filled the Everyday Cognition questionnaire and performed memory and language tasks. RESULTS Participants provided significantly lower assessments of decline than did informants for both memory and language. There was a negative association between informant ratings and memory test scores but no association between participant ratings and memory test scores. Both participant and informant ratings correlated negatively with performance on the language tests. Informant, but not participant, ratings contributed to the prediction of one memory variable beyond demographic factors. Participant ratings contributed to the prediction of language scores beyond demographic factors more than did informant ratings. CONCLUSIONS The findings reflect better awareness of decline in language than of decline in memory in individuals with AD.
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Affiliation(s)
- Noa Bregman
- Center for Memory and Attention Disorders, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gitit Kavé
- Center for Memory and Attention Disorders, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Education and Psychology, The Open University, Ra'anana, Israel
| | - Tamara Shiner
- Center for Memory and Attention Disorders, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Iftah Biran
- Center for Memory and Attention Disorders, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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15
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Bertrand E, Azar M, Rizvi B, Brickman AM, Huey ED, Habeck C, Landeira-Fernandez J, Mograbi DC, Cosentino S. Cortical thickness and metacognition in cognitively diverse older adults. Neuropsychology 2018; 32:700-710. [PMID: 29878837 PMCID: PMC6126945 DOI: 10.1037/neu0000458] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Metacognition, or the ability to accurately identify, appraise, and monitor one's deficits, is commonly impaired in Alzheimer's disease (AD). Poor metacognition prevents correct appraisal of a range of physical, cognitive, and emotional symptoms and facilitates anosognosia, which has important clinical implications for individuals (e.g., diminished treatment adherence, increased engagement in high-risk situations) and caregivers (e.g., higher burden). However, the neural correlates of metacognitive disturbance are still debated in the literature, partly because of the subjective nature of traditional awareness measures. METHOD An objective Feeling of Knowing (FOK) task was used to measure metamemory capacity in a group of cognitively diverse older adults, including 14 with mild to moderate AD and 20 cognitively healthy older adults. The association between three different objective metamemory measures of the FOK task and regional cortical thickness (12 bilateral regions of interest [ROIs] hypothesized to support self-awareness) was analyzed using partial correlations. RESULTS Less accurate metamemory at the local and global levels was associated with reduced right posterior cingulate cortical thickness, r = -0.42, p = .02 and reduced right medial prefrontal, r = -0.39, p = .029, respectively. CONCLUSIONS To our knowledge, this was the first study to examine metacognition in relation to cortical thickness. Both global and local metamemory functions appear to rely on the integrity of right sided midline regions, known to be important for processing self-referential information. Findings are conceptualized with regard to the Default Mode Network, and also considered in relation to recent findings pointing to the right insula as a region critical for self-awareness. (PsycINFO Database Record
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Affiliation(s)
- Elodie Bertrand
- Department of Psychology, Pontifical Catholic University-Rio
| | - Martina Azar
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center
| | - Batool Rizvi
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center
| | - Adam M Brickman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center
| | - Edward D Huey
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center
| | - Christian Habeck
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center
| | | | | | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center
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Repressive Coping Does Not Contribute to Anosognosia in First-Diagnosis Patients With Alzheimer Disease. Alzheimer Dis Assoc Disord 2018; 31:249-255. [PMID: 27819840 DOI: 10.1097/wad.0000000000000169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anosognosia is common in patients with Alzheimer disease (AD) even in early stages. Although neural correlates and the impact of cognitive dysfunctions have been described, possible psychodynamic processes such as a repressive coping style as described in other illnesses, have not been examined. Our study aimed to examine possible psychological influence factors on illness perception embracing a repressive coping style and cognitive functions in AD patients in the diagnostic process. Fifty-four subjects with mild AD diagnosed in our memory clinic were enrolled. Anosognosia was evaluated using a patient-caregiver discrepancy rating. All patients underwent comprehensive neuropsychological testing. In addition, characteristics of a repressive coping style were assessed. In total, 79.6% of our patients showed a lack of awareness at least to some degree. 33.3% of the patients were classified as repressors. Repressors and nonrepressors did not differ in cognition, or the unawareness score. Multivariate regression analysis showed that repressive coping style did not significantly contribute to anosognosia, but that verbal memory and naming ability had a strong influence. Although our data indicate that a high proportion of patients with mild AD show characteristics of repressive coping, this possible defense mechanism had no influence on the awareness of illness-related deficits measured by caregiver patient discrepancy.
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Lai C, Cipriani M, Renzi A, Luciani M, Lombardo L, Aceto P. The Effects of the Perception of Being Recognized by Patients With Alzheimer Disease on a Caregiver's Burden and Psychophysical Health. Am J Hosp Palliat Care 2018; 35:1188-1194. [PMID: 29580073 DOI: 10.1177/1049909118766316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Caring for a patient with Alzheimer disease (AD) represents a real challenge that can have considerable long-term psychological and physical consequences. The aim of this study was to evaluate the impact of the perception of being recognized on both the psychophysical health and the level of burden reported in caregivers of patients with AD. The secondary aim was to evaluate the association between the use of a home care assistance service and the burden and psychophysical health in caregivers. The Caregiver Burden Inventory (CBI), the 36-item Short-Form Health Survey (SF-36), and a visual analog scale (VAS) to evaluate the level of perception of being recognized were administered to 31 caregivers of patients with AD. Data were also collected from patients with AD using the Mini-Mental State Examination (MMSE). The level of perception of being recognized was significantly and negatively correlated with total burden ( r = -0.36; P = .045) and objective burden ( r = -0.53; P = .002). It was also significantly and positively correlated with the MMSE score ( r = 41; P = .02). Regression models showed that only the perception of being recognized, and not MMSE, significantly predicted lower caregiver objective burden scores. Furthermore, the use of a home care assistance service significantly predicted higher caregiver physical functioning. The perception of being recognized by an AD relative significantly predicted the caregiver's objective burden associated with a shortage of time. The use of a home care assistance service also resulted in a promotion in the caregiver's social functioning. Further studies are needed to confirm these results.
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Affiliation(s)
- Carlo Lai
- 1 Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy
| | - Marta Cipriani
- 1 Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy
| | - Alessia Renzi
- 1 Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy
| | - Massimiliano Luciani
- 2 Psychiatry and Psychology Institute, Catholic University of Sacred Heart, Rome, Italy
| | | | - Paola Aceto
- 4 Department of Anaesthesiology and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
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Arroyo-Anlló EM, Bouston AT, Fargeau MN, Orgaz Baz B, Gil R. Self-Consciousness Deficits in Alzheimer's Disease and Frontotemporal Dementia. J Alzheimers Dis 2018; 55:1437-1443. [PMID: 27858712 DOI: 10.3233/jad-160770] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Self-consciousness (SC) is multifaceted and considered to be the consciousness of one's own mental states. The main aim of this paper is to compare SC in patients with Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD). Three groups (control and patient groups) of 23 subjects each were assessed using an SC questionnaire. Both types of dementia clearly induce an alteration of SC. The bvFTD group showed a greater impairment in SC than the AD and control groups. The SC score was strongly associated with frontal functions. The most significantly impaired SC aspects in the bvFTD group were Anosognosia, Introspection, and Moral Judgments. For the AD group, the significantly impaired aspects of SC were Anosognosia and Prospective Memory. The differences in SC between the AD and bvFTD groups were essentially centered on the Anosognosia, Moral Judgments, and Introspection aspects, which were highly impaired in the bvFTD patients. This suggests that SC is related to orbito-frontal functioning and thus, to the default mode network.
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Affiliation(s)
- Eva Ma Arroyo-Anlló
- Department of Psychobiology, Neuroscience Institute of Castilla-León, University of Salamanca, Salamanca, Spain
| | - Adèle Turpin Bouston
- Department of Neurology, Faculty of Medicine, University Hospital, CHU La Milétrie, Poitiers, France
| | - Marie-Noëlle Fargeau
- Department of Neurology, Faculty of Medicine, University Hospital, CHU La Milétrie, Poitiers, France
| | - Begoña Orgaz Baz
- Department of Methodology of Behaviour Sciences, University of Salamanca, Salamanca, Spain
| | - Roger Gil
- Department of Neurology, Faculty of Medicine, University Hospital, CHU La Milétrie, Poitiers, France
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Chapman S, Colvin LE, Vuorre M, Cocchini G, Metcalfe J, Huey ED, Cosentino S. Cross domain self-monitoring in anosognosia for memory loss in Alzheimer's disease. Cortex 2018. [PMID: 29518705 DOI: 10.1016/j.cortex.2018.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anosognosia for memory loss is a common feature of Alzheimer's disease (AD). Recent theories have proposed that anosognosia, a disruption in awareness at a global level, may reflect specific deficits in self-monitoring, or local awareness. Though anosognosia for memory loss has been shown to relate to memory self-monitoring, it is not clear if it relates to self-monitoring deficits in other domains (i.e., motor). The current study examined this question by analyzing the relationship between anosognosia for memory loss, memory monitoring, and motor monitoring in 35 individuals with mild to moderate AD. Anosognosia was assessed via clinical interview before participants completed a metamemory task to measure memory monitoring, and a computerized agency task to measure motor monitoring. Cognitive and psychological measures included memory, executive functions, and mood. Memory monitoring was associated with motor monitoring; however, anosognosia was associated only with memory monitoring, and not motor monitoring. Cognition and mood related differently to each measure of self-awareness. Results are interpreted within a hierarchical model of awareness in which local self-monitoring processes are associated across domain, but appear to only contribute to a global level awareness in a domain-specific fashion.
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Affiliation(s)
- Silvia Chapman
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Goldsmiths College, University of London, London, United Kingdom.
| | - Leigh E Colvin
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Teachers College, Columbia University, New York, NY, United States
| | - Matti Vuorre
- Department of Psychology, Columbia University, New York, NY, United States
| | - Gianna Cocchini
- Goldsmiths College, University of London, London, United Kingdom
| | - Janet Metcalfe
- Department of Psychology, Columbia University, New York, NY, United States
| | - Edward D Huey
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States
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20
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Perales J, Turró-Garriga O, Gascón-Bayarri J, Reñé-Ramírez R, Conde-Sala JL. The Longitudinal Association Between a Discrepancy Measure of Anosognosia in Patients with Dementia, Caregiver Burden and Depression. J Alzheimers Dis 2018; 53:1133-43. [PMID: 27258415 DOI: 10.3233/jad-160065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND According to cross-sectional studies, there is an association between anosognosia in people with dementia and caregiver's burden and depression. Anosognosia in patients may be a cause of caregiver burden and depression. However, variability in caregiver anosognosia ratings may exist as caregivers with burden and depression may have a more pessimistic view of the patients' health. OBJECTIVE To assess the variability of caregiver anosognosia ratings of patients with dementia using a widely used anosognosia scale and its longitudinal relationship with caregiver burden and depression. METHODS A convenience cohort of 221 consecutive dementia outpatient and caregiver dyads was followed up at 12 and 24 months. The main instruments used were the Anosognosia Questionnaire-Dementia (AQ-D), Caregiver Burden Interview, and Geriatric Depression Scale. Linear mixed models were used including time as a factor in every model. Multivariate analyses controlled for caregiver's socio-demographic and possible confounding factors. RESULTS Attrition at 12 and 24 months was 24.9% and 42.5% respectively. Patients at baseline were on average 77.8 years of age, 63.3% were women, and 63.3% had < 5 years of education. In the bivariate analyses, caregiver burden, depression, and gender were associated with caregiver ratings of total, cognitive, and personality AQ-D of the patient at different time points. Multivariate analyses revealed burden as the caregiver variable most consistently associated with total, cognitive, and personality caregiver AQ-D ratings of the patient. CONCLUSION Some caregiver characteristics, especially burden, are associated with caregiver ratings of AQ-D with regard to the patient.
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Affiliation(s)
- Jaime Perales
- University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas, USA
| | - Oriol Turró-Garriga
- Research Unit, Santa Caterina Hospital, Institut d'Assistència Sanitària, Salt, Spain
| | - Jordi Gascón-Bayarri
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Ramón Reñé-Ramírez
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
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Hashimoto A, Matsuoka K, Yasuno F, Takahashi M, Iida J, Jikumaru K, Kishimoto T. Frontal lobe function in elderly patients with Alzheimer's disease and caregiver burden. Psychogeriatrics 2017; 17:267-272. [PMID: 28130804 DOI: 10.1111/psyg.12231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/30/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
Abstract
AIM Understanding of the relationship between caregiver burden and the degree of behavioural deficits in patients with Alzheimer's disease (AD) is relatively limited. Therefore, it is worthwhile to examine the correlations between the various relevant factors to improve the efficacy of care for patients with AD. The aim of this study was to investigate the specific contributions of frontal lobe dysfunction in AD patients to caregiver burden, while controlling for other predictor variables. METHODS Participants included 30 pairs of caregivers and patients with AD. The Zarit Burden Interview and Frontal Assessment Battery were used to measure the caregiver burden and patients' frontal lobe function, respectively. To investigate the effects of frontal lobe dysfunction on caregiver burden, hierarchical regression equations with steps incorporating additional predictor variables were fitted. We also performed a correlation analysis between the individual subdomains of the Zarit Burden Interview and the predictor variables. RESULTS Our study suggests that the degree of frontal lobe dysfunction in AD patients predicts their caregiver burden, when other factors of daily functional limitations and neuropsychiatric symptoms are controlled. Daily functional limitations and neuropsychiatric symptoms affected caregivers' psychosocial burden, whereas frontal lobe dysfunction affected caregivers' burden due to the increase in the dependency of the patients. CONCLUSION Our findings indicate that to ameliorate the disabilities of patients and reduce caregiver burden, there is a need for interventions that focus on psychosocial burdens, as shown in previous studies, as well as on excessive dependency due to frontal lobe dysfunction.
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Affiliation(s)
- Akiko Hashimoto
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Kiwamu Matsuoka
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Fumihiko Yasuno
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Masato Takahashi
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Junzo Iida
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Kiyoko Jikumaru
- Department of Psychiatric and Mental Health Nursing, Nara Medical University, Kashihara, Japan
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Chavoix C, Insausti R. Self-awareness and the medial temporal lobe in neurodegenerative diseases. Neurosci Biobehav Rev 2017; 78:1-12. [DOI: 10.1016/j.neubiorev.2017.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/03/2017] [Accepted: 04/15/2017] [Indexed: 12/13/2022]
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Küçükgüçlü Ö, Söylemez BA, Yener G, Barutcu CD, Akyol MA. Examining Factors Affecting Caregiver Burden: A Comparison of Frontotemporal Dementia and Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2017; 32:200-206. [PMID: 28403621 PMCID: PMC10852758 DOI: 10.1177/1533317517703479] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was conducted to compare the caregiver burden with regard to Alzheimer's disease (AD) and frontotemporal dementia (FTD) and to determine the factors affecting the caregiver burden of patients with AD and FTD. A comparative descriptive study design was used. The sample consisted of 90 patients with AD and 44 patients with FTD and their caregivers. Sociodemographic questionnaire, Mini-Mental State Examination (MMSE), the Caregiver Burden Inventory (CBI), Neuropsychiatric Inventory (NPI), and Functional Activities Questionnaire (FAQ) were used. Descriptive statistics, t tests, χ2 test, and multinominal regression were used for analysis. No difference was found with subscales and the total score of the CBI, except time dependency scale. The total NPI and FAQ scores correlated significantly, and the MMSE score did not show a significant correlation with the AD and FTD caregiver burden. The presence and frequency of neuropsychological symptoms differ among patients with FTD and AD, and different symptoms affect the caregiver burdens in both groups.
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Affiliation(s)
- Özlem Küçükgüçlü
- Department of Internal Medicine Nursing, Faculty of Nursing, Dokuz Eylul University, Inciralti, Izmir, Turkey
| | - Burcu Akpınar Söylemez
- Department of Internal Medicine Nursing, Faculty of Nursing, Dokuz Eylul University, Inciralti, Izmir, Turkey
| | - Görsev Yener
- Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Inciralti, Izmir, Turkey
- International Biomedicine and Genome Institute, Dokuz Eylül University
| | - Canan Demir Barutcu
- Department of Internal Medicine Nursing, Faculty of Health Sciences, University of Mehmet Akif Ersoy, Burdur, Turkey
| | - Merve Aliye Akyol
- Department of Internal Medicine Nursing, Faculty of Nursing, Dokuz Eylul University, Inciralti, Izmir, Turkey
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Mihaljcic T, Haines TP, Ponsford JL, Stolwyk RJ. Investigating the relationship between reduced self-awareness of falls risk, rehabilitation engagement and falls in older adults. Arch Gerontol Geriatr 2016; 69:38-44. [PMID: 27886565 DOI: 10.1016/j.archger.2016.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/24/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
Abstract
The present study aimed to investigate whether self-awareness of falls risk is associated with rehabilitation engagement, motivation for rehabilitation, and number of falls after hospital discharge. The sample comprised 91 older adults (Mage=77.97, SD=8.04) undergoing inpatient rehabilitation. The Self-Awareness of Falls Risk Measure (SAFRM) was used to measure different aspects of self-awareness. The treating physiotherapist and occupational therapist rated the patient's engagement in rehabilitation and the patient reported his/her motivation for treatment. Falls information was collected from the patient and significant other once a month for three months following hospital discharge. Significant correlations were found between physiotherapist-rated engagement and intellectual (rs=-0.22, p<0.05) and anticipatory awareness (rs=-0.24, p<0.05). Occupational therapist-rated engagement and patient-reported motivation for rehabilitation was correlated with emergent awareness (rs=-0.38 and -0.31, p<0.05, respectively) and overall self-awareness (rs=-0.31 and -0.26, p<0.05, respectively). Regression analyses indicated that overall self-awareness provided a unique contribution to occupational therapist-rated engagement when controlling for age, gender, cognition and functional ability. Falls were reported by 29.9% of participants, however, self-awareness did not differ significantly between fallers and non-fallers. The findings suggest that self-awareness of falls risk is associated with rehabilitation engagement and motivation. Therefore, improving patient self-awareness of falls risk may increase engagement in therapy leading to better patient outcomes.
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Affiliation(s)
- Tijana Mihaljcic
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Terry P Haines
- Department of Physiotherapy, Monash University, McMahons Road, Frankston, VIC 3199, Australia; Allied Health Research Unit, Monash Health, Warrigal Road, Cheltenham, VIC 3192, Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia; Monash-Epworth Rehabilitation Research Centre, Suite 1.7, 173 Lennox Street, VIC 3121, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia.
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25
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Mood-congruent recollection and anosognosia in Alzheimer's disease. Cortex 2016; 84:55-62. [DOI: 10.1016/j.cortex.2016.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/05/2016] [Accepted: 09/05/2016] [Indexed: 11/22/2022]
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A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being. Int Psychogeriatr 2016; 28:1761-1774. [PMID: 27345942 DOI: 10.1017/s1041610216000922] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms in dementia (BPSD) are important predictors of institutionalization as well as caregiver burden and depression. Previous reviews have tended to group BPSD as one category with little focus on the role of the individual symptoms. This review investigates the role of the individual symptoms of BPSD in relation to the impact on different measures of family caregiver well-being. METHODS Systematic review and meta-analysis of papers published in English between 1980 and December 2015 reporting which BPSD affect caregiver well-being. Paper quality was appraised using the Downs and Black Checklist (1998). RESULTS Forty medium and high quality quantitative papers met the inclusion criteria, 16 were suitable to be included in a meta-analysis of mean distress scores. Depressive behaviors were the most distressing for caregivers followed by agitation/aggression and apathy. Euphoria was the least distressing. Correlation coefficients between mean total behavior scores and mean distress scores were pooled for four studies. Irritability, aberrant motor behavior and delusions were the most strongly correlated to distress, disinhibition was the least correlated. CONCLUSIONS The evidence is not conclusive as to whether some BPSD impact caregiver well-being more than others. Studies which validly examined BPSD individually were limited, and the included studies used numerous measures of BPSD and numerous measures of caregiver well-being. Future research may benefit from a consistent measure of BPSD, examining BPSD individually, and by examining the causal mechanisms by which BPSD impact well-being by including caregiver variables so that interventions can be designed to target BPSD more effectively.
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DeCaporale-Ryan LN, Steffen AM, Marwit SJ, Meuser TM. Dementia spousal caregivers and past transgressions: Measuring and understanding forgiveness experiences. J Women Aging 2016; 28:510-520. [PMID: 27420648 DOI: 10.1080/08952841.2015.1065143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The transition from "wife" to "caregiver" for a cognitively impaired husband can be an overwhelming experience. Communication patterns change and small conflicts can grow, at times bringing angry feelings and new burdens. Engagement with forgiveness processes may benefit wives by lowering resentment over past tensions, restoring trust, and enhancing the overall caregiving experience. This study examined the utility of the Enright Forgiveness Inventory (EFI) within a sample of caregiving wives. Our intent was to better understand this population's experience with forgiveness when other contextual factors were likely to influence this process. Forgiveness scores on the EFI were positively related to the cognitive status of the care recipient, a particularly important finding for clinical intervention, and inversely related to marital distress and state anxiety.
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Affiliation(s)
- Lauren N DeCaporale-Ryan
- a Psychiatry, Medicine, & Surgery , University of Rochester Medical Center , Rochester , New York , USA
| | - Ann M Steffen
- b Department of Psychological Sciences , University of Missouri-St. Louis , St. Louis , Missouri , USA
| | | | - Thomas M Meuser
- d Department of Gerontology & Social Work , University of Missouri-St. Louis , St. Louis , Missouri , USA
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Abstract
Persons with Alzheimer’s disease (AD) often seem to have a poor insight into the functional deficits brought about by the dementing process. There are many indications that preserved insight into deficits in dementia is of advantage to a person with AD. Various research approaches have been adopted to investigate poor insight related to AD. The purpose of this article was to present various research approaches for investigating poor insight into deficits in AD. The study is based on a literature survey. The findings show that concept of poor insight has been investigated in detail from different perspectives. Each one of the perspectives found, the neuropsychological, the psychological and the socio-psychological, has its merits, but none of them has yet led to study results that make us fully understand what poor insight implies and involves. We need integrated knowledge from the different perspectives, and in multidisciplinary research settings we believe that such knowledge could be developed.
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Affiliation(s)
| | | | - Helle Wijk
- Göteborg University, and Sahlgrenska University Hospital, Sweden
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Abstract
There are strong opinions about the advantages and disadvantages of a disclosure of dementia to the individual affected, but little is known about how they and their families understand and respond to this information. This article reports and examines the impact of receiving a diagnosis of dementia, by comparing descriptions of its impact at two weeks, with descriptions explored at 12 weeks. Interviews were undertaken on two occasions with 18 couples, one of whom had received a diagnosis of dementia, the other being a family member. The interviews revealed a gradual process of realization of what the diagnosis meant, resulting in important subtle changes in understandings of dementia and personal relationships. Disclosure of dementia occurs at one point in time, but its impact should be seen as a process. Suggestions are made on how the process of diagnosis and its sharing may enhance family partnerships and social relationships through support of both individuals with dementia and families.
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Lima S, Gago M, Garrett C, Pereira MG. Medication adherence in Alzheimer's disease: The mediator role of mindfulness. Arch Gerontol Geriatr 2016; 67:92-7. [PMID: 27475468 DOI: 10.1016/j.archger.2016.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/26/2016] [Accepted: 06/28/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Medication adherence is often assessed based on compliance to the dosage and frequency of physician's prescription. Cognitive impairment is one of the biggest barriers in elderly patients with Alzheimer's disease (AD), who are usually polymedicated with different oral drugs. Transdermal drug delivery, also requires mobility abilities, reinforcing the role of patients' caregivers. OBJECTIVE To evaluate the relationship between psychological variables such as social support, family satisfaction, psychological morbidity, awareness of the disease, coping, mindfulness and medication adherence, in patients with AD, taking in consideration the patient's perspective. DESIGN Cross-sectional and quantitative study including 128 patients with mild AD. RESULTS Medication adherence showed a positive relationship with social support, mindfulness, family satisfaction and awareness of the disease. Mindfulness was a mediator in the relationship between awareness of the disease and medication adherence. CONCLUSIONS This study reinforces the importance of psychological assessment in medication adherence in mild AD patients, specially the role of mindfulness. Intervention programs to promote mindfulness may have a potential dual benefit, preserving cognitive skills and promoting medication adherence.
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Affiliation(s)
- Sara Lima
- School of Psychology, University of Minho, Portugal; Research Center on Psychology, University of Minho, Portugal.
| | - Miguel Gago
- Department of Neurology of Hospital Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal
| | - Carolina Garrett
- Faculty of Medicine University of Porto, Portugal; Department of Neurology of Hospital S. João, Portugal
| | - M Graça Pereira
- School of Psychology, University of Minho, Portugal; Research Center on Psychology, University of Minho, Portugal
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Amjad H, Roth DL, Samus QM, Yasar S, Wolff JL. Potentially Unsafe Activities and Living Conditions of Older Adults with Dementia. J Am Geriatr Soc 2016; 64:1223-32. [PMID: 27253366 PMCID: PMC4914464 DOI: 10.1111/jgs.14164] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the prevalence of dementia in the absence of a reported dementia diagnosis and whether potentially unsafe activities and living conditions vary as a function of dementia diagnosis status in a nationally representative sample of older adults. DESIGN Observational cohort study. SETTING Community. PARTICIPANTS Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study (N = 7,609). MEASUREMENTS Participants were classified into four groups based on self-report of dementia diagnosis, proxy screening interview, and cognitive testing: probable dementia with reported dementia diagnosis (n = 457), probable dementia without reported dementia diagnosis (n = 581), possible dementia (n = 996), or no dementia (n = 5,575). Potentially unsafe activities (driving, preparing hot meals, managing finances or medications, attending doctor visits alone) and living conditions (falls, living alone, and unmet needs) were examined according to dementia status subgroups in stratified analyses and multivariate models, adjusting for sociodemographic factors, medical comorbidities, and physical capacity. RESULTS The prevalence of driving (22.9%), preparing hot meals (31.0%), managing finances (21.9%), managing medications (36.6%), and attending doctor visits alone (20.6%) was lowest in persons with probable dementia; however, but in persons with probable dementia, the covariate-adjusted rates of driving, preparing hot meals, managing finances, managing medications, and attending doctor visits alone were significantly higher in those without reported dementia diagnosis than in those with reported diagnosis (all odds ratios ≥2.00, all P < .01). CONCLUSION Older adults with probable dementia who are not aware of a dementia diagnosis are more likely to report engaging in potentially unsafe behaviors. Understanding the prevalence of potentially unsafe activities and living conditions can help clinicians focus safety screening and counseling in older adults with diagnosed or suspected dementia.
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Affiliation(s)
- Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David L. Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Quincy M. Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sevil Yasar
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Jennifer L. Wolff
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
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Conde-Sala JL, Turró-Garriga O, Piñán-Hernández S, Portellano-Ortiz C, Viñas-Diez V, Gascón-Bayarri J, Reñé-Ramírez R. Effects of anosognosia and neuropsychiatric symptoms on the quality of life of patients with Alzheimer's disease: a 24-month follow-up study. Int J Geriatr Psychiatry 2016; 31:109-19. [PMID: 25963296 DOI: 10.1002/gps.4298] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/15/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Neuropsychiatric symptoms and anosognosia are known to influence the perceived quality of life of patients (QoL-p) with Alzheimer's disease (AD). This study analysed their impact on patient and caregiver ratings of QoL-p and how these ratings changed in relation to the severity of dementia. METHODS A baseline sample of 221 patients and caregivers was followed up over 24 months. Instruments: Neuropsychiatric Inventory (NPI), Anosognosia Questionnaire-Dementia (AQ-D), Quality of life-Alzheimer's Disease (QoL-AD) and the Global Deterioration Scale (GDS). Longitudinal data were analysed using generalized linear models. RESULTS In the multivariate analysis, greater anosognosia was always associated with higher ratings of QoL-p among patients, especially at 24 months (p < 0.001), and with more negative ratings among caregivers, especially at baseline (p < 0.001). A higher total NPI score was associated with a more negative rating of QoL-p among caregivers (p < 0.001), and it also had a smaller negative effect on patients' self-ratings (p = 0.001). The neuropsychiatric symptoms (NPI) associated with a more negative view of QoL-p were depression, for patients' self-ratings, and apathy and agitation for caregiver ratings. The discrepancy between patient and caregiver ratings increased in line with the severity of dementia. CONCLUSION Neuropsychiatric symptoms had a similarly negative effect on the QoL-p ratings of both patients and caregivers, whereas the effect of anosognosia differed according to the rater (positive for patients, negative for caregivers).
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Affiliation(s)
| | - Oriol Turró-Garriga
- Research Unit, Santa Caterina Hospital, Institut d'Assistència Sanitària, Salt, Spain
| | | | | | - Vanesa Viñas-Diez
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Jordi Gascón-Bayarri
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Ramón Reñé-Ramírez
- Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
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Verhülsdonk S, Supprian T, Höft B. [Geriatric psychiatric home counseling for people with dementia and anosognosia : Results of a model project]. Z Gerontol Geriatr 2016; 50:219-225. [PMID: 26779708 DOI: 10.1007/s00391-015-1018-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/30/2015] [Accepted: 12/22/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lack of awareness of an illness (anosognosia) is a common symptom in dementia and has a significant impact on the course of the disease. It is associated with dysfunctional interaction with caregivers. Due to unawareness patients are not able to accept diagnostic procedures or medical treatment and refuse any kind of support. Thus, they are not integrated into psychosocial networks and medical support. This has a significant impact on patient-centered care in a domestic environment. In this article a model project with home visits to patients with dementia and anosognosia is described. METHOD A total of 55 home visits were carried out. The aim of this project was the integration into the existing healthcare services in order to safeguard the domestic environment. These visits focused on advice and information for the patients and their caregivers initiating the visits. Sociodemographic data of the patient cohort and the satisfaction of the caregiving relatives and general practitioners are presented. RESULTS Subjects with dementia were found to be in advanced stages of the disease, caring situations were complex and required assistance. Caregivers showed a substantial burden in accordance with previous reports. CONCLUSION New strategies are required to cope with anosognosia in patients with dementia and their caregivers. Even single home visits seem to be sufficient to initiate support for subjects with dementia and their relatives.
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Affiliation(s)
- Sandra Verhülsdonk
- Institutsambulanz Gerontopsychiatrie, LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Mooren Str. 5, Gebäude 14.99, 40225, Düsseldorf, Deutschland.
| | - T Supprian
- Institutsambulanz Gerontopsychiatrie, LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Mooren Str. 5, Gebäude 14.99, 40225, Düsseldorf, Deutschland
| | - B Höft
- Institutsambulanz Gerontopsychiatrie, LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Mooren Str. 5, Gebäude 14.99, 40225, Düsseldorf, Deutschland
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Shim SH, Kang HS, Kim JH, Kim DK. Factors Associated with Caregiver Burden in Dementia: 1-Year Follow-Up Study. Psychiatry Investig 2016; 13:43-9. [PMID: 26766945 PMCID: PMC4701684 DOI: 10.4306/pi.2016.13.1.43] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/05/2015] [Accepted: 03/28/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Dementia symptoms (cognitive function, daily-living function, and neuropsychiatric symptoms) become more serious over time, which is likely to increase caregiver burden. The aim of this study is to investigate which dementia-related symptoms, and how the progression of these symptoms, have influenced caregiver burden during a 1-year follow-up assessment. METHODS A total of 110 patients with dementia were assessed for their cognitive function, daily-living function, and neuropsychiatric symptoms. Caregivers were assessed for their caregiver burden. Bivariate analyses were conducted between caregiver burden and dementia patients' symptoms, in order to examine which particular symptoms were significantly associated with caregiver burden at the baseline. A multiple regression analysis was then conducted with each significantly associated variable with a view to identifying determinants, influencing caregiver burden. Additionally, bivariate analyses were conducted between the changes in caregiver burden and the changes in patients' symptoms, to investigate which patient variable could best describe caregiver burden from baseline to the 1-year follow-up. A multiple regression analysis was conducted with each significantly-associated change in symptom, in order to identify determinants that influence a change in caregiver burden. RESULTS Neuropsychiatric symptoms, such as irritability, aberrant motor-behavior, delusions and disinhibition were found to be significant predictors of caregiver burden at baseline, according to multiple regression analysis. In addition, changes in neuropsychiatric symptoms, such as delusions, agitation and memory-related functioning in daily-living significantly predict a change in caregiver burden. CONCLUSION Our results demonstrate that neuropsychiatric symptoms and memory impairment in daily-living functions are significant predictors of an increase in caregiver burden.
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Affiliation(s)
- Sang Hong Shim
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Hyo Shin Kang
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Ji Hae Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doh Kwan Kim
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Piersma D, de Waard D, Davidse R, Tucha O, Brouwer W. Car drivers with dementia: Different complications due to different etiologies? TRAFFIC INJURY PREVENTION 2015; 17:9-23. [PMID: 25874501 DOI: 10.1080/15389588.2015.1038786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Older drivers with dementia are an at-risk group for unsafe driving. However, dementia refers to various etiologies and the question is whether dementias of different etiology have similar effects on driving ability. METHODS The literature on the effects of dementia of various etiologies on driving ability is reviewed. Studies addressing dementia etiologies and driving were identified through PubMed, PsychINFO, and Google Scholar. RESULTS AND CONCLUSIONS Early symptoms and prognoses differ between dementias of different etiology. Therefore, different etiologies may represent different likelihoods with regard to fitness to drive. Moreover, dementia etiologies could indicate the type of driving problems that can be expected to occur. However, there is a great lack of data and knowledge about the effects of almost all etiologies of dementia on driving. One could hypothesize that patients with Alzheimer's disease may well suffer from strategic difficulties such as finding a route, whereas patients with frontotemporal dementia are more inclined to make tactical-level errors because of impaired hazard perception. Patients with other dementia etiologies involving motor symptoms may suffer from problems on the operational level. Still, the effects of various etiologies of dementias on driving have thus far not been studied thoroughly. For the detection of driving difficulties in patients with dementia, structured interviews with patients but also their family members appear crucial. Neuropsychological assessment could support the identification of cognitive impairments. The impact of such impairments on driving could also be investigated in a driving simulator. In a driving simulator, strengths and weaknesses in driving behavior can be observed. With this knowledge, patients can be advised appropriately about their fitness to drive and options for support in driving (e.g., compensation techniques, car adaptations). However, as long as no valid, reliable, and widely accepted test battery is available for the assessment of fitness to drive, costly on-road test rides are inevitable. The development of a fitness-to-drive test battery for patients with dementia could provide an alternative for these on-road test rides, on condition that differences between dementia etiologies are taken into consideration.
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Affiliation(s)
- Dafne Piersma
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Dick de Waard
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Ragnhild Davidse
- b SWOV Institute for Road Safety Research , The Hague , The Netherlands
| | - Oliver Tucha
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Wiebo Brouwer
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
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Abdollahpour I, Nedjat S, Salimi Y, Noroozian M, Majdzadeh R. Which variable is the strongest adjusted predictor of quality of life in caregivers of patients with dementia? Psychogeriatrics 2015; 15:51-7. [PMID: 25515404 DOI: 10.1111/psyg.12094] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/02/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The central role of family in caregiving for patients with dementia is now widely acknowledged. However, in playing this role, caregivers may neglect their health and quality of life (QOL). The purposes of present study were to measure caregivers' QOL and to determine its adjusted predictors via multiple regression models. METHODS We used sequential sampling to recruit 153 patients and their caregivers from the Iran Alzheimer Association in our cross-sectional study. A single-item question with a Likert scale was applied to measure QOL. A multiple linear regression model was used to determine the adjusted predictors of QOL. RESULTS Of the responding caregivers, 22.8% reported their QOL as poor or very poor. Caregiver burden, the main caregiver's age, the Global Deterioration Scale, and the number of caregivers were introduced as adjusted predictors of QOL. CONCLUSIONS Caregiver burden was proposed as the strongest adjusted predictor for caregivers' poor QOL. Therefore, it seems that interventions to reduce caregiver burden can be effective in enhancing caregivers' QOL.
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Affiliation(s)
- Ibrahim Abdollahpour
- School of Public Health, Arak University of Medical Sciences, Arak, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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García-Alberca J. Cognitive intervention therapy as treatment for behaviour disorders in Alzheimer disease: evidence on efficacy and neurobiological correlations. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2012.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Starkstein SE. Anosognosia in Alzheimer's disease: Diagnosis, frequency, mechanism and clinical correlates. Cortex 2014; 61:64-73. [DOI: 10.1016/j.cortex.2014.07.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/13/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
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Mihaljcic T, Haines TP, Ponsford JL, Stolwyk RJ. Development of a new self-awareness of falls risk measure (SAFRM). Arch Gerontol Geriatr 2014; 59:249-56. [DOI: 10.1016/j.archger.2014.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/03/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
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Armstrong N, Schupf N, Grafman J, Huey ED. Caregiver burden in frontotemporal degeneration and corticobasal syndrome. Dement Geriatr Cogn Disord 2014; 36:310-8. [PMID: 24022248 PMCID: PMC4484601 DOI: 10.1159/000351670] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Caregiver stress is often a serious problem when caring for a patient with frontal lobe dysfunction. METHODS A total of 102 caregivers of both patients with frontotemporal degeneration and corticobasal syndrome completed the Frontal Systems Behavior Scale (FrSBe) and the Zarit Burden Interview (ZBI). To analyze the association between apathy or disinhibition (or both) and caregiver burden, the effects of the total FrSBe and the apathy and disinhibition subscales of the FrSBE on the total ZBI score were assessed with logistic regressions and t tests. RESULTS Total FrSBE score and the apathy FrSBE subscore predicted caregiver burden. Apathy occurred without disinhibition, and the two occurred together, but disinhibition without apathy was very rare. CONCLUSIONS Disinhibition without apathy occurred very rarely. Apathy was more associated with caregiver burden than disinhibition.
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Affiliation(s)
- Nicole Armstrong
- Department of Epidemiology, Mailman School of Public Health, New York, N.Y., USA
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Correlation between behavioural and psychological symptoms of Alzheimer type dementia and plasma homocysteine concentration. BIOMED RESEARCH INTERNATIONAL 2014; 2014:383494. [PMID: 24995291 PMCID: PMC4065769 DOI: 10.1155/2014/383494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 05/19/2014] [Indexed: 12/04/2022]
Abstract
The relationship between plasma homocysteine and behavioral and psychological symptoms of dementia (BPSD) has not been specifically investigated in previous research. In this study, we compared plasma homocysteine (Hcy) among 40 Alzheimer's disease (AD) patients with BPSD, 37 AD patients without BPSD, and 39 healthy controls. Our results evidenced that the plasma homocysteine levels in AD patients with BPSD and without BPSD were higher than healthy controls and that the plasma homocysteine concentration in AD patients with BPSD was the highest among the three groups. Significant correlation between plasma homocysteine concentration and cognitive decline and duration of dementia was observed, but there was no correlation between BPSD and cognitive dysfunction or duration of dementia. In conclusion, this study showed for the first time that BPSD were associated with plasma homocysteine concentration in Alzheimer's dementia, and the results supported that hyperhomocysteine may take part in the pathogenesis of BPSD.
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Kim SS, Oh KM, Richards K. Sleep disturbance, nocturnal agitation behaviors, and medical comorbidity in older adults with dementia: relationship to reported caregiver burden. Res Gerontol Nurs 2014; 7:206-14. [PMID: 24877599 DOI: 10.3928/19404921-20140512-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 05/05/2014] [Indexed: 11/20/2022]
Abstract
The purpose of this secondary analysis study was to determine whether care recipients' nighttime sleep patterns, medical comorbidity, observed nocturnal agitation behaviors, and caregivers' perceptions of nocturnal agitation behaviors in care recipients with dementia are associated with caregiver burden. Sixty care recipient-caregiver dyads, comprising older adults with geriatrician-diagnosed dementia living at home with caregivers, participated. Caregivers' perceptions of the frequency of care recipients' nocturnal agitation behaviors were associated with caregiver burden; however, objective, real-time data on the frequency of nocturnal agitation behaviors were not associated with burden. Care recipients' increased minutes of wakefulness before falling asleep and severe cognitive impairment with musculoskeletal/integument and neurological comorbidities were associated with higher caregiver burden. These results suggest that targeted interventions to reduce sleep onset latency, medical comorbidity, and caregivers' perception of frequency of nocturnal behaviors may reduce caregiver burden.
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Marková IS, Clare L, Whitaker CJ, Roth I, Nelis SM, Martyr A, Roberts JL, Woods RT, Morris R. Phenomena of awareness in dementia: Heterogeneity and its implications. Conscious Cogn 2014; 25:17-26. [DOI: 10.1016/j.concog.2014.01.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/18/2014] [Accepted: 01/21/2014] [Indexed: 12/31/2022]
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Dimensions of caregiver burden in dementia: impact of demographic, mood, and care recipient variables. Am J Geriatr Psychiatry 2014; 22:294-300. [PMID: 23567422 PMCID: PMC3723767 DOI: 10.1016/j.jagp.2012.09.006] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 09/07/2012] [Accepted: 09/26/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE While typically examined as a unitary construct, there is evidence that caregiver burden may be composed of several dimensions. The purpose of this study was to examine the factor structure of the Zarit Burden Interview (ZBI) in a sample of dementia caregivers and to explore the relationship between these factors and demographic, mood, and care recipient variables. DESIGN Cross-sectional. SETTING Academic medical center. PARTICIPANTS 206 spousal or adult child caregivers for patients with mild to moderate dementia residing in the community. MEASUREMENTS Caregiver measures included the ZBI, Center for Epidemiologic Studies Depression Scale, and the Burns Relationship Satisfaction Scale. Patient measures included scores on the Dementia Rating Scale, Lawton-Brody Activities of Daily Living scale, and Revised Memory and Behavior Problems Checklist. RESULTS Factor analysis revealed three dimensions of caregiver burden: direct impact of caregiving upon caregivers' lives, guilt, and frustration/embarrassment. Caregiver depression and age emerged as unique predictors of the first two factors. Caregivers' satisfaction with their relationship with the patient and patients' functional independence also uniquely predicted the direct impact of caregiving upon caregivers' lives. Patients' behavioral problems and caregivers' level of relationship satisfaction with the care recipient served as unique predictors of frustration/embarrassment. CONCLUSIONS Findings demonstrate the multidimensionality of caregiver burden among dementia caregivers. Given the unique predictors of each dimension of burden, caregivers may benefit from different types of tailored interventions specific to the subtype of burden they are experiencing.
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Rosen HJ, Alcantar O, Zakrzewski J, Shimamura AP, Neuhaus J, Miller BL. Metacognition in the behavioral variant of frontotemporal dementia and Alzheimer's disease. Neuropsychology 2014; 28:436-47. [PMID: 24548124 DOI: 10.1037/neu0000012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Impaired self-awareness is characteristic of nearly all dementias, including Alzheimer's disease (AD), but the deficit is most severe in the behavioral variant of frontotemporal dementia (bvFTD). The prominence of frontal pathology in bvFTD suggests that failure of online monitoring, the process by which individuals monitor their own cognitive processing in real time, is an important contributor. Metacognitive research offers several approaches to measure self-assessment, some more and others less sensitive to online monitoring. The goal of this study was to assess metacognition in bvFTD using several approaches, and to compare the results with those in AD. METHOD We examined metacognition in 12 patients with bvFTD, 14 with AD, and 35 healthy controls using feeling of knowing (FOK), ease of learning (EOL), judgment of learning (JOL), and retrospective confidence rating (CR) tasks, as well as response to feedback about performance. RESULTS BvFTD and AD were both impaired at FOK compared with controls, although AD showed some sparing. Both groups were similarly impaired at CR and neither group was impaired at JOL after accounting for memory performance. Most striking, bvFTD patients failed to appropriately adjust their predictions about future memory performance even after receiving explicit feedback that they had performed worse than they expected. CONCLUSIONS Both bvFTD and AD show deficits in online monitoring, although the deficit appears more severe in bvFTD. The insensitivity of bvFTD patients to overt feedback may point to unique mechanisms, possibly frontally mediated, that add to their severe lack of self-awareness.
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Affiliation(s)
- Howard J Rosen
- Department of Neurology, University of California San Francisco
| | - Oscar Alcantar
- Department of Neurology, University of California San Francisco
| | | | | | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Bruce L Miller
- Department of Neurology, University of California San Francisco
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Kudlicka A, Clare L, Hindle JV. Quality of life, health status and caregiver burden in Parkinson's disease: relationship to executive functioning. Int J Geriatr Psychiatry 2014; 29:68-76. [PMID: 23625583 DOI: 10.1002/gps.3970] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 01/12/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High-quality person-centred care for people with Parkinson's disease (PwPD) and their families relies on identifying and addressing factors that specifically impact on quality of life (QoL). Deficits in executive functions (EF) are common in Parkinson's disease, but their impact on PwPD and their caregivers is not well understood. The present study evaluated how EF contributes to QoL and health status for the PwPD and caregiver burden. METHODS Sixty-five PwPD completed measures of QoL, health status and EF, and 50 caregivers rated the EF of the PwPD and their own burden. Multiple regression analyses examined predictors of QoL (general life, health and movement disorders domains), health status and caregiver burden. RESULTS Quality of life in the health and movement disorders domains was best explained by caregiver-rated EF, whereas QoL in the general life domain was best explained by level of depression. Health status was predicted by self-rated EF, with an objective EF measure also included in the regression model. Caregiver burden was best explained by caregiver-rated EF and disease severity, with general cognition and other factors also included in the regression model. CONCLUSIONS Executive functions-related behavioural problems may contribute to QoL and health status in PwPD and affect caregiver burden. The findings support the view that the concepts of subjective QoL and self-assessed health status are only partially related and should not be seen as identical. Adequate strategies to reduce the impact of EF deficits are needed as this may have the potential to improve QoL in PwPD.
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Clare L, Whitaker CJ, Roberts JL, Nelis SM, Martyr A, Marková IS, Roth I, Woods RT, Morris RG. Memory awareness profiles differentiate mild cognitive impairment from early-stage dementia: evidence from assessments of performance monitoring and evaluative judgement. Dement Geriatr Cogn Disord 2013; 35:266-79. [PMID: 23548548 DOI: 10.1159/000346735] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Measures of memory awareness based on evaluative judgement and performance monitoring are often regarded as equivalent, but the Levels of Awareness Framework suggests they reflect different awareness phenomena. Examination of memory awareness among groups with differing degrees of impairment provides a test of this proposition. METHOD Ninety-nine people with dementia (PwD), 30 people with mild cognitive impairment (PwMCI), and their relatives completed isomorphic performance monitoring and evaluative judgement measures of memory awareness and were followed up at 12 and (PwD only) 20 months. In addition to the resulting awareness indices, comparative accuracy scores were calculated using the relatives' data to establish whether any inaccuracy was specific to self-ratings. RESULTS When making evaluative judgements about their memory in general, both PwD and PwMCI tended to overestimate their own functioning relative to informant ratings made by relatives. When monitoring performance on memory tests, PwD again overestimated performance relative to test scores, but PwMCI were much more accurate. Comparative accuracy scores indicated that, unlike PwD, PwMCI do not show a specific inaccuracy in self-related appraisals. CONCLUSIONS The results support the proposition that awareness indices at the levels of evaluative judgement and performance monitoring should be regarded as reflecting distinct awareness phenomena.
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Affiliation(s)
- Linda Clare
- School of Psychology, Bangor University, Bangor LL57 2AS, UK.
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Hsieh S, Irish M, Daveson N, Hodges JR, Piguet O. When one loses empathy: its effect on carers of patients with dementia. J Geriatr Psychiatry Neurol 2013; 26:174-84. [PMID: 23857888 DOI: 10.1177/0891988713495448] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effects of empathy loss in frontotemporal dementia (FTD) and Alzheimer disease (AD) on carer symptomatology were investigated. Carers of patients with 2 clinical subtypes of FTD (behavioral-variant FTD [bvFTD] = 18; semantic dementia [SD] = 14) and AD (n = 18) completed the Interpersonal Reactivity Index (IRI), a standardized questionnaire of empathy as well as a measure of perceived burden (Zarit Burden Interview) and the quality of the marital relationship (Intimate Bond Measure). Patient ratings were also obtained on the IRI. Loss of empathy was most striking in the bvFTD group with a marked discrepancy observed between carer and patient ratings for change in emotional warmth and the ability to take the perspective of others. Empathy loss in bvFTD was associated with a loss of a caring marital relationship. Empathic deficits in SD were milder by comparison to bvFTD and correlated with disease severity and increased perceived carer burden. The behavioral pattern observed in AD differed from the FTD syndromes; deficits were observed only for measures of personal distress with carers reporting that patients were less able to handle emotionally evocative situations. Results highlight that changes in aspects of empathy differ across dementia syndromes and are associated with differing carer and clinical variables. These findings might be explained by the progression of atrophy in regions that are known to be critical for empathy and social behavior and has implications for the delivery and planning of services in dementia.
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Affiliation(s)
- Sharpley Hsieh
- Neuroscience Research Australia, Hospital Road, Randwick, Australia
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Trzepacz PT, Saykin A, Yu P, Bhamditipati P, Sun J, Dennehy EB, Willis B, Cummings JL. Subscale validation of the neuropsychiatric inventory questionnaire: comparison of Alzheimer's disease neuroimaging initiative and national Alzheimer's coordinating center cohorts. Am J Geriatr Psychiatry 2013; 21:607-22. [PMID: 23602309 PMCID: PMC3913908 DOI: 10.1016/j.jagp.2012.10.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 10/17/2012] [Accepted: 10/26/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Neuropsychiatric symptoms are prevalent in mild cognitive impairment (MCI) and Alzheimer disease (AD) and commonly measured using the Neuropsychiatric Inventory (NPI). Based on existing exploratory literature, we report preliminary validation of three NPI Questionnaire (NPI-Q-10) subscales that measure clinically meaningful symptom clusters. METHODS Cross-sectional results for three subscales (NPI-Q-4-Frontal, NPI-Q-4-Agitation/Aggression, NPI-Q-3-Mood) in amnestic MCI and AD dementia cases from the National Alzheimer's Coordinating Center (NACC) and Alzheimer's Disease Neuroimaging Initiative (ADNI) databases were analyzed using confirmatory unrotated principal component analysis. RESULTS ADNI contributed 103 MCI, 90 MCI converters, and 112 AD dementia cases, whereas NACC contributed 1,042 MCI, 763 MCI converters, and 3,048 AD dementia cases. NACC had higher baseline mean age (75.7 versus 74.6), and more impaired mean scores (at month 24) on Mini-Mental State Exam (19.5 versus 22.4) and NPI-Q-10 (5.0 versus 4.3), and all NPI-Q subscales than ADNI. Medians were not different between cohorts for NPI-Q-4-Agitation/Aggression, and NPI-Q-3-Mood, however. Each item on all scales/subscales contributed variance in principal component analysis Pareto plots. All items in Factor (F) 1 for each scale/subscale projected in a positive direction on biplots (revealing coherence), whereas F2 and F3 items showed more spatial separation (revealing independence). There were remarkable similarities between cohorts for factor loadings and spatial patterns of item projections, although factor item identities varied somewhat, especially beyond F1. CONCLUSION The similar pattern of results across two cohorts support validity of these subscales, which are worthy of further psychometric evaluation in MCI and AD patients and preliminary application in clinical settings.
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Conde-Sala JL, Reñé-Ramírez R, Turró-Garriga O, Gascón-Bayarri J, Juncadella-Puig M, Moreno-Cordón L, Viñas-Diez V, Vilalta-Franch J, Garre-Olmo J. Factors associated with the variability in caregiver assessments of the capacities of patients with Alzheimer disease. J Geriatr Psychiatry Neurol 2013; 26:86-94. [PMID: 23514974 DOI: 10.1177/0891988713481266] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several studies have identified certain caregiver factors that can produce variability in their assessments of the capacities of patients with Alzheimer disease (AD). OBJECTIVES To identify the caregiver variables associated with variability in their ratings of patients' capacities. METHODS Consecutive sample of 221 outpatients with AD and their family caregivers. The capacities evaluated by caregivers were the degree of functional disability, using the Disability Assessment for Dementia (DAD); psychological and behavioral symptoms, via the Neuropsychiatric Inventory (NPI); anosognosia, with the Anosognosia Questionnaire-Dementia (AQ-D); and quality of life, using the Quality of Life in AD (QOL-AD). The relationship between these measures and caregiver's gender, burden, depression, and health was analyzed by means of a bivariate analysis, calculating the effect size (Cohen d) and subsequently by a regression analysis, calculating the contribution coefficient (CC). RESULTS The greatest variability in caregiver assessments was observed in relation to patients with early-stage dementia, where caregiver's burden was the main factor associated with a more negative evaluation (d = 1.02-1.25). Depression in the caregiver was associated with less variability and only in the assessments of patients with moderate dementia (d = 0.38-0.69). In the regression analysis, caregiver factors were associated with greater variance in scores on the NPI (CC = 37.4%) and QOL-AD (CC = 27.2%), and lower variance in AQ-D (CC = 21.6%) and DAD (CC = 10.3%) scores. CONCLUSIONS Caregiver's burden and depression were associated with more negative assessments of patients' psychological and behavioral symptoms and quality of life.
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