Objective Screening Tools to Assess Cognitive Impairment and Depression:

Retirement community residents' physical activity, depressive symptoms, and functional limitations

This study examined the types of physical activity (PA) retirement community residents report and the effects of PA and depressive symptoms on functional limitations. Elders (N=38) enrolled in a 2-year sensor technology study in senior housing completed regular assessments of functional limitations and depressive symptoms with the Short Physical Performance Battery and Geriatric Depression Scale, respectively. Evaluation of reported PA using the Physical Activity Scale for the Elderly coincided with 12-month functional limitation testing. Subjects were 69% female with mean age of 85 years. Individuals reporting greater PA had significantly fewer functional limitations at 12 months. In multiple regression analysis, baseline functional limitations explained 66% of the variance in 12-month functional limitations, while current PA explained an additional 5%. Although PA explained a small amount of variance in 12-month functional limitations, as a modifiable behavior, PA should be championed and supported to help ameliorate functional limitations in older adults.

Effects of a creative expression intervention on emotions, communication, and quality of life in persons with dementia

BACKGROUND

Effective nonpharmacological interventions are needed to treat neuropsychiatric symptoms and to improve quality of life for the 5.3 million Americans affected by dementia.

OBJECTIVE

The purpose of this study was to test the effect of a storytelling program, TimeSlips, on communication, neuropsychiatric symptoms, and quality of life in long-term care residents with dementia.

METHODS

A quasi-experimental, two-group, repeated measures design was used to compare persons with dementia who were assigned to the twice-weekly, 6-week TimeSlips intervention group (n = 28) or usual care group (n = 28) at baseline and postintervention at Weeks 7 and 10. Outcome measures included the Cornell Scale for Depression in Dementia, the Neuropsychiatric Inventory-Nursing Home Version, the Functional Assessment of Communication Skills, the Quality of Life-Alzheimer's Disease, and the Observed Emotion Rating Scale (this last measure was collected also at Weeks 3 and 6 during TimeSlips for the treatment group and during mealtime for the control group).

RESULTS

Compared with the control group, the treatment group exhibited significantly higher pleasure at Week 3 (p < .001), Week 6 (p < .001), and Week 7 (p < .05). Small to moderate treatment effects were found for Week 7 social communication (d = .49) and basic needs communication (d = .43). A larger effect was found for pleasure at Week 7 (d = .58).

DISCUSSION

As expected, given the engaging nature of the TimeSlips creative storytelling intervention, analyses revealed increased positive affect during and at 1 week postintervention. In addition, perhaps associated with the intervention's reliance on positive social interactions and verbal communication, participants evidenced improved communication skills. However, more frequent dosing and booster sessions of TimeSlips may be needed to show significant differences between treatment and control groups on long-term effects and other outcomes.

Validation of a Mini-Mental State Examination (MMSE) for the Persian population: a pilot study

The objective of the study was to develop and validate a translated and culturally adapted Mini-Mental State Examination (MMSE) for the Persian-speaking population. The MMSE was translated into Persian. Two groups of neurologically intact subjects (n = 100) and subjects with Alzheimer's disease (n = 13) were studied. The difference between groups on the mean total scores of the Persian MMSE was statistically significant (control = 28.62 +/- 2.09; subjects with Alzheimer's disease = 11.77 +/- 5.66; p < .001). The cutoff score of 23 was the best cutoff score for our subjects with a sensitivity and specificity of 98% and 100%, respectively. There was a significant correlation between the Persian MMSE score and the level of education (r = .46) and with age (r = -.77). There was no significant correlation between the Persian MMSE and gender. The Persian MMSE was found to be valid for discrimination of cognitive impairment in the Persian-speaking community.

Psychometric properties of the Depressive Symptom Assessment for Older Adults in individuals with moderate or severe dementia

Many older adults with moderate or severe dementia also have depression, but identifying depressive symptoms in these individuals can be challenging. The Depressive Symptom Assessment for Older Adults (DSA), a newly developed instrument designed to evaluate older adults for depression, regardless of their cognitive status, facilitates longitudinal evaluation. This investigation examined the psychometric properties of the DSA in older adults (n = 68) with moderate or severe dementia. Internal consistency for the overall instrument and three of the six subscales, inter-rater reliability, and concurrent validity were established. Preliminary factor analysis yielded two strong factors; however, the other four factors were conceptually unclear. Although the DSA performed well statistically, the instrument may have over-identified depressive symptoms related to disagreeable behavior and lethargy and may have under-identified other depressive symptoms.

The performance of the Clock Drawing Test in elderly medical inpatients: does it have utility in the identification of delirium?

The Clock Drawing Test is an often-used test for the detection of cognitive impairment, but the few studies that have evaluated its utility in delirium have produced rather inconsistent results. In a longitudinal study of delirium in elderly medical inpatients, we have investigated the relationships between the Clock Drawing Test, the presence and severity of delirium, and cognitive impairment. Using mixed linear model analysis we found that cognitive impairment was the major factor associated with low Clock Drawing Test scores (P < .0001): neither the presence nor the severity of delirium had additional significant effect on the Clock Drawing Test. Thus, we conclude that although the Clock Drawing Test is a good detector of cognitive impairment, it is not a suitable tool for detection of delirium in elderly medical inpatients.