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Cheng S, Yin R, Wu K, Wang Q, Zhang H, Ling L, Chen W, Shi L. Trajectories and influencing factors of cognitive function and physical disability in Chinese older people. Front Public Health 2024; 12:1380657. [PMID: 39026589 PMCID: PMC11256785 DOI: 10.3389/fpubh.2024.1380657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Dementia and physical disability are serious problems faced by the aging population, and their occurrence and development interact. Methods Based on data from a national cohort of Chinese people aged 60 years and above from the China Health and Retirement Longitudinal Survey from 2011 to 2018, we applied the group-based trajectory model to identify the heterogeneous trajectories of cognitive function and physical disability in participants with different physical disability levels. Next, multinomial logistic regression models were used to explore the factors affecting these trajectories. Results The cognitive function trajectories of the Chinese older people could be divided into three characteristic groups: those who maintained the highest baseline level of cognitive function, those with a moderate baseline cognitive function and dramatic progression, and those with the worst baseline cognitive function and rapid-slow-rapid progression. The disability trajectories also fell into three characteristic groups: a consistently low baseline disability level, a low initial disability level with rapid development, and a high baseline disability level with rapid development. Compared with those free of physical disability at baseline, a greater proportion of participants who had physical disability at baseline experienced rapid cognitive deterioration. Education, income, type of medical insurance, gender, and marital status were instrumental in the progression of disability and cognitive decline in the participants. Discussion We suggest that the Chinese government, focusing on the central and western regions and rural areas, should develop education for the older people and increase their level of economic security to slow the rate of cognitive decline and disability among this age group. These could become important measures to cope with population aging.
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Affiliation(s)
- Shuyuan Cheng
- International Cooperation and Exchange Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Health Policy and Management Department, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Rong Yin
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Kunpeng Wu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qiong Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hui Zhang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Do KN, Le LTT, Dang SC, Nguyen HTT, Nguyen GT, Ngo HVT, Nguyen HLT, Nguyen LTT, Dang AK, Le HT. An Assessment of Physical Activity and Risk Factors in People Living with Dementia: Findings from a Cross-Sectional Study in a Long-Term Care Facility in Vietnam. Geriatrics (Basel) 2024; 9:57. [PMID: 38804314 PMCID: PMC11130955 DOI: 10.3390/geriatrics9030057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND People living with dementia (PLWD) may experience substantial cognitive decline as the disease progresses, which interferes with their daily activities. This study aimed to assess physical activity (PA) performance and care dependency (CD) and identify factors related to PA among PLWD. METHODS We conducted a cross-sectional study in 63 PLWD from National Geriatrics Hospital, Vietnam, from 2021 to 2023. We used the Mini Nutritional Assessment (MNA), International Physical Activity Questionnaire (IPAQ), and Care Dependency Scale (CDS) to assess the nutritional status and the levels of PA and CD, respectively. We used the Mann-Whitney test to compare the differences in the PA types and CD levels between dementia levels and a multivariable logistics regression model to analyze factors related to PA. RESULTS More than half of the subjects had mild dementia. In total, 35% of the PLWD had a low level of PA, and 46.3% were completely independent of care. The mean score in each CDS aspect of the subjects with moderate/severe dementia was statistically significantly lower than that of those with mild dementia (p ≤ 0.05). Lower dependency (OR = 0.9; 95% CI = 0.88-0.99) and malnutrition (OR = 15.4; 95% CI = 1.18-20.21) were associated with insufficient PA in the PLWD. CONCLUSION Formal caregivers and healthcare workers should encourage PLWD to perform physical activities at any level and personalize the development of tailored and nutritional care strategies for each individual.
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Affiliation(s)
- Khanh Nam Do
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
| | - Linh Thao Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
| | - Son Cong Dang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
| | - Ha Thu Thi Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
| | - Giang Thu Nguyen
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Tyne NE2 4HH, UK;
| | - Hang Van Thi Ngo
- VinUniversity Medical Simulation Center, College of Health Sciences, VinUniversity, Hanoi 100000, Vietnam;
| | - Huong Lan Thi Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
- Department of Nutrition, Saint Paul General Hospital, Hanoi 100000, Vietnam
| | - Lieu Thu Thi Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
- Department of Nutrition, National Hospital of Obstetrics and Gynecology, Hanoi 100000, Vietnam
| | - Anh Kim Dang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane 4102, Australia
| | - Huong Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.N.D.); (S.C.D.); (H.T.T.N.); (H.L.T.N.); (L.T.T.N.); (A.K.D.); (H.T.L.)
- Department of Nutrition and Dietetics, Hanoi Medical University Hospital, Hanoi 100000, Vietnam
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Rampalli I, Pavlik VN, Yu MM, Bishop J, Lin CYR. Cognitive Function Remains Associated With Functional Impairment in Profound Dementia: Alzheimer Disease and Dementia With Lewy Bodies. Neurol Clin Pract 2024; 14:e200262. [PMID: 38322828 PMCID: PMC10846794 DOI: 10.1212/cpj.0000000000200262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/21/2023] [Indexed: 02/08/2024]
Abstract
Background and Objectives The Baylor Profound Mental Status Examination (BPMSE) was developed to assess cognitive function in the profound stage of dementia. The Clinical Dementia Rating (CDR) scale has been widely used in measuring functional performance in dementia. We aimed to determine whether cognitive function is related to overall functional impairment in profound dementia. Methods We selected 864 patients with probable Alzheimer disease (AD) and 25 patients with possible dementia with Lewy Bodies (DLB) cases with profound dementia by Mini-Mental Status Examination or/and clinical global impression. We used BPMSE to measure cognitive function and the CDR sum-of-boxes (CDR-SB) score to determine overall functional status. We used Spearman rank order correlation to examine the univariate association between CDR-SB and BPMSE in the 2 diagnostic groups separately and multivariable regression analysis to investigate whether BPMSE remained associated with functional status after adjustment for age, sex, education, and APOE ε4 genotype. We expected to see an inverse correlation between BPMSE and CDR-SB scores based on the directionality of the rating scale scoring. Results In both AD and DLB, total BPMSE scores had a significant inverse correlation with CDR-SB scores (AD: r = -0.453, p < 0.001; DLB: r = -0.489, p = 0.013). It is of interest that in DLB, the "attention" domain of BPMSE had the strongest association with CDR-SB (r = -0.700, p < 0.001) compared with other domains. The multivariable regression models showed that higher BPMSE scores (i.e., better cognitive function) remained significantly correlated with lower CDR-SB scores (i.e., better global function) in AD (CDR-SB: β = -0.340, p < 0.001), but the regression coefficient for BPMSE did not reach significance in the DLB model (CDR-SB: β = -0.298, p = 0.174). Discussion In patients with AD and DLB who enter the profound dementia stage, cognitive function is associated with the severity of functional impairment. The lack of significance for DLB in multivariable regression could be due to small sample size because the correlation magnitude is similar to that in AD.
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Affiliation(s)
- Ihika Rampalli
- Alzheimer's Disease and Memory Disorders Center (IR, VNP, MMY, JB, C-YRL) and Parkinson's Disease Center and Movement Disorders Clinic (C-YRL), Department of Neurology, Baylor College of Medicine, Houston, TX
| | - Valory N Pavlik
- Alzheimer's Disease and Memory Disorders Center (IR, VNP, MMY, JB, C-YRL) and Parkinson's Disease Center and Movement Disorders Clinic (C-YRL), Department of Neurology, Baylor College of Medicine, Houston, TX
| | - Melissa M Yu
- Alzheimer's Disease and Memory Disorders Center (IR, VNP, MMY, JB, C-YRL) and Parkinson's Disease Center and Movement Disorders Clinic (C-YRL), Department of Neurology, Baylor College of Medicine, Houston, TX
| | - Jeffrey Bishop
- Alzheimer's Disease and Memory Disorders Center (IR, VNP, MMY, JB, C-YRL) and Parkinson's Disease Center and Movement Disorders Clinic (C-YRL), Department of Neurology, Baylor College of Medicine, Houston, TX
| | - Chi-Ying R Lin
- Alzheimer's Disease and Memory Disorders Center (IR, VNP, MMY, JB, C-YRL) and Parkinson's Disease Center and Movement Disorders Clinic (C-YRL), Department of Neurology, Baylor College of Medicine, Houston, TX
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Ostroumova OD, Ostroumova TM, Kochetkov AI, Vorobyova AE, Gadzhibekov AA, Sychev DA. [Drug-induced cognitive impairment and dementia]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:77-85. [PMID: 38696155 DOI: 10.17116/jnevro202412404277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
One of the reasons for the development or worsening of cognitive impairment (CI) may be the use of a number of drugs: non-steroidal anti-inflammatory drugs, antiarrhythmics, antidepressants, glucocorticosteroids, antitumor drugs and a number of others. The negative effect of drugs on cognitive functions is realized due to many pathophysiological mechanisms: disruption of hormonal regulation, decreased neuronal excitability, increased activity of gamma-aminobutyric acid receptors, decreased cerebral circulation, atrophic changes in the brain; many mechanisms have not been fully established. Risk factors for the development of drug-induced CIs are: old age or childhood, brain damage, chronic diseases, genetic factors, the patient's initial CI, polypharmacy, dose and duration of drug use, acute infectious diseases, metabolic disorders, dehydration, acute urinary retention, etc. To diagnose and differentially diagnose drug-induced CI, it is necessary to establish a connection between the start of taking a suspected drug-inducer and a decrease in cognitive functions. The first step in the treatment of drug-induced CI is the abolition of an inducer drug or a reduction in its dose, in cases where it is impossible to discontinue the drug and there is no replacement, special slow-release dosage forms can be considered. The main measures to prevent drug-induced CI include the use of drugs with the lowest risk of their development, assessment of drug interactions, and the use of modern scales to assess the risk of developing this side-effect (anticholinergic burden scale, etc.).
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Affiliation(s)
- O D Ostroumova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - T M Ostroumova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A I Kochetkov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A E Vorobyova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | | | - D A Sychev
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Gupta U, Lau JL, Chia PZ, Tan YY, Ahmed A, Tan NC, Soh GS, Low HY. All Knitted and Integrated Soft Wearable of High Stretchability and Sensitivity for Continuous Monitoring of Human Joint Motion. Adv Healthc Mater 2023; 12:e2202987. [PMID: 36977464 DOI: 10.1002/adhm.202202987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/22/2023] [Indexed: 03/30/2023]
Abstract
E-textiles have recently gained significant traction in the development of soft wearables for healthcare applications. However, there have been limited works on wearable e-textiles with embedded stretchable circuits. Here, stretchable conductive knits with tuneable macroscopic electrical and mechanical properties are developed by varying the yarn combination and the arrangement of stitch types at the meso-scale. Highly extensible piezoresistive strain sensors are designed (>120% strain) with high sensitivity (gauge factor 8.47) and durability (>100,000 cycles), interconnects (>140% strain) and resistors (>250% strain), optimally arranged to form a highly stretchable sensing circuit. The wearable is knitted with a computer numerical control (CNC) knitting machine that offers a cost effective and scalable fabrication method with minimal post-processing. The real-time data from the wearable is transmitted wirelessly using a custom designed circuit board. In this work, an all knitted and fully integrated soft wearable is demonstrated for wireless and continuous real-time sensing of knee joint motion of multiple subjects performing various activities of daily living.
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Affiliation(s)
- Ujjaval Gupta
- Digital Manufacturing and Design Centre, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
| | - Jun Liang Lau
- Robotics Innovation Lab, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
- Rehabilitation Research Institute of Singapore (RRIS), 308232, 11 Mandalay Rd, #14-03 Clinical Science Building, Singapore, Singapore
| | - Pei Zhi Chia
- Digital Manufacturing and Design Centre, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
| | - Ying Yi Tan
- Digital Manufacturing and Design Centre, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
| | - Alvee Ahmed
- Robotics Innovation Lab, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, 167 Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Gim Song Soh
- Robotics Innovation Lab, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
| | - Hong Yee Low
- Digital Manufacturing and Design Centre, Singapore University of Technology and Design (SUTD), 8 Somapah Road, Singapore, 487372, Singapore
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Vargese SS, Jylhä M, Raitanen J, Enroth L, Halonen P, Aaltonen M. Dementia-related disability in the population aged 90 years and over: differences over time and the role of comorbidity in the vitality 90 + study. BMC Geriatr 2023; 23:276. [PMID: 37149593 PMCID: PMC10163713 DOI: 10.1186/s12877-023-03980-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/18/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The burden of dementia, multimorbidity, and disability is high in the oldest old. However, the contribution of dementia and comorbidities to functional ability in this age group remains unclear. We examined the combined effects of dementia and comorbidities on ADL and mobility disability and differences between dementia-related disability between 2001, 2010, and 2018. METHODS Our data came from three repeated cross-sectional surveys in the population aged 90 + in the Finnish Vitality 90 + Study. The associations of dementia with disability and the combined effects of dementia and comorbidity on disability adjusted for age, gender, occupational class, number of chronic conditions, and study year were determined by generalized estimating equations. An interaction term was calculated to assess differences in the effects of dementia on disability over time. RESULTS In people with dementia, the odds of ADL disability were almost five-fold compared to people with three other diseases but no dementia. Among those with dementia, comorbidities did not increase ADL disability but did increase mobility disability. Differences in disability between people with and without dementia were greater in 2010 and 2018 than in 2001. CONCLUSION We found a widening gap in disability between people with and without dementia over time as functional ability improved mainly in people without dementia. Dementia was the main driver of disability and among those with dementia, comorbidities were associated with mobility disability but not with ADL disability. These results imply the need for strategies to maintain functioning and for clinical updates, rehabilitative services, care planning, and capacity building among care providers.
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Affiliation(s)
- Saritha Susan Vargese
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland.
- Believers Church Medical College Hospital, Thiruvalla, India.
| | - Marja Jylhä
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Linda Enroth
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland
| | - Pauliina Halonen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland
| | - Mari Aaltonen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Tan FHP, Azzam G, Najimudin N, Shamsuddin S, Zainuddin A. Behavioural Effects and RNA-seq Analysis of Aβ42-Mediated Toxicity in a Drosophila Alzheimer's Disease Model. Mol Neurobiol 2023:10.1007/s12035-023-03368-x. [PMID: 37145377 DOI: 10.1007/s12035-023-03368-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023]
Abstract
Alzheimer's disease (AD) is the most common neurological ailment worldwide. Its process comprises the unique aggregation of extracellular senile plaques composed of amyloid-beta (Aβ) in the brain. Aβ42 is the most neurotoxic and aggressive of the Aβ42 isomers released in the brain. Despite much research on AD, the complete pathophysiology of this disease remains unknown. Technical and ethical constraints place limits on experiments utilizing human subjects. Thus, animal models were used to replicate human diseases. The Drosophila melanogaster is an excellent model for studying both physiological and behavioural aspects of human neurodegenerative illnesses. Here, the negative effects of Aβ42-expression on a Drosophila AD model were investigated through three behavioural assays followed by RNA-seq. The RNA-seq data was verified using qPCR. AD Drosophila expressing human Aβ42 exhibited degenerated eye structures, shortened lifespan, and declined mobility function compared to the wild-type Control. RNA-seq revealed 1496 genes that were differentially expressed from the Aβ42-expressing samples against the control. Among the pathways that were identified from the differentially expressed genes include carbon metabolism, oxidative phosphorylation, antimicrobial peptides, and longevity-regulating pathways. While AD is a complicated neurological condition whose aetiology is influenced by a number of factors, it is hoped that the current data will be sufficient to give a general picture of how Aβ42 influences the disease pathology. The discovery of molecular connections from the current Drosophila AD model offers fresh perspectives on the usage of this Drosophila which could aid in the discovery of new anti-AD medications.
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Affiliation(s)
- Florence Hui Ping Tan
- School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
- USM-RIKEN Interdisciplinary Centre for Advanced Sciences (URICAS), Universiti Sains Malaysia, 11800, Penang, Malaysia.
| | - Ghows Azzam
- USM-RIKEN Interdisciplinary Centre for Advanced Sciences (URICAS), Universiti Sains Malaysia, 11800, Penang, Malaysia.
- School of Biological Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia.
- Malaysia Genome and Vaccine Institute (MGVI), National Institutes of Biotechnology Malaysia (NIBM), Jalan Bangi, 43000, Kajang, Selangor, Malaysia.
| | - Nazalan Najimudin
- School of Biological Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia
| | - Shaharum Shamsuddin
- School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
- USM-RIKEN Interdisciplinary Centre for Advanced Sciences (URICAS), Universiti Sains Malaysia, 11800, Penang, Malaysia
- Nanobiotech Research Initiative, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, 11800, Penang, Malaysia
| | - Azalina Zainuddin
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
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Braz de Oliveira MP, Moreira Padovez RDFC, Serrão PRMDS, de Noronha MA, Cezar NODC, Andrade LPD. Effectiveness of physical exercise at improving functional capacity in older adults living with Alzheimer's disease: a systematic review of randomized controlled trials. Disabil Rehabil 2023; 45:391-402. [PMID: 35171074 DOI: 10.1080/09638288.2022.2037744] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate the effects of physical exercise at improving functional capacity in older adults living with Alzheimer's disease (AD). METHODS Medline, Embase, Web of Science, The Cochrane Library, Lilacs, and PEDro were searched from inception until January 2021. Randomized controlled trials (RCTs) that reported functional capacity outcomes were included. The evidence was assessed using the GRADE approach. RESULTS Thirteen RCTs were included, involving 811 older adults living with AD. Multimodal exercise (ME), aerobic exercise (AE), and resistance exercise (RE) were used. The interventions were mainly supervised by caregivers. The evidence was low and with effect for activities of daily living (ADLs), moderate and with no effect for mobility and very low and with no effect for muscle strength, postural balance and flexibility after treatment with ME, moderate and with no effect for cardiorespiratory function and ADLs after treatment with AE. It was not possible to synthesize any type of evidence for RE. CONCLUSIONS Multimodal exercise promotes improvements in functional capacity (ADLs). Therefore, the practice of physical exercise can be recommended for older adults living with AD. The involvement of the caregiver in the physical exercises should also be considered, as it could enhance the benefits of exercise for these older adults.Implications for rehabilitationHealthcare providers with clinical knowledge regarding physical exercise should promote, prescribe and support the daily practice of physical exercises for older adults living with Alzheimer's disease (AD).The involvement of caregivers in home-based physical exercise programs should be considered, as it could enhance the benefits of such programs for these older adults.It is important to consider the degree of cognitive impairment in older adults living with AD when outlining goals for the improvement in functional capacity through physical exercise.Multimodal exercise involving aerobic training, postural balance, muscle strengthening, and flexibility is capable of promoting an improvement in functional capacity (activities of daily living) for these older adults.
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Affiliation(s)
- Marcos Paulo Braz de Oliveira
- Physical Therapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos, Brazil
| | | | | | | | | | - Larissa Pires de Andrade
- Physical Therapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos, Brazil
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9
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Ward DD, Martin J, Gordon EH. Is There a Sex-Frailty Paradox in Dementia? J Nutr Health Aging 2023; 27:1281-1283. [PMID: 38151880 DOI: 10.1007/s12603-023-2040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/29/2023]
Affiliation(s)
- D D Ward
- David D. Ward, Centre for Health Services Research, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4121, Australia.
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Shimokihara S, Tabira T, Hotta M, Tanaka H, Yamaguchi T, Maruta M, Han G, Ikeda Y, Ishikawa T, Ikeda M. Differences by cognitive impairment in detailed processes for basic activities of daily living in older adults with dementia. Psychogeriatrics 2022; 22:859-868. [PMID: 36184572 DOI: 10.1111/psyg.12894] [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: 06/03/2022] [Revised: 07/27/2022] [Accepted: 09/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Impairment of activities of daily living in patients with dementia has a fundamental and lasting impact on their quality of life and requires a detailed assessment. This study investigated to clarify characteristic of basic activities of daily living (BADL) processes with the severity of cognitive impairment in community-dwelling older adults with dementia using the Process Analysis of Daily Activity for Dementia (PADA-D). METHODS Participants were recruited from outpatient departments of 24 hospitals, daycare centres, and home rehabilitation services in Japan. The severity of cognitive impairment was determined using the Mini-mental State Examination (mild: score ≥ 20; moderate: 10 ≤ score < 20; severe: score < 10). Patient's BADL were assessed according to the PADA-D by observation of the occupational therapist and interviews with family members. Basic information and the scores of BADL items of the PADA-D were compared between the three groups. Subsequently, we compared the percentage of independent or non-independent processes included in the sub-items of BADL in the PADA-D. RESULTS A total of 143 patients were included in the analysis. Performance on BADL was shown to decrease significantly with increasing severity of cognitive impairment. The percentage of all BADL processes performed ranged from 58% to 100% in mild, 38% to 97% in moderate, and 0% to 88% in severe. Some of the processes included in BADL of PADA-D showed no significant differences in independence between the three groups. DISCUSSION/CONCLUSION Most BADL processes differed with respect to different independence rates depending on the severity of cognitive impairment of the older adults with dementia. However, some BADL processes were not associated with the severity of cognitive impairment. Our findings may suggest that a detailed BADL assessment of patients with dementia is useful in terms of caregiver education to avoid excessive caregiving and in predicting BADL impairment.
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Affiliation(s)
- Suguru Shimokihara
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Takayuki Tabira
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Maki Hotta
- Department of Psychiatry, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Tanaka
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan
| | - Tomoharu Yamaguchi
- Department of Rehabilitation, Gunma University of Health and Welfare, Maebashi, Japan
| | - Michio Maruta
- Visiting Researcher, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.,Unit of Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Gwanghee Han
- Visiting Researcher, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.,Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Yuriko Ikeda
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Tomohisa Ishikawa
- Department of Psychiatry, Arao Kokoronosato Hospital, Kumamoto, Japan.,Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan.,Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University, Graduate School of Medicine, Osaka, Japan
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11
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Buawangpong N, Aramrat C, Pinyopornpanish K, Phrommintikul A, Soontornpun A, Jiraporncharoen W, Pliannuom S, Angkurawaranon C. Risk Prediction Performance of the Thai Cardiovascular Risk Score for Mild Cognitive Impairment in Adults with Metabolic Risk Factors in Thailand. Healthcare (Basel) 2022; 10:healthcare10101959. [PMID: 36292406 PMCID: PMC9602158 DOI: 10.3390/healthcare10101959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022] Open
Abstract
Individuals with metabolic risks are at high risk of cognitive impairment. We aimed to investigate whether the Thai Cardiovascular Risk (TCVR) score can be used to predict mild cognitive impairment (MCI) in Thai adults with metabolic risks. The study was conducted using secondary data of patients with metabolic risks from Maharaj Nakorn Chiang Mai Hospital. MCI was indicated by an MoCA score of less than 25. Six different TCVR models were used with various combinations of ten different variables for predicting the risk of MCI. The area under the receiver operator characteristic curve (AuROC) and Hosmer–Lemeshow goodness of fit tests were used for determining discriminative performance and model calibration. The sensitivity of the discriminative performance was further evaluated by stratifying by age and gender. From a total of 421 participants, 348 participants had MCI. All six TCVR models showed a similar AuROC, varying between 0.58 and 0.61. The anthropometric-based model showed the best risk prediction performance in the older age group (AuROC 0.69). The laboratory-based model provided the highest discriminative performance for the younger age group (AuROC 0.60). There is potential for the development of an MCI risk model based on values from routine cardiovascular risk assessments among patients with metabolic risks.
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Affiliation(s)
- Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chanchanok Aramrat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: ; Tel.: +66-53935462
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Atiwat Soontornpun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suphawita Pliannuom
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand
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12
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Lee KH, Lee JY, Kim B. Information and communication technology for physical activity in persons living with dementia: A systematic review with implications for evidence-based practice. Worldviews Evid Based Nurs 2022; 19:275-281. [PMID: 35635249 DOI: 10.1111/wvn.12591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/30/2022] [Accepted: 04/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persons living with dementia often encounter many difficulties in their community due to functional limitations. Information and Communication Technology (ICT) could be useful to monitor changes in their physical function. However, there is a lack of systematic reviews about using ICT for physical activity. AIM This review aimed to synthesize the literature regarding the use of ICT to monitor the physical activity of persons living with dementia. METHODS A systematic search was conducted in five electronic databases using search terms derived from the Patient, Intervention, Comparison, Outcome (PICO) framework. We included articles published in English from 2011 to 2021. Quality of the included studies was evaluated by two independent authors using the Mixed Methods Appraisal Tool (MMAT). RESULTS Thirty-three quantitative studies were included for review. Included studies showed fairly good quality in the MMAT evaluation. Wearable devices were mainly employed (88%). The ICTs were used to objectively measure physical activity, activity status, gait, and circadian rhythm. ICTs have been utilized for four purposes: (1) comparing physical activity within the dementia subgroups or with the normal group, (2) exploring the relationship with other variables, 3) examining the experimental study's outcomes, and (4) checking the sensors' feasibility. The results demonstrated that ICT devices were feasible to use in persons living with dementia in the community, helpful for monitoring the physical activity of persons living with dementia, and useful for improving physical activity when properly incorporated in care planning. LINKING EVIDENCE TO ACTION ICTs can help gather objective data regarding the type, intensity, and level of physical activity in persons living with dementia without time constraints. Also, ICTs use in persons living with dementia in the community was acceptable. We suggest future studies to activate and use ICTs in dementia research.
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Affiliation(s)
- Kyung Hee Lee
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, South Korea
| | - Ji Yeon Lee
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, South Korea
| | - Bora Kim
- Yonsei University College of Nursing and the Brain Korea 21 FOUR Project, Seoul, South Korea
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13
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de Araújo JRT, Jerez-Roig J, Machado DGDS, Ferreira LMDBM, de Lima KC. Mobility during walking and incidence and risk factors for mobility decline among institutionalized older adults: A two-year longitudinal study. Arch Gerontol Geriatr 2022; 101:104702. [DOI: 10.1016/j.archger.2022.104702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
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14
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Park J, Heilman KJ, Sullivan M, Surage J, Levine H, Hung L, Ortega M, Kirk Wiese LA, Ahn H. Remotely supervised home-based online chair yoga intervention for older adults with dementia: Feasibility study. Complement Ther Clin Pract 2022; 48:101617. [PMID: 35738115 DOI: 10.1016/j.ctcp.2022.101617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND and Purpose: Social isolation and caregiver burden call for an innovative way to deliver a chair yoga (CY) intervention to older adults with dementia who cannot travel to a community center. During a remotely supervised CY session, the yoga instructor can monitor each participant's pose and correct poses to optimize efficacy of CY and reduce chances of injury. This study assessed the feasibility of a remotely supervised online CY intervention for older adults with dementia and explored the relationship between CY and clinical outcomes: pain interference, mobility, risk of falling, sleep disturbance, autonomic reactivity, and loneliness. METHODS Using a one-group pretest/posttest design, a home-based CY intervention was delivered remotely to 10 older adults with dementia twice weekly in 60-minute sessions for 8 weeks. Psychosocial and physiological (i.e., cardiac) data were collected remotely at baseline, mid-intervention, and post-intervention. RESULTS The results indicated that remotely supervised online CY is a feasible approach for managing physical and psychological symptoms in socially isolated older adults with dementia, based on retention (70%) and adherence (87.5%), with no injury or other adverse events. While there were no significant findings for pain interference, mobility, sleep, or social loneliness longitudinally, emotional loneliness showed a significant increase, F(1.838, 11.029) = 6.293, p = .016, η2 = 0.512, from baseline to post-intervention. Although participants were socially connected to other participants via a videoconferencing platform, emotional loneliness increased during the pandemic period. CONCLUSION A home-based remotely supervised online CY is a feasible approach for socially isolated older adults with dementia who are unable to travel to a facility.
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Affiliation(s)
- Juyoung Park
- Florida Atlantic University, Phyllis and Harvey Sandler School of Social Work, USA.
| | - Keri J Heilman
- University of North Carolina, Chapel Hill, College of Medicine, Department of Psychiatry, USA
| | - Marlysa Sullivan
- Integrative Health Sciences, Maryland University of Integrative Health, USA
| | - Jayshree Surage
- Integrative Health Sciences, Maryland University of Integrative Health, USA
| | - Hannah Levine
- Charles E. Schmidt College of Medicine, Marcus Institute of Integrative Health at FAU Medicine, Florida Atlantic University, USA
| | - Lillian Hung
- University of British Columbia, School of Nursing, Vancouver, Canada
| | - María Ortega
- Louis and Anne Green Memory and Wellness Center of the Christine E. Lynn College of Nursing, Florida Atlantic University, USA
| | | | - Hyochol Ahn
- Florida State University College of Nursing, Tallahassee, FL, USA
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15
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Zang E, Shi Y, Wang X, Wu B, Fried TR. Trajectories of physical functioning among US adults with cognitive impairment. Age Ageing 2022; 51:6615423. [PMID: 35751871 PMCID: PMC9233517 DOI: 10.1093/ageing/afac139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND physical functioning impairment is common among persons with cognitive impairment, but little is known about physical functioning trajectories across the US population or how trajectories may differ among persons with dementia and mild cognitive impairment (MCI). OBJECTIVE to examine trajectories of physical functioning among persons with MCI and dementia in the USA. DESIGN we used data from the National Health and Aging Trends study (NHATS) 2011-18. Physical functioning was assessed using the NHATS Expanded Short Physical Performance Battery. PARTICIPANTS the 661 individuals with MCI and 980 individuals with dementia were included in this study. METHODS we applied group-based trajectory models to identify latent groups and estimate their trajectories. Multinomial logistic regressions were applied to examine relationships between sociodemographic and health characteristics and trajectory group memberships. RESULTS both MCI- and dementia-specific trajectories differed at baseline levels and declined at varying rates across groups. Approximately, 78.43% of persons with MCI were in trajectories with a moderate rate of decline, with only 9.75% in a trajectory with good physical function and 11.82% with poor physical function without as much change over time. Among persons with dementia, approximately 81.4% experienced moderate or fast declines, and 18.52% with virtually no functional ability remained at this same low level. Worse physical functioning trajectories were found among persons who were females, Blacks, with at least four comorbidities, and among persons who had a low socioeconomic status. CONCLUSIONS persons with both dementia and MCI experienced steady declines in physical functioning. Socioeconomically disadvantaged groups have worse physical functioning trajectories.
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Affiliation(s)
- Emma Zang
- Address correspondence to: Emma Zang, Departments of Sociology and Biostatistics, Yale University, New Haven, CT 06511, USA. Tel: +1 (919) 536-9621.
| | - Yu Shi
- Department of Biostatistics, Yale University, New Haven, CT 06520, USA
| | - Xueqing Wang
- Office of Population Research, Princeton University, Princeton, NJ 08540, USA
- School of Public and International Affairs, Princeton University, Princeton, NJ 08540, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA
| | - Terri R Fried
- Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA
- Department of Medicine, Yale School of Medicine, New Haven, CT 06520, USA
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16
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Diaz Baquero AA, Perea Bartolomé MV, Toribio-Guzmán JM, Martínez-Abad F, Parra Vidales E, Bueno Aguado Y, van der Roest HG, Franco-Martín MA. Determinants of Adherence to a "GRADIOR" Computer-Based Cognitive Training Program in People with Mild Cognitive Impairment (MCI) and Mild Dementia. J Clin Med 2022; 11:1714. [PMID: 35330040 PMCID: PMC8955227 DOI: 10.3390/jcm11061714] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Computer-based programs have been implemented from a psychosocial approach for the care of people with dementia (PwD). However, several factors may determine adherence of older PwD to this type of treatment. The aim of this paper was to identify the sociodemographic, cognitive, psychological, and physical-health determinants that helped predict adherence or not to a "GRADIOR" computerized cognitive training (CCT) program in people with mild cognitive impairment (MCI) and mild dementia. METHOD This study was part of a randomized clinical trial (RCT) (ISRCTN: 15742788). However, this study will only focus on the experimental group (n = 43) included in the RCT. This group was divided into adherent people (compliance: ≥60% of the sessions and persistence in treatment up to 4 months) and non-adherent. The participants were 60-90 age and diagnosed with MCI and mild dementia. We selected from the evaluation protocol for the RCT, tests that evaluated cognitive aspects (memory and executive functioning), psychological and physical health. The CCT with GRADIOR consisted of attending 2-3 weekly sessions for 4 months with a duration of 30 min Data analysis: Phi and Biserial-point correlations, a multiple logical regression analysis was obtained to find the adherence model and U Mann-Whitney was used. RESULTS The adherence model was made up of the Digit Symbol and Arithmetic of Wechsler Adult Intelligence Scale (WAIS-III) and Lexical Verbal Fluency (LVF) -R tests. This model had 90% sensitivity, 50% specificity and 75% precision. The goodness-of-fit p-value of the model was 0.02. CONCLUSIONS good executive functioning in attention, working memory (WM), phonological verbal fluency and cognitive flexibility predicted a greater probability that a person would be adherent.
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Affiliation(s)
- Angie A. Diaz Baquero
- Institute of Biomedical Research of Salamanca, University of Salamanca, 37001 Salamanca, Spain;
- Department of Research and Development, INTRAS Foundation, 49001 Zamora, Spain;
| | - María V. Perea Bartolomé
- Basic Psychology, Psychobiology and Methodology Department, Salamanca University, 37001 Salamanca, Spain;
| | | | - Fernando Martínez-Abad
- University Institute of Educational Sciences, University of Salamanca, 37008 Salamanca, Spain;
| | - Esther Parra Vidales
- IBIP Center for Clinical Care in Mental Health and Aging, INTRAS Foundation, 49024 Zamora, Spain;
| | - Yolanda Bueno Aguado
- Gradior Department and Cognitive Research, INTRAS Foundation, 47016 Valladolid, Spain;
| | - Henriëtte G. van der Roest
- Department on Aging, Netherlands Institute of Mental Health and Addiction (TrimbosI Institute), 1013 GM Utrecht, The Netherlands;
| | - Manuel A. Franco-Martín
- Institute of Biomedical Research of Salamanca, University of Salamanca, 37001 Salamanca, Spain;
- Psychiatric Department, Rio Hortega University Hospital, 47012 Valladolid, Spain
- Psychiatric Department, Zamora Healthcare Complex, 49071 Zamora, Spain
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17
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Ghosh A, Puthusseryppady V, Chan D, Mascolo C, Hornberger M. Machine learning detects altered spatial navigation features in outdoor behaviour of Alzheimer's disease patients. Sci Rep 2022; 12:3160. [PMID: 35210486 PMCID: PMC8873255 DOI: 10.1038/s41598-022-06899-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/31/2022] [Indexed: 11/14/2022] Open
Abstract
Impairment of navigation is one of the earliest symptoms of Alzheimer's disease (AD), but to date studies have involved proxy tests of navigation rather than studies of real life behaviour. Here we use GPS tracking to measure ecological outdoor behaviour in AD. The aim was to use data-driven machine learning approaches to explore spatial metrics within real life navigational traces that discriminate AD patients from controls. 15 AD patients and 18 controls underwent tracking of their outdoor navigation over two weeks. Three kinds of spatiotemporal features of segments were extracted, characterising the mobility domain (entropy, segment similarity, distance from home), spatial shape (total turning angle, segment complexity), and temporal characteristics (stop duration). Patients significantly differed from controls on entropy (p-value 0.008), segment similarity (p-value [Formula: see text]), and distance from home (p-value [Formula: see text]). Graph-based analyses yielded preliminary data indicating that topological features assessing the connectivity of visited locations may also differentiate patients from controls. In conclusion, our results show that specific outdoor navigation features discriminate AD patients from controls, which has significant implication for future AD diagnostics, outcome measures and interventions. Furthermore, this work illustrates how wearables-based sensing of everyday behaviour may be used to deliver ecologically-valid digital biomarkers of AD pathophysiology.
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Affiliation(s)
- Abhirup Ghosh
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Vaisakh Puthusseryppady
- Norwich Medical School, 2.04 Bob Champion Research and Education Building, University of East Anglia, Norwich, NR4 7TJ, UK
- Department of Neurobiology and Behaviour, University of California Irvine, Irvine, USA
| | - Dennis Chan
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Cecilia Mascolo
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Michael Hornberger
- Norwich Medical School, 2.04 Bob Champion Research and Education Building, University of East Anglia, Norwich, NR4 7TJ, UK.
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18
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de Oliveira MPB, da Silva Serrão PRM, de Medeiros Takahashi AC, Pereira ND, de Andrade LP. Reproducibility of Assessment Tests Addressing Body Structure and Function and Activity in Older Adults With Dementia: A Systematic Review. Phys Ther 2022; 102:6427349. [PMID: 34935975 DOI: 10.1093/ptj/pzab263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/17/2021] [Accepted: 10/04/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the relative and absolute reliability of assessment tests addressing body structure and function and activity in older adults with dementia. METHODS Medline, Embase, Web of Science, The Cochrane Library, and Scielo were searched from inception until March 2021. Two independent reviewers performed the selection process based on titles, abstracts, and full text. Reliability studies of assessment tests in older adults with dementia were included. Methodological quality of the studies was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist. Relative reliability was analyzed using the intraclass correlation coefficient (ICC) interpreted based on Munro classification. Absolute reliability was analyzed using the minimal detectable change (MDC) and standard error of measurement. RESULTS Fifteen studies involving a total of 560 older adults with dementia were included. Nineteen assessment tests were identified: 13 addressing body structure and function (muscle strength, postural balance, cardiorespiratory fitness) and 6 addressing activity (walking and mobility). Studies determined test-retest and interrater reliability. Fifteen studies evaluated relative reliability using the ICC, with values ranging from no or small correlation to very high correlations. Ten studies evaluated absolute reliability using the MDC or standard error of measurement or both. CONCLUSION Relative reliability of the assessment tests for body structure and function and activity was high to very high based on ICCs, demonstrating good reproducibility. Regarding absolute reliability, the analysis of the MDC values revealed the need for substantial change to determine that a real change had occurred. Future investigations should consider the type of dementia and standardization of verbal encouragement during the assessment. IMPACT This review identified the good reproducibility of assessment tests of body structure and function (muscle strength, postural balance, cardiorespiratory fitness) and activity (walking and mobility) domains in older adults with dementia. Clinically important values may differ when older adults with dementia of diverse etiologies are analyzed together and older adults specifically with Alzheimer disease. Identifying the type of dementia, analyzing types of dementia separately, and standardizing verbal commands during the execution of tests is of considerable clinical importance for this population of older adults.
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Affiliation(s)
- Marcos Paulo Braz de Oliveira
- Physiotherapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos/SP, Brazil
| | | | | | - Natalia Duarte Pereira
- Physiotherapy Department, Research Group in Functionality and Technological Innovation in NeuroRehabilitation, Federal University of São Carlos, São Carlos/SP, Brazil
| | - Larissa Pires de Andrade
- Physiotherapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos/SP, Brazil
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19
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Kaur P, Wu HY, Hum A, Heng BH, Tan WS. Medical cost of advanced illnesses in the last-year of life-retrospective database study. Age Ageing 2022; 51:6406695. [PMID: 34673931 DOI: 10.1093/ageing/afab212] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study aims to quantify medical care utilisation, and to describe the cost trajectories of individuals with advanced illnesses in the last-year of life, differentiated by advanced cancer, end-stage organ failure and progressive neurological disorders. METHODS This retrospective database study included decedents who had previous inpatient or outpatient encounters at a public hospital in Singapore. Patients with advanced diseases were identified based on diagnostic codes and clinical criteria. Using a look-back approach, the amount of healthcare services utilised and the corresponding mean monthly and annual costs to the healthcare system in the last 12-months of life were quantified. RESULTS The last 12-months of life among 6,598 decedents was associated with £20,524 (95% confidence interval: £20,013-£21,036) in medical costs, of which 80% was accounted for by inpatient admissions. Costs increased sharply in the last 2-months of life, with a large proportion of monthly costs accounted for by inpatient admissions which rose rapidly from 61% at 12-months prior to death to 94% in the last-month of life. Compared to patients with cancer, individuals diagnosed with non-cancer advanced illnesses accumulated 1.6 times more healthcare costs in the last-year of life with significant differences across patients with end-stage organ failure and progressive neurological disorders. CONCLUSION Healthcare costs varied across disease conditions at the end-of-life. With advance care planning and close collaboration between the inpatient clinical team and the community providers, it may be possible to re-direct some of the hospitalisation costs to community-based palliative care services.
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Affiliation(s)
- Palvinder Kaur
- Health Services and Outcomes Research Department, National Healthcare Group, Singapore 138543
| | - Huei Yaw Wu
- Department of Palliative Medicine, Tan Tock Seng Hospital Singapore, Singapore 308433
- Palliative Care Centre for Excellence in Research and Education, Singapore 308436
| | - Allyn Hum
- Department of Palliative Medicine, Tan Tock Seng Hospital Singapore, Singapore 308433
- Palliative Care Centre for Excellence in Research and Education, Singapore 308436
| | - Bee Hoon Heng
- Health Services and Outcomes Research Department, National Healthcare Group, Singapore 138543
| | - Woan Shin Tan
- Health Services and Outcomes Research Department, National Healthcare Group, Singapore 138543
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20
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Wu B, Toseef MU, Stickel AM, González HM, Tarraf W. Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study. J Alzheimers Dis 2022; 85:1621-1637. [PMID: 34958028 PMCID: PMC9116387 DOI: 10.3233/jad-215192] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging. OBJECTIVE We examined how midlife self-rated physical functioning and health may predict cognitive health in older age. METHODS We used data from the Health and Retirement Study (1998-2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50-64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications. RESULTS After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment. CONCLUSION Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life.
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Affiliation(s)
- Benson Wu
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California San Diego School of Medicine, San Diego, CA
| | - Mohammad Usama Toseef
- Department of Healthcare Sciences and Institute of Gerontology, Wayne State University, Detroit, MI
| | - Ariana M. Stickel
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California San Diego School of Medicine, San Diego, CA
| | - Hector M. González
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California San Diego School of Medicine, San Diego, CA
| | - Wassim Tarraf
- Department of Healthcare Sciences and Institute of Gerontology, Wayne State University, Detroit, MI
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21
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Chu CH, Quan AML, McGilton KS. Depression and Functional Mobility Decline in Long Term Care Home Residents with Dementia: a Prospective Cohort Study. Can Geriatr J 2021; 24:325-331. [PMID: 34912487 PMCID: PMC8629506 DOI: 10.5770/cgj.24.511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Assess the association between depression among new long-term care residents (<3 months stay) with dementia and functional mobility decline. Methods A multi-site prospective cohort study was carried out among 26 participants diagnosed with dementia. Functional mobility was measured by Timed-Up-and-Go (TUG) and 2-Minute walk test (2MWT) at baseline, and 60-day post-baseline while participants received usual care. Linear mixed models were applied to examine the association between depression and functional mobility decline. Results Residents experienced a statistically significant decline in functional mobility in as soon as 60 days. Each additional year of age was associated with a 2% increase in TUG. The interaction between depression and time spent in LTC was statistically significant. Age and time living in LTC were significantly associated with functional mobility decline in new residents with dementia. Discussion Further work determining why residents with dementia experience decline in functional mobility at an accelerated rate is needed.
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Affiliation(s)
- Charlene H Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto.,Institute for Life Course and Aging, University of Toronto, Toronto
| | | | - Katherine S McGilton
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON
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22
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Hall AJ, Febrey S, Goodwin VA. Physical interventions for people with more advanced dementia - a scoping review. BMC Geriatr 2021; 21:675. [PMID: 34863094 PMCID: PMC8642899 DOI: 10.1186/s12877-021-02577-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia is a neuro-degenerative condition resulting in cognitive and physical decline over time. In the early stages of the condition, physical decline may be slow, but in the later stages, it may become more pronounced. Physical interventions may be employed to try and reduce the physical decline that people experience, yet it is unclear what interventions may be effective. The aim of this study was to explore the breadth and quantity of evidence that exists in relation to the delivery of physical interventions for people with advanced dementia. METHODS We undertook a scoping review in order to map the current literature. All types of study design were included in the search in order to gain a comprehensive scope of the literature. We searched a variety of databases from inception until March 2021, focusing on physical interventions. Double screening and data extraction were employed in order to increase the reliability of the results. RESULTS Our review found four studies which focused on physical interventions aimed at improving physical outcomes for people with more advanced dementia. The majority of studies were excluded as their interventions were not specific to people with advanced dementia. The studies that were included incorporated functional activities and, despite small sample sizes, suggested statistically significant improvements in outcomes for people with advanced dementia. CONCLUSION There is currently limited evidence relating to physical rehabilitation interventions for people with more advanced dementia, however, the evidence we presented suggests potential benefits for physical outcomes. Future research should focus on robust research to determine the most effective and cost-effective interventions that meet the needs of this population.
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Affiliation(s)
- Abigail J Hall
- University of Exeter, Heavitree Road, Exeter, EX1 2LU, UK.
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Mehdizadeh S, Faieghi M, Sabo A, Nabavi H, Mansfield A, Flint AJ, Taati B, Iaboni A. Gait changes over time in hospitalized older adults with advanced dementia: Predictors of mobility change. PLoS One 2021; 16:e0259975. [PMID: 34788342 PMCID: PMC8598066 DOI: 10.1371/journal.pone.0259975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022] Open
Abstract
People with dementia are at risk of mobility decline. In this study, we measured changes in quantitative gait measures over a maximum 10-week period during the course of a psychogeriatric admission in older adults with dementia, with the aims to describe mobility changes over the duration of the admission, and to determine which factors were associated with this change. Fifty-four individuals admitted to a specialized dementia inpatient unit participated in this study. A vision-based markerless motion capture system was used to record participants' natural gait. Mixed effect models were developed with gait measures as the dependent variables and clinical and demographic variables as predictors. We found that gait stability, step time, and step length decreased, and step time variability and step length variability increased over 10 weeks. Gait stability of men decreased more than that of women, associated with an increased sacrum mediolateral range of motion over time. In addition, the sacrum mediolateral range of motion decreased in those with mild neuropsychiatric symptoms over 10 weeks, but increased in those with more severe neuropsychiatric symptoms. Our study provides evidence of worsening of gait mechanics and control over the course of a hospitalization in older adults with dementia. Quantitative gait monitoring in hospital environments may provide opportunities to intervene to prevent adverse events, decelerate mobility decline, and monitor rehabilitation outcomes.
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Affiliation(s)
- Sina Mehdizadeh
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Mohammadreza Faieghi
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrea Sabo
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Hoda Nabavi
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Avril Mansfield
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alastair J. Flint
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Babak Taati
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Iaboni
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
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Reichold M, Heß M, Kolominsky-Rabas P, Gräßel E, Prokosch HU. Usability Evaluation of an Offline Electronic Data Capture App in a Prospective Multicenter Dementia Registry (digiDEM Bayern): Mixed Method Study. JMIR Form Res 2021; 5:e31649. [PMID: 34730543 PMCID: PMC8600440 DOI: 10.2196/31649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/23/2021] [Accepted: 09/19/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Digital registries have been shown to provide an efficient way of gaining a better understanding of the clinical complexity and long-term progression of diseases. The paperless method of electronic data capture (EDC) during a patient interview saves both time and resources. In the prospective multicenter project "Digital Dementia Registry Bavaria (digiDEM Bayern)," interviews are also performed on site in rural areas with unreliable internet connectivity. It must be ensured that EDC can still be performed in such a context and that there is no need to fall back on paper-based questionnaires. In addition to a web-based data collection solution, the EDC system REDCap (Research Electronic Data Capture) offers the option to collect data offline via an app and to synchronize it afterward. OBJECTIVE The aim of this study was to evaluate the usability of the REDCap app as an offline EDC option for a lay user group and to examine the necessary technology acceptance of using mobile devices for data collection. The feasibility of the app-based offline data collection in the digiDEM Bayern dementia registry project was then evaluated before going live. METHODS An exploratory mixed method design was employed in the form of an on-site usability test with the "Thinking Aloud" method combined with an online questionnaire including the System Usability Scale (SUS). The acceptance of mobile devices for data collection was surveyed based on five categories of the technology acceptance model. RESULTS Using the "Thinking Aloud" method, usability issues were identified and solutions were accordingly derived. Evaluation of the REDCap app resulted in a SUS score of 74, which represents "good" usability. After evaluating the technology acceptance questionnaire, it can be concluded that the lay user group is open to mobile devices as interview tools. CONCLUSIONS The usability evaluation results show that a lay user group generally agree that data collecting partners in the digiDEM project can handle the REDCap app well. The usability evaluation provided statements about positive aspects and could also identify usability issues relating to the REDCap app. In addition, the current technology acceptance in the sample showed that heterogeneous groups of different ages with diverse experiences in handling mobile devices are also ready for the use of app-based EDC systems. Based on these results, it can be assumed that the offline use of an app-based EDC system on mobile devices is a viable solution for collecting data in a decentralized registry-based research project.
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Affiliation(s)
- Michael Reichold
- Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Miriam Heß
- Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Peter Kolominsky-Rabas
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Elmar Gräßel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Stamatelos P, Economou A, Stefanis L, Yannis G, Papageorgiou SG. Driving and Alzheimer's dementia or mild cognitive impairment: a systematic review of the existing guidelines emphasizing on the neurologist's role. Neurol Sci 2021; 42:4953-4963. [PMID: 34581880 DOI: 10.1007/s10072-021-05610-7] [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: 04/27/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Driving is a complex task requiring the integrity and the cooperation of cognition, motor, and somatosensory skills, all of which are impacted by neurological diseases. OBJECTIVE Identification of neurologist's role when assessing fitness to drive of cognitively impaired individuals. METHODS We performed a systematic review of the guidelines/recommendations (G/Rs) regarding the evaluation of driving fitness of patients with mild cognitive impairment (MCI) and/or dementia. Emphasis was put on the neurological and neuropsychological aspects of the evaluation. RESULTS Eighteen G/Rs were included in the review (9 national guidelines, 5 recommendation papers, 3 consensus statements, and 1 position paper). All G/Rs referred to drivers with dementia and 9/18 referred to drivers with MCI. A common approach among G/Rs is the initial trichotomization of patients in safe to drive, unsafe to drive, and undetermined cases, which are referred to a second-line evaluator. First-line evaluators are general practitioners in 10/18 G/Rs; second-line evaluators are neurologists in 7/18 G/Rs. Specific neuropsychological tests are proposed in 11/18 G/Rs and relative cut-off values in 7/18. The most commonly used tests are the MMSE, TMT, and CDT. A thorough neurological examination is proposed in only 1/18 G/R. CONCLUSION Although extensive multi-disciplinary research has provided useful information for driving behavior of cognitively impaired individuals, we are still far from a widely accepted approach of driving ability evaluation in this increasing population. A comprehensive assessment from a multi-disciplinary team in which the neurologist plays a critical role seems to be required, although this has not yet been implemented in any G/Rs.
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Affiliation(s)
- Petros Stamatelos
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - Alexandra Economou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - George Yannis
- School of Civil Engineering, Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece.
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Sundaram ME, Calzavara A, Mishra S, Kustra R, Chan AK, Hamilton MA, Djebli M, Rosella LC, Watson T, Chen H, Chen B, Baral SD, Kwong JC. Déterminants individuels et sociaux du test de dépistage du SRAS-CoV-2 et de l’obtention d’un résultat positif en Ontario, au Canada: une étude populationnelle. CMAJ 2021; 193:E1261-E1276. [PMID: 34400488 PMCID: PMC8386493 DOI: 10.1503/cmaj.202608-f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/08/2022] Open
Abstract
Contexte: Optimiser la réponse de la santé publique pour diminuer le fardeau de la COVID-19 nécessite la caractérisation de l’hétérogénéité du risque posé par la maladie à l’échelle de la population. Cependant, l’hétérogénéité du dépistage du SRAS-CoV-2 peut fausser les estimations selon le modèle d’étude analytique utilisé. Notre objectif était d’explorer les biais collisionneurs dans le cadre d’une vaste étude portant sur les déterminants de la maladie et d’évaluer les déterminants individuels, environnementaux et sociaux du dépistage et du diagnostic du SRAS-CoV-2 parmi les résidents de l’Ontario, au Canada. Méthodes: Nous avons exploré la présence potentielle de biais collisionneurs et caractérisé les déterminants individuels, environnementaux et sociaux de l’obtention d’un test de dépistage et d’un résultat positif à la présence de l’infection au SRAS-CoV-2 à l’aide d’analyses transversales parmi les 14,7 millions de personnes vivant dans la collectivité en Ontario, au Canada. Parmi les personnes ayant obtenu un diagnostic, nous avons utilisé des études analytiques distinctes afin de comparer les prédicteurs pour les personnes d’obtenir un résultat de test de dépistage positif plutôt que négatif, pour les personnes symptomatiques d’obtenir un résultat de test de dépistage positif plutôt que négatif et pour les personnes d’obtenir un résultat de test de dépistage positif plutôt que de ne pas obtenir un résultat positif (c.-à-d., obtenir un résultat de test de dépistage négatif ou ne pas obtenir de test de dépistage). Nos analyses comprennent des tests de dépistage réalisés entre le 1er mars et le 20 juin 2020. Résultats: Sur 14 695 579 personnes, nous avons constaté que 758 691 d’entre elles ont passé un test de dépistage du SRAS-CoV-2, parmi lesquelles 25 030 (3,3 %) ont obtenu un résultat positif. Plus la probabilité d’obtenir un test de dépistage s’éloignait de zéro, plus la variabilité généralement observée dans la probabilité d’un diagnostic était grande parmi les modèles d’études analytiques, particulièrement en ce qui a trait aux facteurs individuels. Nous avons constaté que la variabilité dans l’obtention d’un test de dépistage était moins importante en fonction des déterminants sociaux dans l’ensemble des études analytiques. Les facteurs tels que le fait d’habiter dans une région ayant une plus haute densité des ménages (rapport de cotes corrigé 1,86; intervalle de confiance [IC] à 95 % 1,75–1,98), une plus grande proportion de travailleurs essentiels (rapport de cotes corrigé 1,58; IC à 95 % 1,48–1,69), une population atteignant un plus faible niveau de scolarité (rapport de cotes corrigé 1,33; IC à 95 % 1,26–1,41) et une plus grande proportion d’immigrants récents (rapport de cotes corrigé 1,10; IC à 95 % 1,05–1,15), étaient systématiquement corrélés à une probabilité plus importante d’obtenir un diagnostic de SRAS-CoV-2, peu importe le modèle d’étude analytique employé. Interprétation: Lorsque la capacité de dépister est limitée, nos résultats suggèrent que les facteurs de risque peuvent être estimés plus adéquatement en utilisant des comparateurs populationnels plutôt que des comparateurs de résultat négatif au test de dépistage. Optimiser la lutte contre la COVID-19 nécessite des investissements dans des interventions structurelles déployées de façon suffisante et adaptées à l’hétérogénéité des déterminants sociaux du risque, dont le surpeuplement des ménages, l’occupation professionnelle et le racisme structurel.
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Affiliation(s)
- Maria E Sundaram
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Andrew Calzavara
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Sharmistha Mishra
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Rafal Kustra
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Adrienne K Chan
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Mackenzie A Hamilton
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Mohamed Djebli
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Laura C Rosella
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Tristan Watson
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Hong Chen
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Branson Chen
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Stefan D Baral
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md
| | - Jeffrey C Kwong
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Département de médecine (Mishra, Chan); Institut de gestion, d'évaluation et de politiques de santé (Mishra, Chan); Institut des sciences médicales (Mishra); École de santé publique Dalla Lana (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Département des sciences statistiques (Kustra); Département de médecine familiale et communautaire (Kwong), Université de Toronto; MAP Centre for Urban Health Solutions (Mishra), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Centre des sciences de la santé Sunnybrook (Chan); Santé publique Ontario (Kwong, H. Chen); Toronto, Ont.; Département d'épidémiologie (Baral), École de santé publique Bloomberg de l'Université Johns Hopkins, Baltimore, Md.
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Afifi T, Collins NL, Rand K, Fujiwara K, Mazur A, Otmar C, Dunbar NE, Harrison K, Logsdon R. Testing the Feasibility of Virtual Reality With Older Adults With Cognitive Impairments and Their Family Members Who Live at a Distance. Innov Aging 2021; 5:igab014. [PMID: 34632105 PMCID: PMC8494141 DOI: 10.1093/geroni/igab014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study tests the feasibility of using virtual reality (VR) with older adults with mild cognitive impairment (MCI) or mild-to-moderate dementia with a family member who lives at a distance. RESEARCH DESIGN AND METHODS 21 residents in a senior living community and a family member (who participated in the VR with the older adult from a distance) engaged in a baseline telephone call, followed by 3 weekly VR sessions. RESULTS Residents and family members alike found the VR safe, extremely enjoyable, and easy to use. The VR was also acceptable and highly satisfying for residents with MCI and dementia. Human and automated coding revealed that residents were more conversationally and behaviorally engaged with their family member in the VR sessions compared to the baseline telephone call and in the VR sessions that used reminiscence therapy. The results also illustrate the importance of using multiple methods to assess engagement. Residents with dementia reported greater immersion in the VR than residents with MCI. However, the automated coding indicated that residents with MCI were more kinesically engaged while using the VR than residents with dementia. DISCUSSION AND IMPLICATIONS Combining networking and livestreaming features in a single VR platform can allow older adults in senior living communities to still travel, relive their past, and engage fully with life with their family members, despite geographical separation and physical and cognitive challenges.
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Affiliation(s)
- Tamara Afifi
- Department of Communication, University of California
Santa Barbara, USA
| | - Nancy L Collins
- Department of Psychological and Brain Sciences, University
of California Santa Barbara, USA
| | - Kyle Rand
- Rendever, Boston,
Massachusetts, USA
| | - Ken Fujiwara
- Department of Psychology, National Chung Cheng
University, Taiwan
| | - Allison Mazur
- Department of Communication, University of California
Santa Barbara, USA
| | - Chris Otmar
- Department of Communication, University of California
Santa Barbara, USA
| | - Norah E Dunbar
- Department of Communication, University of California
Santa Barbara, USA
| | - Kathryn Harrison
- Corporate Applications, Blizzard
Entertainment, Irvine, California, USA
| | - Rebecca Logsdon
- Department of Psychosocial and Community Health,
University of Washington, Seattle, USA
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Sundaram ME, Calzavara A, Mishra S, Kustra R, Chan AK, Hamilton MA, Djebli M, Rosella LC, Watson T, Chen H, Chen B, Baral SD, Kwong JC. Individual and social determinants of SARS-CoV-2 testing and positivity in Ontario, Canada: a population-wide study. CMAJ 2021; 193:E723-E734. [PMID: 33906966 PMCID: PMC8177943 DOI: 10.1503/cmaj.202608] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Optimizing the public health response to reduce the burden of COVID-19 necessitates characterizing population-level heterogeneity of risks for the disease. However, heterogeneity in SARS-CoV-2 testing may introduce biased estimates depending on analytic design. We aimed to explore the potential for collider bias in a large study of disease determinants, and evaluate individual, environmental and social determinants associated with SARS-CoV-2 testing and diagnosis among residents of Ontario, Canada. METHODS We explored the potential for collider bias and characterized individual, environmental and social determinants of being tested and testing positive for SARS-CoV-2 infection using cross-sectional analyses among 14.7 million community-dwelling people in Ontario, Canada. Among those with a diagnosis, we used separate analytic designs to compare predictors of people testing positive versus negative; symptomatic people testing positive versus testing negative; and people testing positive versus people not testing positive (i.e., testing negative or not being tested). Our analyses included tests conducted between Mar. 1 and June 20, 2020. RESULTS Of 14 695 579 people, we found that 758 691 were tested for SARS-CoV-2, of whom 25 030 (3.3%) had a positive test result. The further the odds of testing from the null, the more variability we generally observed in the odds of diagnosis across analytic design, particularly among individual factors. We found that there was less variability in testing by social determinants across analytic designs. Residing in areas with the highest household density (adjusted odds ratio [OR] 1.86, 95% confidence interval [CI] 1.75-1.98), highest proportion of essential workers (adjusted OR 1.58, 95% CI 1.48-1.69), lowest educational attainment (adjusted OR 1.33, 95% CI 1.26-1.41) and highest proportion of recent immigrants (adjusted OR 1.10, 95% CI 1.05-1.15) were consistently related to increased odds of SARS-CoV-2 diagnosis regardless of analytic design. INTERPRETATION Where testing is limited, our results suggest that risk factors may be better estimated using population comparators rather than test-negative comparators. Optimizing COVID-19 responses necessitates investment in and sufficient coverage of structural interventions tailored to heterogeneity in social determinants of risk, including household crowding, occupation and structural racism.
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Affiliation(s)
- Maria E Sundaram
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Andrew Calzavara
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Sharmistha Mishra
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Rafal Kustra
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Adrienne K Chan
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Mackenzie A Hamilton
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Mohamed Djebli
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Laura C Rosella
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Tristan Watson
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Hong Chen
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Branson Chen
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Stefan D Baral
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Jeffrey C Kwong
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
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29
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Sundaram ME, Calzavara A, Mishra S, Kustra R, Chan AK, Hamilton MA, Djebli M, Rosella LC, Watson T, Chen H, Chen B, Baral SD, Kwong JC. Individual and social determinants of SARS-CoV-2 testing and positivity in Ontario, Canada: a population-wide study. CMAJ 2021. [PMID: 33906966 DOI: 10.1101/2020.11.09.20223792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Optimizing the public health response to reduce the burden of COVID-19 necessitates characterizing population-level heterogeneity of risks for the disease. However, heterogeneity in SARS-CoV-2 testing may introduce biased estimates depending on analytic design. We aimed to explore the potential for collider bias in a large study of disease determinants, and evaluate individual, environmental and social determinants associated with SARS-CoV-2 testing and diagnosis among residents of Ontario, Canada. METHODS We explored the potential for collider bias and characterized individual, environmental and social determinants of being tested and testing positive for SARS-CoV-2 infection using cross-sectional analyses among 14.7 million community-dwelling people in Ontario, Canada. Among those with a diagnosis, we used separate analytic designs to compare predictors of people testing positive versus negative; symptomatic people testing positive versus testing negative; and people testing positive versus people not testing positive (i.e., testing negative or not being tested). Our analyses included tests conducted between Mar. 1 and June 20, 2020. RESULTS Of 14 695 579 people, we found that 758 691 were tested for SARS-CoV-2, of whom 25 030 (3.3%) had a positive test result. The further the odds of testing from the null, the more variability we generally observed in the odds of diagnosis across analytic design, particularly among individual factors. We found that there was less variability in testing by social determinants across analytic designs. Residing in areas with the highest household density (adjusted odds ratio [OR] 1.86, 95% confidence interval [CI] 1.75-1.98), highest proportion of essential workers (adjusted OR 1.58, 95% CI 1.48-1.69), lowest educational attainment (adjusted OR 1.33, 95% CI 1.26-1.41) and highest proportion of recent immigrants (adjusted OR 1.10, 95% CI 1.05-1.15) were consistently related to increased odds of SARS-CoV-2 diagnosis regardless of analytic design. INTERPRETATION Where testing is limited, our results suggest that risk factors may be better estimated using population comparators rather than test-negative comparators. Optimizing COVID-19 responses necessitates investment in and sufficient coverage of structural interventions tailored to heterogeneity in social determinants of risk, including household crowding, occupation and structural racism.
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Affiliation(s)
- Maria E Sundaram
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Andrew Calzavara
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Sharmistha Mishra
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Rafal Kustra
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Adrienne K Chan
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Mackenzie A Hamilton
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Mohamed Djebli
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Laura C Rosella
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Tristan Watson
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Hong Chen
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Branson Chen
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Stefan D Baral
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Jeffrey C Kwong
- ICES Central (Sundaram, Calzavara, Hamilton, Djebli, Rosella, Watson, H. Chen, B. Chen, Kwong); Department of Medicine (Mishra, Chan); Institute of Health Policy, Management and Evaluation (Mishra, Chan); Institute of Medical Science (Mishra); Dalla Lana School of Public Health (Kustra, Chan, Hamilton, Djebli, Rosella, Watson, H. Chen, Kwong); Department of Statistical Sciences (Kustra); and Department of Family and Community Medicine (Kwong), University of Toronto; MAP Centre for Urban Health Solutions (Mishra), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto; Sunnybrook Health Sciences Centre (Chan); Public Health Ontario (Kwong, H. Chen); University Health Network (Kwong), Toronto, Ont.; Department of Epidemiology (Baral), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
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Sverdrup K, Selbæk G, Bergh S, Strand BH, Thingstad P, Skjellegrind HK, Skjerve KN, Tangen GG. Physical performance across the cognitive spectrum and between dementia subtypes in a population-based sample of older adults: The HUNT study. Arch Gerontol Geriatr 2021; 95:104400. [PMID: 33798998 DOI: 10.1016/j.archger.2021.104400] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/20/2021] [Accepted: 03/20/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Literature on physical performance in older adults across the cognitive spectrum remains inconclusive, and knowledge on differences between dementia subtypes is lacking. We aim to identify distinct physical-performance deficits across the cognitive spectrum and between dementia subtypes. METHODS 11,466 persons were included from the 70-year-and-older cohort in the fourth wave of the Trøndelag Health Study (HUNT4 70+). Physical performance was assessed with the Short Physical Performance Battery (SPPB), 4-meter gait speed, five-times-sit-to-stand (FTSS), grip strength and one-leg-standing (OLS). Clinical experts diagnosed dementia per DSM-5 criteria. Multiple linear and logistic regression were performed to analyze differences between groups. Age, sex, education, somatic comorbidity, physical activity and smoking status were used as covariates. RESULTS Gait speed declined across the cognitive spectrum, beginning in people with subjective cognitive decline (SCD). Participants with mild cognitive impairment (MCI) additionally showed reduced lower-limb muscle strength, balance and grip strength. Those with dementia scored lowest on all physical-performance measures. Participants with Alzheimer's disease (AD) had a higher SPPB sum score and faster gait speed than participants with vascular dementia (VaD) and Lewy body dementia (LBD); participants with VaD and LBD had lower odds of being able to perform FTSS and OLS than participants with AD. CONCLUSIONS Physical performance declined across the spectrum from cognitively healthy to SCD to MCI and to dementia. Participants with AD performed better on all assessments except grip strength than participants with VaD and LBD. Stage of cognitive impairment and dementia subtype should guide exercise interventions to prevent mobility decline and dependency.
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Affiliation(s)
- Karen Sverdrup
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway; Department of Geriatric Medicine, Oslo University Hospital, Norway; Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway; Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway; Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Bjørn Heine Strand
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway; Department of Geriatric Medicine, Oslo University Hospital, Norway; Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Trondheim Municipality, Trondheim, Norway
| | - Håvard Kjesbu Skjellegrind
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Kjerstin Næss Skjerve
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Trondheim Municipality, Trondheim, Norway
| | - Gro Gujord Tangen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway; Department of Geriatric Medicine, Oslo University Hospital, Norway
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Gendron WH, Fertan E, Pelletier S, Roddick KM, O'Leary TP, Anini Y, Brown RE. Age related weight loss in female 5xFAD mice from 3 to 12 months of age. Behav Brain Res 2021; 406:113214. [PMID: 33677013 DOI: 10.1016/j.bbr.2021.113214] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/04/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023]
Abstract
In addition to cognitive decline, patients with Alzheimer's disease (AD) exhibit sensory, motor, and neuropsychiatric deficits. Many AD patients also show weight loss, suggesting that AD may involve a metabolic syndrome. The 5xFAD mouse model shows age-related weight loss compared to wildtype controls, and thus may exhibit metabolic dysfunction. This longitudinal study measured age-related weight loss in female 5xFAD and B6SJL/JF2 wild-type mice from 3 to 12 months of age, and examines some of the behavioural and physiological phenotypes in these mice that have been proposed to contribute to this weight loss. Because some mice had to be singly housed during the study, we also examined genotype by housing interactions. The 5xFAD mice weighed less and ate less than WT littermates starting at 6 months of age, exhibited less home cage activity, had higher frailty scores, less white adipose tissue, and lower leptin expression. At 9 and 12 months of age, heavier 5xFAD mice performed better on the rotarod, suggesting that metabolic deficits which begin between 6 and 9 months of age may exacerbate the behavioural deficits in 5xFAD mice. These results indicate that the 5xFAD mouse is a useful model to study the behavioural and metabolic changes in AD.
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Affiliation(s)
- William H Gendron
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Emre Fertan
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Stephanie Pelletier
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Kyle M Roddick
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Timothy P O'Leary
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Younes Anini
- Departments of Physiology and Biophysics, Halifax, Nova Scotia, B3H 4R2, Canada; Departments of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Richard E Brown
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada; Departments of Physiology and Biophysics, Halifax, Nova Scotia, B3H 4R2, Canada.
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Bertoncello C, Sperotto M, Bellio S, Pistellato I, Fonzo M, Bigolaro C, Ramon R, Imoscopi A, Baldo V. Effectiveness of individually tailored exercise on functional capacity and mobility in nursing home residents. Br J Community Nurs 2021; 26:144-149. [PMID: 33719558 DOI: 10.12968/bjcn.2021.26.3.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Deterioration of physical and functional capacities is often seen in nursing homes. The present study aimed at assessing the effectiveness of an individually tailored physical exercise intervention on mobility and functional decline in nursing home residents in a 1-year follow-up period. Information on gender, age, education, profession and cognitive status was collected at baseline and at 6 and 12 months of the intervention. The decline in functional capacity and mobility was assessed using the Barthel index. Some 221 participants were included. Results from the multivariate logistic regression showed how residents who never participated in physical activities had a five-fold higher risk of mobility decline compared with residents who did engage for the whole follow-up time. A lower effect was seen in residents who participated for only 6 months. Although dementia appeared to be a significant predictor of decline, a substantial stabilisation in mobility capacity was noted in patients with both mild and severe dementia performing exercise. The findings suggest that preventing or slowing physical decline in nursing home residents is an achievable goal, and even those with a higher degree of cognitive decline may benefit from a tailored physical activity plan.
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Affiliation(s)
- Chiara Bertoncello
- Lead Researcher, Hygiene and Public Health Unit, Department of Cardiovascular Medicine and Public Health, University of Padua, Padua, Italy
| | - Milena Sperotto
- Statistician, Hygiene and Public Health Unit, Department of Cardiovascular Medicine and Public Health, University of Padua, Padua, Italy
| | - Stefania Bellio
- Doctor in Specialist Training, Hygiene and Public Health Unit, Department of Cardiovascular Medicine and Public Health, University of Padua, Padua, Italy
| | - Ilaria Pistellato
- Doctor in Specialist Training, Hygiene and Public Health Unit, Department of Cardiovascular Medicine and Public Health, University of Padua, Padua, Italy
| | - Marco Fonzo
- Research Associate, Hygiene and Public Health Unit, Department of Cardiovascular Medicine and Public Health, University of Padua, Padua, Italy
| | - Chiara Bigolaro
- Psychologist, Istituto AltaVita-Istituzioni Riunite di Assistenza, Padua, Italy
| | - Roberto Ramon
- Physician, Istituto AltaVita-Istituzioni Riunite di Assistenza, Padua, Italy
| | - Alessandra Imoscopi
- Physician, Istituto AltaVita-Istituzioni Riunite di Assistenza, Padua, Italy
| | - Vincenzo Baldo
- Professor, Hygiene and Public Health Unit, Department of Cardiovascular Medicine and Public Health, University of Padua, Padua, Italy
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Rosso AL, Harding AB, Clarke PJ, Studenski SA, Rosano C. Associations of Neighborhood Walkability and Walking Behaviors by Cognitive Trajectory in Older Adults. THE GERONTOLOGIST 2021; 61:1053-1061. [PMID: 33428735 DOI: 10.1093/geront/gnab005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Lawton's Ecological Model of Aging suggests that associations between environment and mobility differ based on individual factors such as cognitive decline. RESEARCH DESIGN AND METHODS Virtual walkability audits were conducted within 1/8 mile of residences of older adults (n = 545; average age = 82; 57% female; 33% Black) who had been enrolled in the Health, Aging, and Body Composition (Health ABC) cohort for 10 years. The primary outcome was self-reported walking in past week and the secondary was mobility disability, self-reported difficulty to walk ¼ mile. Linear mixed models of general cognitive function over the prior 10 years calculated participant-specific slopes; those below 0 were cognitive decliners. Logistic regression models, adjusted for demographics and neighborhood socioeconomic status, tested associations between each walkability variable and each mobility outcome. Interaction terms between walkability and cognitive status were tested and walkability analyses stratified on cognitive status where p for interaction < .2. RESULTS In the sample, 57.4% reported walking, 24.2% reported mobility disability, and 51% were cognitive decliners. Sidewalk quality was related to walking in cognitive maintainers; slope was related in decliners. Mixed land use (odds ratio [OR] = 1.61; 95% confidence interval [CI]: 1.12, 2.30) and senior residence (OR = 2.14; 95% CI: 1.27, 3.60) were related to greater walking, regardless of cognitive status. Mixed land use was related to less mobility disability in decliners and abandoned properties were related to greater mobility disability in maintainers. DISCUSSION AND IMPLICATIONS Policy-level interventions targeted at walkability, including improved sidewalk quality and increasing mixed land use could support walking in older adults, regardless of cognitive status.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
| | - Alyson B Harding
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Philippa J Clarke
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA.,Institute of Social Research, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Stephanie A Studenski
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
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Galvin JE, Kleiman MJ, Chrisphonte S, Cohen I, Disla S, Galvin CB, Greenfield KK, Moore C, Rawn S, Riccio ML, Rosenfeld A, Simon J, Walker M, Tolea MI. The Resilience Index: A Quantifiable Measure of Brain Health and Risk of Cognitive Impairment and Dementia. J Alzheimers Dis 2021; 84:1729-1746. [PMID: 34744081 PMCID: PMC10731582 DOI: 10.3233/jad-215077] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is increasing interest in lifestyle modification and integrative medicine approaches to treat and/or prevent mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD). OBJECTIVE To address the need for a quantifiable measure of brain health, we created the Resilience Index (RI). METHODS This cross-sectional study analyzed 241 participants undergoing a comprehensive evaluation including the Clinical Dementia Rating and neuropsychological testing. Six lifestyle factors including physical activity, cognitive activity, social engagements, dietary patterns, mindfulness, and cognitive reserve were combined to derive the RI (possible range of scores: 1-378). Psychometric properties were determined. RESULTS The participants (39 controls, 75 MCI, 127 ADRD) had a mean age of 74.6±9.5 years and a mean education of 15.8±2.6 years. The mean RI score was 138.2±35.6. The RI provided estimates of resilience across participant characteristics, cognitive staging, and ADRD etiologies. The RI showed moderate-to-strong correlations with clinical and cognitive measures and very good discrimination (AUC: 0.836; 95% CI: 0.774-0.897) between individuals with and without cognitive impairment (diagnostic odds ratio = 8.9). Individuals with high RI scores (> 143) had better cognitive, functional, and behavioral ratings than individuals with low RI scores. Within group analyses supported that controls, MCI, and mild ADRD cases with high RI had better cognitive, functional, and global outcomes than those with low RI. CONCLUSION The RI is a brief, easy to administer, score and interpret assessment of brain health that incorporates six modifiable protective factors. Results from the RI could provide clinicians and researchers with a guide to develop personalized prevention plans to support brain health.
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Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael J. Kleiman
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephanie Chrisphonte
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Iris Cohen
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shanell Disla
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Conor B. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Keri K. Greenfield
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Claudia Moore
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susan Rawn
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary Lou Riccio
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amie Rosenfeld
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Judith Simon
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marcia Walker
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Magdalena I. Tolea
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Functional Decline and Body Composition Change in Older Adults With Alzheimer Disease: A Retrospective Cohort Study at a Japanese Memory Clinic. Alzheimer Dis Assoc Disord 2020; 35:36-43. [PMID: 33323780 DOI: 10.1097/wad.0000000000000426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is a dearth of longitudinal data on body composition, function, and physical performance in persons with Alzheimer's disease (AD). OBJECTIVES The aim was to describe the trajectories of function, body composition, and physical performance in older adults with AD. METHODS In this retrospective cohort study, data were collected from older adults (n=1402) diagnosed with AD (mean age: 78.1 y old, women: 69.3%). Cognitive function was assessed using the mini-mental state examination. Proxy-reported instrumental and basic activities of daily living were assessed using the Lawton and Barthel indexes. Body composition was assessed using bioelectrical impedance analysis. Physical performance was assessed using the timed up and go test and grip strength. RESULTS Median (interquartile range) of follow-up time was 2.2 (1.2 to 3.6) years. Participants' mini-mental state examination score, Barthel index, and Lawton index declined over time. Skeletal muscle mass index and physical performance (timed up and go test and grip strength) decreased, while fat mass index increased with time. No significant changes or slight decline in weight and body mass index was observed. CONCLUSIONS Muscle mass and physical performance are likely to decline in older adults with AD. Clinicians should assess muscle mass and physical performance trajectories regularly in these patients and intervene appropriately.
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Sverdrup K, Bergh S, Selbæk G, Benth JŠ, Røen IM, Husebo B, Tangen GG. Trajectories of physical performance in nursing home residents with dementia. Aging Clin Exp Res 2020; 32:2603-2610. [PMID: 32060802 PMCID: PMC7680334 DOI: 10.1007/s40520-020-01499-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 12/22/2022]
Abstract
Background In nursing homes (NH) the prevalence of dementia ranges from 50 to 84% and most residents have extensive physical-performance impairments. However, from time of admission, development of physical performance in NH residents with dementia remains unexplored. Aims To explore the overall trend in physical performance, associated characteristics, and groups following distinct trajectories from time of admission, in NH residents with dementia. Methods We followed newly admitted NH residents diagnosed with dementia (N = 583) from 47 NHs across Norway for 3 years. Individual assessments were conducted biannually, and main outcome measure was the Short Physical Performance Battery (SPPB). Facility-level characteristics included unit size, staff-to-resident ratio, and quality of the physical environment (Special Care Unit Environmental Quality Scale, SCUEQS). Results From time of admission, NH residents with dementia showed a significant overall decline in physical performance. Further, we identified three distinct trajectory groups with significantly different baseline physical-performance status (“good,” “moderate,” and “poor”), differences between groups maintained and all declined across time. Younger age, good general medical health, less-severe dementia, and less musculoskeletal pain were associated with both an average higher overall trend and better baseline group-belonging. Additionally, less apathy and more psychosis were associated with a higher overall trend, and agitation was associated with poorer baseline group-belonging. Conclusions To prevent excessive decline in physical performance in this population, NH clinicians should focus efforts specifically on assessment of physical performance at admission and on identification and management of musculoskeletal pain and neuropsychiatric symptoms. Electronic supplementary material The online version of this article (10.1007/s40520-020-01499-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Sverdrup
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Sverre Bergh
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Irene M Røen
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Centre for Development of Institutional and Home Care Services, Hamar, Hedmark, Norway
| | - Bettina Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Municipality of Bergen, Bergen, Norway
| | - Gro G Tangen
- Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Predictors of depression and dementia among elderly people in rural Jodhpur. Asian J Psychiatr 2020; 54:102419. [PMID: 33271710 DOI: 10.1016/j.ajp.2020.102419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022]
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Galvin JE, Tolea MI, Rosenfeld A, Chrisphonte S. The Quick Physical Activity Rating (QPAR) scale: A brief assessment of physical activity in older adults with and without cognitive impairment. PLoS One 2020; 15:e0241641. [PMID: 33125429 PMCID: PMC7598491 DOI: 10.1371/journal.pone.0241641] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/18/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Alzheimer's disease and related dementias (ADRD) currently affect over 5.7 million Americans and over 35 million people worldwide. At the same time, over 31 million older adults are physically inactive with impaired physical performance interfering with activities of daily living. Low physical activity is a risk factor for ADRD. We examined the utility of a new measure, the Quick Physical Activities Rating (QPAR) as an informant-rated instrument to quantify the dosage of physical activities in healthy controls, MCI and ADRD compared with Gold Standard assessments of objective measures of physical performance, fitness, and functionality. METHODS This study analyzed 390 consecutive patient-caregiver dyads who underwent a comprehensive evaluation including the Clinical Dementia Rating (CDR), mood, neuropsychological testing, caregiver ratings of patient behavior and function, and a comprehensive physical performance and gait assessment. The QPAR was completed prior to the office visit and was not considered in the clinical evaluation, physical performance assessment, staging or diagnosis of the patient. Psychometric properties including item variability and distribution, floor and ceiling effects, strength of association, known-groups performance, and internal consistency were determined. RESULTS The patients had a mean age of 75.3±9.2 years, 15.7±2.8 years of education and were 46.9% female. The patients had a mean CDR-SB of 4.8±4.7 and a mean MoCA score of 18.6±7.1 and covered a range of healthy controls (CDR 0 = 54), MCI or very mild dementia (CDR 0.5 = 161), mild dementia (CDR 1 = 92), moderate dementia (CDR 2 = 64), and severe dementia (CDR 3 = 29). The mean QPAR score was 20.2±18.9 (range 0-132) covering a wide range of physical activity. The QPAR internal consistency (Cronbach alpha) was very good at 0.747. The QPAR was correlated with measures of physical performance (dexterity, grip strength, gait, mobility), physical functionality rating scales, measures of activities of daily living and comorbidities, the UPDRS, and frailty ratings (all p < .001). The QPAR report of physical activities was able to discriminate between individuals with impaired physical functionality (32.2±23.9 vs 15.2±13.8, p < .001), falls risk (28.4±21.6 vs. 14.5±13.2, p < .001), and the presence of frailty (28.1±22.7 vs. 11.8±9.4, p < .001). The QPAR showed strong psychometric properties and excellent data quality, and worked equally well across different patient ages, sexes, informant relationships, and in individuals with and without cognitive impairment. DISCUSSION The QPAR is a brief detection tool that captures informant reports of physical activities and differentiates individuals with normal physical functionality from those individuals with impaired physical functionality. The QPAR correlated with Gold Standard assessments of strength and sarcopenia, activities of daily living, gait and mobility, fitness, health related quality of life, frailty, global physical performance, and provided good discrimination between states of physical functionality, falls risk, and frailty. The QPAR performed well in comparison to standardized scales of objective physical performance, but in a brief fashion that could facilitate its use in clinical care and research.
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Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Magdalena I. Tolea
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Amie Rosenfeld
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Stephanie Chrisphonte
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Yap TL, Alderden J, Sabol VK, Horn SD, Kennerly SM. Real-time Positioning Among Nursing Home Residents Living With Dementia: A Case Study. Wound Manag Prev 2020; 66:16-22. [PMID: 32614327 PMCID: PMC10507611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dementia contributes to the development of pressure injuries (PrIs). PURPOSE This study describes the real-time body positions of 2 nursing home (NH) residents, residing in the United States and living with dementia, to inform development of PrI prevention strategies tailored to individual risk profiles. METHODS As part of a larger study, eligible residents were fitted with a triaxial accelerometer sensor placed on the anterior chest to monitor body positions 24-hours daily through a 4-week monitoring period. The current study used an observational, prospective design during routine repositioning events for 2 residents. A convenience sample of 2 residents from a single NH wing who were considered moderately at risk for PrI development (Braden Scale score 13-14) with a Brief Interview for Mental Status score in the severely impaired range were selected based on nursing staff recommendation. RESULTS Sensor data showed that both residents, although "chairfast" according to the Braden Scale, spent <5% in an upright position and the great majority of time reclining at an angle <50%. One (1) resident demonstrated a persistent side preference. CONCLUSIONS Wearable sensors are not a long-term solution for protecting those with dementia from PrI formation but do provide a crude picture of overall body positions throughout the 24-hour day that may inform individualized PrI prevention strategies. Studies including large samples of NH residents living with dementia are warranted.
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Affiliation(s)
- Tracey L Yap
- Duke University School of Nursing, Durham, North Carolina
| | - Jenny Alderden
- University of Utah College of Nursing, Salt Lake City, Utah
| | | | - Susan D Horn
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Susan M Kennerly
- East Carolina University College of Nursing, Greenville, North Carolina
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Quinn K, Miyawaki CE, Croff R, Vogel MT, Belza B, Souza AM, Liu M, Edwards VJ, Friedman DB. Terms and Measures of Cognitive Health Associated With Dementia and Alzheimer's Disease: A Scoping Review. Res Aging 2020; 42:174-185. [PMID: 32195637 PMCID: PMC7785029 DOI: 10.1177/0164027520911284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Healthy Brain Initiative: National Public Health Road Map to Maintaining Cognitive Health (2007) called on the research community to disseminate its work on cognitive aging and cognitive health. The purpose of this scoping review was to (1) identify terminology that cognitive, social, and behavioral scientists use to describe cognitive aging and cognitive health, in association with dementia and Alzheimer's disease, among older adults; (2) demonstrate how such terms are defined; and (3) illustrate how these constructs are measured in research settings. Empirical studies published 2007-2018 were examined for terminology, definitions, disciplinary orientation, and measurement mechanisms. Analysis of the corpus and a detailed review of the terms "cognitive impairment" and "mild cognitive impairment" reveal that formal definitions are provided infrequently and measurement of constructs ranges widely. Overall, the variability in terminology, definitions, and measures reflects a need for greater specificity in research communication, such that cross-disciplinary collaboration can be facilitated.
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Affiliation(s)
- Kelly Quinn
- Department of Communication, University of Illinois at Chicago
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Palese A, Gonella S, Grassetti L, Longobardi M, De Caro A, Achil I, Hayter M, Watson R. What nursing home environment can maximise eating independence among residents with cognitive impairment? Findings from a secondary analysis. Geriatr Nurs 2020; 41:709-716. [PMID: 32414542 DOI: 10.1016/j.gerinurse.2020.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 01/09/2023]
Abstract
To explore the influence of the Nursing Home (NH) environment on eating independence while taking into account individual and nursing care factors, was the aim of the study. A secondary analysis was performed based on data collected in a multicentre prospective observational study involving 13 NHs. Residents aged >65 were included (n = 1,027). Dependence in eating was measured using the Edinburgh Feeding Evaluation in Dementia scale (EdFED, range 0-20). In addition to individual and nursing care variables, the NHs environments were assessed with the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH, range 0-149). The mean EdFED score was 2.48 (95% Confidence Interval [CI]=2.22-2.73) and the TESS-NH score was 122.19 (95% CI=115.89-128.49). A linear regression analysis explained 30.8% of the total variance in eating dependence. Alongside individual and nursing care factors, in poor NH unit environments, residents with severe cognitive impairment showed increased eating dependence; in contrast, in better environments, similar residents showed maximal eating performance.
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Affiliation(s)
- Alvisa Palese
- Associate Professor in Nursing Science, Department of Medical Science, University of Udine, Viale Ungheria 20, 33010 Udine, Italy.
| | - Silvia Gonella
- Research Assistant, Public Health Department, University of Torino, Italy
| | - Luca Grassetti
- PhD in Statistics, Lecturer, Department of Economics and Statistics, University of Udine, Italy
| | - Melania Longobardi
- Clinical Nurse, Department of Medical Science, University of Udine, Italy
| | - Alessandro De Caro
- Clinical Nurse, Department of Medical Science, University of Udine, Italy
| | - Illarj Achil
- Clinical Teacher, Department of Medical Science, University of Udine, Italy
| | - Mark Hayter
- Professor, Faculty of Health Sciences, University of Hull, UK
| | - Roger Watson
- Professor, Faculty of Health Sciences, University of Hull, UK
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Diepstraten M, Douven R, Wouterse B. Can your house keep you out of a nursing home? HEALTH ECONOMICS 2020; 29:540-553. [PMID: 32003931 PMCID: PMC7187432 DOI: 10.1002/hec.4001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/17/2019] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
We examine the impact of the accessibility of an older individual's house on her use of nursing home care. We link administrative data on the accessibility of all houses in the Netherlands to data on long-term care use of all older persons from 2011 to 2014. We find that older people living in more accessible houses are less likely to use nursing home care. The effects increase with age and are largest for individuals aged 90 or older. The effects are stronger for people with physical limitations than for persons with cognitive problems. We also provide suggestive evidence that older people living in more accessible houses substitute nursing home care by home care.
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Affiliation(s)
- Maaike Diepstraten
- CPB The Netherlands Bureau for Economic Policy AnalysisThe HagueThe Netherlands
| | - Rudy Douven
- CPB The Netherlands Bureau for Economic Policy AnalysisThe HagueThe Netherlands
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Bram Wouterse
- CPB The Netherlands Bureau for Economic Policy AnalysisThe HagueThe Netherlands
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
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Dansereau A, Hunter SW, Gomez F, Guralnik JM, DePaul VG, Auais M. Global cognition predicts the incidence of poor physical performance among older adults: A cross-national study. Geriatr Gerontol Int 2020; 20:218-222. [PMID: 31960569 DOI: 10.1111/ggi.13864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/25/2019] [Accepted: 12/16/2019] [Indexed: 11/28/2022]
Abstract
AIM The relationship between physical performance and cognition is well established. However, findings on the relationship between global cognition and the incidence of functional disability has been inconsistent. Using data from the International Mobility in Aging Study, we investigated the relationship between baseline cognitive function and the incidence of poor physical performance 2 years later. METHODS A total of 1071 community-dwelling participants (aged 64-75 years) from four sites in Canada and Latin America, with a Short Physical Performance Battery score ≥9 at baseline (good performance) were included. We carried out two sets of analyses, measuring cognition with either the Leganés Cognitive Test or the Montreal Cognitive Assessment. We used three logistic regression models, controlling for either no confounders, sociodemographic confounders or sociodemographic and health confounders. The full model was also stratified by site. A score <9 on the Short Physical Performance Battery indicated poor physical performance. RESULTS In the fully adjusted model, each 1-point increase in the baseline Leganés Cognitive Test score (range 0-32) was associated with a 10% decrease in the odds of incidence of poor physical performance at the 2-year follow-up (P = 0.019). Likewise, each 1-point increase in the baseline Montreal Cognitive Assessment score (range 0-30) was associated with a 16% decrease in the odds of developing poor physical performance (P = 0.005). When stratified by site, the results were significant at the Latin American sites (P = 0.02), but not at the Canadian sites (P = 0.08). CONCLUSIONS Poor baseline cognition is associated with the incidence of poor physical performance in community-dwelling older adults. To prevent physical disability, interventions addressing both cognitive and physical performance are required. Geriatr Gerontol Int 2020; ••: ••-••.
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Affiliation(s)
- Alexandra Dansereau
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Susan W Hunter
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Fernando Gomez
- Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | - Jack M Guralnik
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Vincent G DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Mohammad Auais
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Van Ooteghem K, Musselman K, Gold D, Marcil MN, Keren R, Tartaglia MC, Flint AJ, Iaboni A. Evaluating Mobility in Advanced Dementia: A Scoping Review and Feasibility Analysis. THE GERONTOLOGIST 2019; 59:e683-e696. [PMID: 29982355 DOI: 10.1093/geront/gny068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Mobility decline is a symptom of advanced dementia that affects function, safety, caregiving, and quality of life. Monitoring mobility status is essential for initiating timely and targeted interventions aimed at preventing excess disability in people with dementia (PWD). The physical, cognitive, and behavioral symptoms of dementia however, present unique challenges for mobility assessment. The goals of this review were to (a) identify and describe measures of mobility used for PWD and (b) assess measures' feasibility for use in people with advanced dementia; a group whose degree of cognitive impairment results in severe functional deficits. RESEARCH DESIGN AND METHODS Electronic searches of Medline, Embase, CINAHL, and PsychInfo databases were conducted using keywords related to dementia, mobility, measurement, and validation. Descriptive characteristics were extracted and measures coded for mobility components. Tools were also evaluated for feasibility of use in advanced dementia and those deemed feasible, screened for psychometric strength. RESULTS Thirty-eight measures were included and 68% of these tools were performance-based. Elements of mobility evaluated were walking (53% of measures), postural transitions (42%), standing (40%), mobility-related behavioral/psychological symptoms (24%), transfers (10%), bed mobility (5%), and wheeled mobility (3%). 36% of studies included people with advanced dementia. Only 18% of tools received high scores for feasibility. DISCUSSION AND IMPLICATIONS Existing measures provide only partial information regarding mobility and few target elements that become relevant as dementia progresses. Most measures are not feasible for people with advanced dementia, and the psychometric evaluation of these measures is limited. Further research is needed to develop a comprehensive, dementia-specific, mobility assessment tool.
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Affiliation(s)
| | - Kristin Musselman
- Toronto Rehabilitation Institute, University Health Network, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Canada
| | - David Gold
- Neuropsychology Clinic, Krembil Neuroscience Centre-Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
| | - Meghan N Marcil
- Toronto Rehabilitation Institute, University Health Network, Canada
| | - Ron Keren
- Toronto Rehabilitation Institute, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
| | - Maria Carmela Tartaglia
- Memory Clinic, University Health Network, Toronto, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, Faculty of Medicine, University of Toronto, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
| | - Andrea Iaboni
- Toronto Rehabilitation Institute, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
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Haaksma ML, Rizzuto D, Leoutsakos JMS, Marengoni A, Tan EC, Olde Rikkert MG, Fratiglioni L, Melis RJ, Calderón-Larrañaga A. Predicting Cognitive and Functional Trajectories in People With Late-Onset Dementia: 2 Population-Based Studies. J Am Med Dir Assoc 2019; 20:1444-1450. [DOI: 10.1016/j.jamda.2019.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 10/26/2022]
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Wang Y, Haaksma ML, Ramakers IH, Verhey FR, van de Flier WM, Scheltens P, van Maurik I, Olde Rikkert MG, Leoutsakos JS, Melis RJ. Cognitive and functional progression of dementia in two longitudinal studies. Int J Geriatr Psychiatry 2019; 34:1623-1632. [PMID: 31318090 PMCID: PMC6803041 DOI: 10.1002/gps.5175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/08/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Previous studies have identified several subgroups (ie, latent trajectories) with distinct disease progression among people with dementia. However, the methods and results were not always consistent. This study aims to perform a coordinated analysis of latent trajectories of cognitive and functional progression in dementia across two datasets. METHODS Included and analyzed using the same statistical approach were 1628 participants with dementia from the US National Alzheimer's Coordinating Center (NACC) and 331 participants with dementia from the Dutch Clinical Course of Cognition and Comorbidity study (4C-Study). Trajectories of cognition and instrumental activities of daily living (IADL) were modeled jointly in a parallel-process growth mixture model. RESULTS Cognition and IADL tended to decline in unison across the two samples. Slow decline in both domains was observed in 26% of the US sample and 74% of the Dutch sample. Rapid decline in cognition and IADL was observed in 7% of the US sample and 26% of the Dutch sample. The majority (67%) of the US sample showed moderate cognitive decline and rapid IADL decline. CONCLUSIONS Trajectories of slow and rapid dementia progression were identified in both samples. Despite using the same statistical methods, the number of latent trajectories was not replicated and the relative class sizes differed considerably across datasets. These results call for careful consideration when comparing progression estimates in the literature. In addition, the observed discrepancy between cognitive and functional decline stresses the need to monitor dementia progression across multiple domains.
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Affiliation(s)
- Yuwei Wang
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Miriam L. Haaksma
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Inez H.G.B. Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
| | - Frans R.J. Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht UniversityMaastrichtThe Netherlands
| | - Wiesje M. van de Flier
- Alzheimer Center Amsterdam, Department of Neurology, Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ingrid van Maurik
- Alzheimer Center Amsterdam, Department of Neurology, Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Epidemiology and BiostatisticsVU University Medical CenterAmsterdamThe Netherlands
| | - Marcel G.M. Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Jeannie‐Marie S. Leoutsakos
- Department of Psychiatry, Division of Geriatric Psychiatry and NeuropsychiatryJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - René J.F. Melis
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
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Taylor ME, Boripuntakul S, Toson B, Close JCT, Lord SR, Kochan NA, Sachdev PS, Brodaty H, Delbaere K. The role of cognitive function and physical activity in physical decline in older adults across the cognitive spectrum. Aging Ment Health 2019; 23:863-871. [PMID: 29798680 DOI: 10.1080/13607863.2018.1474446] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The aim of this study was to investigate physical decline over 1-year in a cohort of older people across the cognitive spectrum. METHODS Physical function was assessed using the Physiological Profile Assessment (PPA) in 593 participants (cognitively normal [CN]: n = 342, mild cognitive impairment [MCI]: n = 77, dementia: n = 174) at baseline and in 490 participants available for reassessment 1-year later. Neuropsychological performance and physical activity (PA) were assessed at baseline. RESULTS Median baseline PPA scores for CN, MCI and dementia groups were 0.41 (IQR = -0.09-1.02), 0.66 (IQR = -0.06-1.15) and 2.37 (IQR = 0.93-3.78) respectively. All baseline neuropsychological domains and PA were significantly associated with baseline PPA. There were significant interaction terms (Time × Cognitive Group, Global Cognition, Processing Speed, Executive Function and PA) in the models investigating PPA decline. In multivariate analysis the Time × Executive Function and PA interaction terms were significant, indicating that participants with poorer baseline executive function and reduced PA demonstrated greater physical decline when compared to individuals with better executive function and PA respectively. DISCUSSION Having MCI or dementia is associated with greater physical decline compared to CN older people. Physical inactivity and executive dysfunction were associated with physical decline in this sample, which included participants with MCI and dementia. Both factors influencing physical decline are potentially amenable to interventions e.g. exercise.
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Affiliation(s)
- Morag E Taylor
- a Falls, Balance and Injury Research Centre, Neuroscience Research Australia , University of New South Wales , Sydney , Australia.,b Prince of Wales Clinical School, Medicine , University of New South Wales , Sydney , Australia.,c Cognitive Decline Partnership Centre, Sydney Medical School , The University of Sydney , Sydney , Australia
| | - Sirinun Boripuntakul
- d Department of Physical Therapy , Chiang Mai University , Chiang Mai , Thailand
| | - Barbara Toson
- a Falls, Balance and Injury Research Centre, Neuroscience Research Australia , University of New South Wales , Sydney , Australia
| | - Jacqueline C T Close
- a Falls, Balance and Injury Research Centre, Neuroscience Research Australia , University of New South Wales , Sydney , Australia.,b Prince of Wales Clinical School, Medicine , University of New South Wales , Sydney , Australia
| | - Stephen R Lord
- a Falls, Balance and Injury Research Centre, Neuroscience Research Australia , University of New South Wales , Sydney , Australia
| | - Nicole A Kochan
- e Neuropsychiatric Institute , Prince of Wales Hospital , Randwick , New South Wales , Australia.,f Centre For Healthy Brain Ageing (CHeBA), School of Psychiatry, Medicine , University of New South Wales , Sydney , Australia
| | - Perminder S Sachdev
- e Neuropsychiatric Institute , Prince of Wales Hospital , Randwick , New South Wales , Australia.,f Centre For Healthy Brain Ageing (CHeBA), School of Psychiatry, Medicine , University of New South Wales , Sydney , Australia.,g Dementia Centre for Research Collaboration, School of Psychiatry, Medicine , University of New South Wales , Sydney , Australia
| | - Henry Brodaty
- f Centre For Healthy Brain Ageing (CHeBA), School of Psychiatry, Medicine , University of New South Wales , Sydney , Australia.,g Dementia Centre for Research Collaboration, School of Psychiatry, Medicine , University of New South Wales , Sydney , Australia
| | - Kim Delbaere
- a Falls, Balance and Injury Research Centre, Neuroscience Research Australia , University of New South Wales , Sydney , Australia
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Limbic and Basal Ganglia Neuroanatomical Correlates of Gait and Executive Function: Older Adults With Mild Cognitive Impairment and Intact Cognition. Am J Phys Med Rehabil 2019; 97:229-235. [PMID: 29261535 DOI: 10.1097/phm.0000000000000881] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to examine differences in spatiotemporal gait parameters between older adults with amnestic mild cognitive impairment and normal cognition and to examine limbic and basal ganglia neural correlates of gait and executive function in older adults without dementia. DESIGN This was a cross-sectional study of 46 community-dwelling older adults, ages 70-95 yrs, with amnestic mild cognitive impairment (n = 23) and normal cognition (n = 23). Structural magnetic resonance imaging was used to attain volumetric measures of limbic and basal ganglia structures. Quantitative motion analysis was used to measure spatiotemporal parameters of gait. The Trail Making Test was used to assess executive function. RESULTS During fast-paced walking, older adults with amnestic mild cognitive impairment demonstrated significantly slower gait speed and shorter stride length compared with older adults with normal cognition. Stride length was positively correlated with hippocampal, anterior cingulate, and nucleus accumbens volumes (P < 0.05). Executive function was positively correlated with hippocampal, anterior cingulate, and posterior cingulate volumes (P < 0.05). CONCLUSIONS Compared with older adults with normal cognition, those with amnestic mild cognitive impairment demonstrated slower gait speed and shorter stride length, during fast-paced walking, and lower executive function. Hippocampal and anterior cingulate volumes demonstrated moderate positive correlation with both gait and executive function, after adjusting for age. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) discuss gait performance and cognitive function in older adults with amnestic mild cognitive impairment versus normal cognition, (2) discuss neurocorrelates of gait and executive function in older adults without dementia, and (3) recognize the importance of assessing gait speed and cognitive function in the clinical management of older adults at risk for dementia. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Wang L, Lakin J, Riley C, Korach Z, Frain LN, Zhou L. Disease Trajectories and End-of-Life Care for Dementias: Latent Topic Modeling and Trend Analysis Using Clinical Notes. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:1056-1065. [PMID: 30815148 PMCID: PMC6371376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite the increasing prevalence, growing costs, and high mortality of dementia in older adults in the U.S., little is known about the course of these diseases and what care dementia patients receive in their final years of life. Using a large volume of clinical notes of dementia patients over the last two years of life, we conducted automatic topic modeling to capture the trends of various themes mentioned in care provider notes, including patients' physical function status, mental health, falls, nutrition and feeding, infections, hospital care, intensive care, end-of-life care, and family and social supports. Our research contributes to the adoption and evaluation of an unsupervised machine learning method using large amounts of retrospective free-text electronic health record data to discover and understand illness and health care trajectories.
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Affiliation(s)
- Liqin Wang
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joshua Lakin
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Clay Riley
- Brigham and Women's Hospital, Boston, MA, USA
| | - Zfania Korach
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura N Frain
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Li Zhou
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Boublay N, Fédérico D, Pesce A, Verny M, Blanc F, Paccalin M, Desmidt T, Grosmaître P, Moreaud O, Relland S, Bravant E, Bouet R, Krolak-Salmon P. Study protocol on Alzheimer's disease and related disorders: focus on clinical and imaging predictive markers in co-existing lesions. BMC Geriatr 2018; 18:280. [PMID: 30428832 PMCID: PMC6236893 DOI: 10.1186/s12877-018-0949-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/16/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND One of the crucial challenges for the future of therapeutic approaches to Alzheimer's disease (AD) is to target the main pathological processes responsible for disability and dependency. However, a progressive cognitive impairment occurring after the age of 70, the main population affected by dementia, is often related to mixed lesions of neurodegenerative and vascular origins. Whereas young patients are mostly affected by pure lesions, ageing favours the occurrence of co-lesions of AD, cerebrovascular disease (CVD) and Lewy body dementia (LBD). Most of clinical studies report on functional and clinical disabilities in patients with presumed pure pathologies. But, the weight of co-morbid processes involved in the transition from an independent functional status to disability in the elderly with co-lesions still remains to be elucidated. Neuropathological examination often performed at late stages cannot answer this question at mild or moderate stages of cognitive disorders. Brain MRI, Single Photon Emission Computed Tomography (SPECT) with DaTscan®, amyloid Positron Emission Tomography (PET) and CerebroSpinal Fluid (CSF) AD biomarkers routinely help in performing the diagnosis of underlying lesions. The combination of these measures seems to be of incremental value for the diagnosis of mixed profiles of AD, CVD and LBD. The aim is to determine the clinical, neuropsychological, neuroradiological and biological features the most predictive of cognitive, behavioral and functional impairment at 2 years in patients with co-existing lesions. METHODS A multicentre and prospective cohort study with clinical, neuro-imaging and biological markers assessment will recruit 214 patients over 70 years old with a cognitive disorder of AD, cerebrovascular and Lewy body type or with coexisting lesions of two or three of these pathologies and fulfilling the diagnostic criteria for dementia at a mild to moderate stage. Patients will be followed every 6 months (clinical, neuropsychological and imaging examination and collection of cognitive, behavioural and functional impairment) for 24 months. DISCUSSION This study aims at identifying the best combination of markers (clinical, neuropsychological, MRI, SPECT-DaTscan®, PET and CSF) to predict disability progression in elderly patients presenting coexisting patterns. TRIAL REGISTRATION NCT02052947 .
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Affiliation(s)
- Nawele Boublay
- Clinical and Research Memory Centre of Lyon, Hospital of Charpennes, Hospices Civils de Lyon, Lyon, France
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, F-69000 Lyon, France
- University Lyon, F-69000 Lyon, France
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, F-69424 Lyon, France
- Hospices civils de Lyon, hôpital des Charpennes, 27 rue Gabriel Péri, 69100 Villeurbanne, France
| | - Denis Fédérico
- Clinical and Research Memory Centre of Lyon, Hospital of Charpennes, Hospices Civils de Lyon, Lyon, France
| | - Alain Pesce
- Département de gérontologie clinique et centre mémoire, Centre Rainier III, Monaco, France
| | - Marc Verny
- Clinical and Research Memory Centre and Geriatrics department of Ile de France Sud, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
- University Pierre et Marie Curie et DHU FAST, UMR 8256 (CNRS), Paris, France
| | - Frédéric Blanc
- Geriatrics day hospital. Geriatrics department, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France
- Team IMIS/Neurocrypto, French National Center for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Marc Paccalin
- Clinical and Research Memory Centre of Poitiers, CHU Poitiers, Poitiers, France
- Pôle de Gériatrie CHU Poitiers 86000 Poitiers, 3INSERM, CHU de Poitiers, Université de Poitiers, centre d’investigation clinique CIC1402, Poitiers, France
| | - Thomas Desmidt
- Clinical and Research Memory Centre of Tours, CHRU Tours, Tours, France
| | - Pierre Grosmaître
- Clinical and Research Memory Centre of Lyon, Hospital of Dugoujon, Hospices Civils de Lyon, Lyon, France
| | - Olivier Moreaud
- Clinical and Research Memory Centre of Grenoble Arc Alpin, Pôle de psychiatrie et neurologie, CHU de Grenoble, Laboratoire de psychologie et neurocognition, CNRS UMR 5105, Grenoble, France
| | - Solveig Relland
- Clinical and Research Memory Centre of Lyon, Hospital of Charpennes, Hospices Civils de Lyon, Lyon, France
| | - Estelle Bravant
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, F-69424 Lyon, France
| | - Romain Bouet
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, F-69000 Lyon, France
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Centre of Lyon, Hospital of Charpennes, Hospices Civils de Lyon, Lyon, France
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, F-69000 Lyon, France
- Clinical Research Centre (Vieillissement – Cerveau - Fragilité), Hospital of Charpennes, Hospices Civils de Lyon, Lyon, France
- University Lyon, F-69000 Lyon, France
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