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Molvik I, Kjelvik G, Selbæk G, Rokstad AMM. Exploring the lived experience: impact of dementia diagnosis on individuals with cognitive impairment - a qualitative study. BMC Geriatr 2024; 24:121. [PMID: 38302870 PMCID: PMC10832106 DOI: 10.1186/s12877-024-04665-3] [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] [Received: 08/14/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE Although knowledge about the experience of being diagnosed with dementia is limited, with the expected rise in dementia's prevalence in the coming decades, such knowledge is pivotal for the people diagnosed, their families, and healthcare planners. Thus, the aim of our study was to explore the experience of living with cognitive impairment and dementia and the impact of being diagnosed with dementia. METHOD A qualitative design was applied. Participants were recruited based on age-adjusted values below threshold values on the Montreal Cognitive Assessment Scale (i.e. 70-79 years, < 22; 80-89 years, < 21; 90 + years, < 20), and the sample ultimately included 15 participants: six with and nine without a documented dementia diagnosis. Qualitative content analysis was performed on the transcribed interviews in four steps to identify codes, categories, and the overall theme. RESULTS Three major categories emerged from the interviews: (1) experiences with changes, (2) experiences with being diagnosed with dementia, and (3) existential experience. All participants with and most participants without a dementia diagnosis experienced changes in cognition. CONCLUSION Our findings imply that being diagnosed with dementia is a relief because it explains observed cognitive and functional decreases and reduces confusion, shame and stigma. However, it also raises concerns about an unknown future. Most participants not diagnosed with dementia reported having little or no difficulty with everyday living and leading a fulfilling life. Those findings emphasise the significance of timely versus early diagnosis.
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Affiliation(s)
- Inger Molvik
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
- Ageing and Health, Postboks 2136, Tønsberg, 3103, Norway.
| | - Grete Kjelvik
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Marie Mork Rokstad
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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Wang W, Peng J, Hou J, Yuan Z, Xie W, Mao G, Pan Y, Shao Y, Shu Z. Predicting mild cognitive impairment progression to Alzheimer's disease based on machine learning analysis of cortical morphological features. Aging Clin Exp Res 2023:10.1007/s40520-023-02456-1. [PMID: 37405620 DOI: 10.1007/s40520-023-02456-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/25/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To establish a model for predicting mild cognitive impairment (MCI) progression to Alzheimer's disease (AD) using morphological features extracted from a joint analysis of voxel-based morphometry (VBM) and surface-based morphometry (SBM). METHODS We analyzed data from 121 MCI patients from the Alzheimer's Disease Neuroimaging Initiative, 32 of whom progressed to AD during a 4-year follow-up period and were classified as the progression group, while the remaining 89 were classified as the non-progression group. Patients were divided into a training set (n = 84) and a testing set (n = 37). Morphological features measured by VBM and SBM were extracted from the cortex of the training set and dimensionally reduced to construct morphological biomarkers using machine learning methods, which were combined with clinical data to build a multimodal combinatorial model. The model's performance was evaluated using receiver operating characteristic curves on the testing set. RESULTS The Alzheimer's Disease Assessment Scale (ADAS) score, apolipoprotein E (APOE4), and morphological biomarkers were independent predictors of MCI progression to AD. The combinatorial model based on the independent predictors had an area under the curve (AUC) of 0.866 in the training set and 0.828 in the testing set, with sensitivities of 0.773 and 0.900 and specificities of 0.903 and 0.747, respectively. The number of MCI patients classified as high-risk for progression to AD was significantly different from those classified as low-risk in the training set, testing set, and entire dataset, according to the combinatorial model (P < 0.05). CONCLUSION The combinatorial model based on cortical morphological features can identify high-risk MCI patients likely to progress to AD, potentially providing an effective tool for clinical screening.
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Affiliation(s)
- Wei Wang
- Jinzhou Medical University Postgraduate Education Base (Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Jiaxuan Peng
- Jinzhou Medical University Postgraduate Education Base (Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Jie Hou
- Jinzhou Medical University Postgraduate Education Base (Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Zhongyu Yuan
- Jinzhou Medical University Postgraduate Education Base (Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Wutao Xie
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Guohe Mao
- Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Yaling Pan
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou City, Zhejiang Province, China
| | - Yuan Shao
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou City, Zhejiang Province, China
| | - Zhenyu Shu
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou City, Zhejiang Province, China.
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Kim H, Lingler JH, Bender CM, Albert SM, Sereika SM. Do Individuals Aged 50 or Older View Cognitive Conditions Differently Than Physical Conditions? Evidence From a Pooled Analysis of Illness Perceptions in Type 2 Diabetes and Mild Cognitive Impairment. Innov Aging 2023; 7:igad027. [PMID: 37128237 PMCID: PMC10148452 DOI: 10.1093/geroni/igad027] [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: 10/11/2022] [Indexed: 05/03/2023] Open
Abstract
Background and Objectives Type 2 diabetes (T2DM) and mild cognitive impairment (MCI) are common late-life physical and cognitive health conditions. Illness perceptions, an individual's personal beliefs about the conditions, should be explored in the context of disease characteristics (physical or cognitive). This secondary analysis explored illness perceptions with a priori hypotheses about control (perceived controllability) and coherence (perceived understanding) dimensions among persons with T2DM and MCI, treating each as an exemplar of late-life physical and cognitive health conditions. We also explored whether age, education, and comorbid conditions moderate the relationships between T2DM or MCI condition groups and illness perceptions. Research Design and Methods This cross-sectional, descriptive study examined baseline data collected from 146 T2DM to 90 MCI participants in 2 independent studies. The 9-item Brief Illness Perception Questionnaire was used to identify the similarities and differences in illness perceptions among persons with T2DM and MCI. We performed hierarchical linear regression controlling for identified covariates. Results We found that T2DM and MCI participants had significantly different illness perceptions, including perceptions of personal control (b = -0.943, p = .009), treatment control (b = -1.619, p < .001), and coherence (b = -1.265, p = .001), after controlling for covariates. The results suggest that persons with MCI were likely to believe that their condition is less controllable (through their own strategies or medical treatment) and less understandable compared with their T2DM counterparts. Such associations remained statistically significant when the interactions were added to the models. Discussion and Implications As T2DM and MCI are prevalent late-life conditions, health care professionals should consider individuals' subjective perceptions about their conditions in the context of disease characteristics when counseling secondary prevention strategies for disease management. Further research on illness perceptions in other conditions is needed to ensure the replicability of our findings.
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Affiliation(s)
- Hyejin Kim
- Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, Illinois, USA
| | - Jennifer H Lingler
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
- Alzheimer’s Disease Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine M Bender
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan M Sereika
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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Carter C, James T, Higgs P, Cooper C, Rapaport P. Understanding the subjective experiences of memory concern and MCI diagnosis: A scoping review. DEMENTIA 2023; 22:439-474. [PMID: 36574609 PMCID: PMC9841475 DOI: 10.1177/14713012221147710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Many older people experience memory concerns; a minority receive a diagnosis of Mild Cognitive Impairment (MCI) or Subjective Cognitive decline (SCD). There are concerns that medicalisation of MCI and memory concern may fail to acknowledge subjective experiences. AIM We explore the meaning individuals give to their memory concerns, with or without a diagnosis of MCI and SCD. METHOD We scoped literature exploring subjective experiences of memory concern, with or without a diagnosis of MCI or SCD. We searched CINAHL, PsycINFO and MEDLINE in March 2020, and updated in Sept 2021.We used (Arksey & O'Malley, 2005) framework to guide our scoping review method and thematic analysis to analyse our findings. RESULTS We screened 12,033 search results reviewing the full texts of 92 papers. We included 24 papers, including a total of 453 participants, the majority of whom were female, from White ethnic majority populations (or from studies where ethnicity was not identified) with high levels of education. In 15 out of 24 studies, 272 participants were diagnosed with MCI. We identified two themes; Making a diagnosis personal and Remembering not to forget. We found that subjective experiences include normative comparison with others of the same age and responses including fear, relief, and acceptance, but culminating in uncertainty. CONCLUSION Drawing upon sociology, we highlight the subjective experiences of living with memory concerns, SCD and an MCI diagnosis. We identify a gap between the intended purpose of diagnostic labels to bring understanding and certainty and the lived experiences of those ascribed them.
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Affiliation(s)
- Christine Carter
- Christine Carter, Division of Psychiatry,
University College London, Maple House, 149 Tottenham Court Road, Bloomsbury,
London W1T7NF, UK.
| | - Tiffeny James
- Division of Psychiatry, 4919University College London, London, UK
| | - Paul Higgs
- Division of Psychiatry, 4919University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, 4919University College London, London, UK
| | - Penny Rapaport
- Division of Psychiatry, 4919University College London, London, UK
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Ma J, Zhang H, Li Z. 'Redeemed' or 'isolated': A systematic review of the experiences of older adults receiving a mild cognitive impairment diagnosis. Geriatr Nurs 2023; 49:57-64. [PMID: 36446146 DOI: 10.1016/j.gerinurse.2022.11.007] [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: 09/05/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Understanding the experiences of older adults living with MCI can benefit healthcare professionals in diagnosing and implementing early interventions to delay cognitive decline. OBJECTIVE To assess and synthesize qualitative research exploring the experience of older adults diagnosed with MCI. METHODS PubMed, Embase, CINAHL, Web of Science, and PsycINFO databases were searched. Studies involving the experience of being diagnosed with MCI in older adults were included. Thomas and Harden's methodology of synthesizing qualitative studies was used. RESULTS Eleven studies were included. Three themes were identified: perceived reality of the MCI diagnosis; emotional and psychological responses to the MCI label; coping engaged in parallel processing. Older adults had confusing perspectives on the MCI diagnosis, leading to complicated and diverse emotional reactions and coping measures. CONCLUSIONS The relationship between perspectives, emotional reactions, and coping methods might be the key for healthcare professionals to break through the early diagnosis and intervention of MCI.
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Affiliation(s)
- Jingya Ma
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33 Ba Da Chu Road, Shijingshan District, Beijing 100144, China
| | - Huan Zhang
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33 Ba Da Chu Road, Shijingshan District, Beijing 100144, China
| | - Zheng Li
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, No 33 Ba Da Chu Road, Shijingshan District, Beijing 100144, China.
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van Maurik IS, Broulikova HM, Mank A, Bakker ED, de Wilde A, Bouwman FH, Stephens AW, van Berckel BNM, Scheltens P, van der Flier WM. A more precise diagnosis by means of amyloid PET contributes to delayed institutionalization, lower mortality, and reduced care costs in a tertiary memory clinic setting. Alzheimers Dement 2022; 19:2006-2013. [PMID: 36419238 DOI: 10.1002/alz.12846] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We aim to study the effect of a more precise diagnosis, by means of amyloid positron emission tomography (PET), on institutionalization, mortality, and health-care costs. METHODS Between October 27, 2014 and December 31, 2016, we offered amyloid PET to all patients as part of their diagnostic work-up. Patients who accepted to undergo amyloid PET (n = 449) were propensity score matched with patients without amyloid PET (n = 571, i.e., no PET). Matched groups (both n = 444) were compared on rate of institutionalization, mortality, and health-care costs in the years after diagnosis. RESULTS Amyloid PET patients had a lower risk of institutionalization (10% [n = 45] vs. 21% [n = 92]; hazard ratio [HR] = 0.48 [0.33-0.70]) and mortality rate (11% [n = 49] vs. 18% [n = 81]; HR = 0.51 [0.36-0.73]) and lower health-care costs in the years after diagnosis compared to matched no-PET patients (β = -4573.49 [-6524.76 to -2523.74], P-value < 0.001). DISCUSSION A more precise diagnosis in tertiary memory clinic patients positively influenced the endpoints of institutionalization, death, and health-care costs.
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Affiliation(s)
- Ingrid S. van Maurik
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam Epidemiology and Data Science Amsterdam the Netherlands
- Amsterdam Public Health Methodology Amsterdam the Netherlands
| | - Hana M. Broulikova
- Department of Health Sciences Faculty of Science Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | - Arenda Mank
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam Epidemiology and Data Science Amsterdam the Netherlands
- Amsterdam Public Health Methodology Amsterdam the Netherlands
| | - Els D. Bakker
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
| | - Arno de Wilde
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
- EQT Life Sciences Amsterdam the Netherlands
| | - Femke H. Bouwman
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
| | | | - Bart N. M. van Berckel
- Department of Radiology and Nuclear Medicine Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam the Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
- EQT Life Sciences Amsterdam the Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands
- Amsterdam Neuroscience Neurodegeneration Amsterdam the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam Epidemiology and Data Science Amsterdam the Netherlands
- Amsterdam Public Health Methodology Amsterdam the Netherlands
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Henderson JT, Martin A, Patnode CD, Henrikson NB. A synthesis of qualitative studies on patient and caregiver experiences with cognitive impairment screening and diagnosis. Aging Ment Health 2022:1-12. [PMID: 36193565 DOI: 10.1080/13607863.2022.2126431] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To understand patient and caregiver perspectives on the experience of being screened or diagnosed with cognitive impairment to inform preventive clinical care. METHODS Systematic review and synthesis of qualitative studies with searches in Ovid MEDLINE ALL, EBSCOHost CINAHL, and Scopus in February 2021. Included studies were assessed for quality and coded with descriptive, deductive, and inductive codes and findings were rated using GRADE-CER-qual. RESULTS We included 15 qualitative studies representing 153 patients and 179 caregivers. Most studies involved in-depth interviews. No studies examined screening experiences for older adults presenting without cognitive function concerns; nearly all patients received a diagnosis of cognitive impairment. Seven themes emerged with moderate to high confidence. Findings showed the role of caregivers in pursuing assessment and its benefits in validating concerns and for future planning. Patients were less inclined to be evaluated, fearing judgements or social consequences from the diagnostic label. Caregivers and patients were at times frustrated with the assessment process yet believed it might result in treatments to cure or slow disease progression. CONCLUSION Clinicians and care systems can support caregivers and patients by providing timely and informative resources to support their shared and separate motivations, needs, and concerns.
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Affiliation(s)
- Jillian T Henderson
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Portland, Oregon, USA
| | - Allea Martin
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Portland, Oregon, USA
| | - Carrie D Patnode
- Kaiser Permanente Research Affiliates Evidence-Based Practice Center, Portland, Oregon, USA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Pereira ME, Souza JV, Galiciolli MEA, Sare F, Vieira GS, Kruk IL, Oliveira CS. Effects of Selenium Supplementation in Patients with Mild Cognitive Impairment or Alzheimer's Disease: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14153205. [PMID: 35956381 PMCID: PMC9370215 DOI: 10.3390/nu14153205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Elevated levels of oxidative stress could cause and aggravate Alzheimer’s disease (AD). Selenium (Se) is a trace element with antioxidant and anti-inflammatory activity with neuroprotective effects. To evaluate the effects of Se supplementation in patients with AD or mild cognitive impairment (MCI) through a systematic review and meta-analysis, data were searched and collected from four electronic databases, including clinical trial studies published until December 2020, following the PRISMA guidelines. Statistical analysis was performed by RevMan, and the risk of bias was assessed using the Rob 2 tool. A total of 1350 scientific papers were collected, and following evaluation 11 papers were included in the systematic review and 6 of these were used in the meta-analysis. Studies that evaluated only Se supplementation observed an improvement in Se levels, glutathione peroxidase (GPX) activity, and in some cognitive tests in MCI patients; similarly, improvement in Se levels and mini-mental score was also observed in AD patients. Regarding supplementation of Se plus other nutrients, improvement in cognitive tests was observed in both AD and MCI patients. Therefore, Se supplementation is a good alternative for patients with AD and MCI for improving Se levels and GPX activity. More detailed studies are required to further evaluate the effects of Se on the cognitive deficit and oxidative stress associated with AD and MCI.
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Affiliation(s)
- Meire Ellen Pereira
- Instituto de Pesquisa Pelé Pequeno Príncipe, Rua Silva Jardim 1632, Curitiba 80250-060, Brazil
- Faculdades Pequeno Príncipe, Avenida Iguaçu 333, Curitiba 80230-020, Brazil
| | | | - Maria Eduarda Andrade Galiciolli
- Instituto de Pesquisa Pelé Pequeno Príncipe, Rua Silva Jardim 1632, Curitiba 80250-060, Brazil
- Faculdades Pequeno Príncipe, Avenida Iguaçu 333, Curitiba 80230-020, Brazil
| | - Fernanda Sare
- Faculdades Pequeno Príncipe, Avenida Iguaçu 333, Curitiba 80230-020, Brazil
| | | | - Isabeli Lopes Kruk
- Faculdades Pequeno Príncipe, Avenida Iguaçu 333, Curitiba 80230-020, Brazil
| | - Cláudia Sirlene Oliveira
- Instituto de Pesquisa Pelé Pequeno Príncipe, Rua Silva Jardim 1632, Curitiba 80250-060, Brazil
- Faculdades Pequeno Príncipe, Avenida Iguaçu 333, Curitiba 80230-020, Brazil
- Correspondence:
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Christova M, Strohmaier R, Fuchs-Neuhold B, Guggenberger B, Loder-Fink B, Draxler T, Palli C, Simi H, Schadenbauer S, Nischelwitzer A, Sprung G, Pilz R, Darkow R, Staubmann W. Mixed Reality Prototype of Multimodal Screening for Early Detection of Cognitive Impairments in Elderly Individuals: Protocol Development and Usability Study (Preprint). JMIR Res Protoc 2022; 11:e39513. [PMID: 36239994 PMCID: PMC9617182 DOI: 10.2196/39513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/28/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background The early diagnosis of cognitive impairments is an important step in the adequate management of dementia. The project “Smart Cognition & Behaviour Screening powered by Augmented Reality” (SCOBES-AR) aims to develop a multimodal screening tool (MST) for the early detection of cognitive impairments using augmented and virtual reality. The first project phase selected validated assessments for combination with the MST and tested it in 300 healthy older adults. Objective This study established a protocol for the implementation and usability of a mixed reality (MR)–enhanced multidisciplinary screening tool for the early detection of cognitive impairments in older adults. The developed MST will be partially enhanced by MR, which is a combination of augmented reality (AR) and virtual reality (VR). This MR-enhanced prototype of the screening tool (MR-MST) will be tested and compared to the previously developed MST. The usability of the prototype will also be examined. Methods This single-center observational crossover design study screens 100 healthy participants (aged 60-75 years) for cognitive decline using a specially developed MST (assessment of cognitive functions, olfactory sensitivity, nutritional preferences, gait parameters, reaction times, and activities of daily living) and an MR-enhanced MST in which the assessments of cognitive functions, reaction time, activities of daily living, and gait will be performed using tailor-made software and AR and VR hardware. The results of the MR-enhanced MST will be compared to those without MR. The usability of the developed MR-enhanced MST will be tested on 10 investigators and 10 test participants using observed summative evaluation and the codiscovery method, and on 2 usability experts using the codiscovery and cognitive walkthrough methods. Results This study was funded by the Austrian Research Promotion Agency (grant 866873) and received approval from the ethics committee of the Medical University of Graz. The MR-MST and the experimental protocol for this study were developed. All participants gave written informed consent. As of July 15, 2022, a total of 70 participants have been screened. Data analysis and dissemination are scheduled for completion by September 2023. Conclusions The development and testing of the MR-MST is an important step toward the establishment of the best practice procedure for the implementation of AR and VR in the screening of cognitive declines in older adults. It will help improve our knowledge of the usability and applicability of the developed prototype and promote further advancement in AR and VR technologies to be used in therapeutic settings. International Registered Report Identifier (IRRID) DERR1-10.2196/39513
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Affiliation(s)
- Monica Christova
- Institute of Physiotherapy, University of Applied Sciences FH JOANNEUM, Graz, Austria
- Section of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Robert Strohmaier
- Institute of Business Informatics and Data Science, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Bianca Fuchs-Neuhold
- Institute of Dietetics and Nutrition, University of Applied Sciences FH JOANNEUM, Graz, Austria
- Institute of Health and Tourism Management, University of Applied Sciences FH JOANNEUM, Bad Gleichenberg, Austria
| | - Bernhard Guggenberger
- Institute of Physiotherapy, University of Applied Sciences FH JOANNEUM, Graz, Austria
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Brigitte Loder-Fink
- Institute of Occupational Therapy, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Theresa Draxler
- Institute of Dietetics and Nutrition, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Christoph Palli
- Institute of Health Care and Nursing, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Helmut Simi
- Institute of Health and Tourism Management, University of Applied Sciences FH JOANNEUM, Bad Gleichenberg, Austria
| | - Sandra Schadenbauer
- Institute of Business Informatics and Data Science, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Alexander Nischelwitzer
- Institute of Business Informatics and Data Science, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Gerhard Sprung
- Institute of Business Informatics and Data Science, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - René Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Robert Darkow
- Institute of Logopedics, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Wolfgang Staubmann
- Institute of Dietetics and Nutrition, University of Applied Sciences FH JOANNEUM, Graz, Austria
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Abstract
OBJECTIVES Mild cognitive impairment (MCI) is a concept that is steeped in controversy not limited to prognostic uncertainty; it is unclear how patients interpret or attribute meaning to the label, and whether they perceive that being made aware is beneficial. METHODS A systematic review was conducted, searching ISI Web of Science, PubMed and PsycINFO in accordance with PRISMA guidelines. Search terms were developed to include articles concerning perceptions regarding MCI and experiences and impact of being informed. Thematic synthesis was applied to the findings. RESULTS Fourteen papers met criteria. Three themes emerged regarding the MCI label: 1) Individual differences relating to living circumstances, personal perceptions and experiences, and coping style affect how patients adjust to the MCI label; 2) Patients' reactions to the MCI label and their perceptions about how useful it was to receive are affected by the nebulous nature of the construct and information available regarding MCI; 3) Care partners are uncertain about what MCI means and how to address and cope with the patient's cognitive difficulties. CONCLUSIONS Patient and care partner perspectives were affected by the quality of information and support provided, possibly influenced by clinicians' understanding of the concept. Personal perceptions and experiences, living circumstance and coping styles also shaped experiences of being informed. CLINICAL IMPLICATIONS Clinicians should develop their understanding of MCI to deliver clear information to patients and consider the necessity of applying the label. Offering support tailored to patients' specific needs may improve perceptions about the label's utility, whilst aiding coping and adjustment.
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Affiliation(s)
- Lisa Blatchford
- Clinical Psychology Research, Currently Undertaking Clinical Psychology Doctoral Training, School of Psychology, University of Birmingham, Birmingham, UK
| | - Julia Cook
- Clinical Psychology, New Haven, Princess of Wales Community Hospital, Worcestershire Older Adult Community and Inpatient Mental Health Services, Worcestershire Health and Care NHS Trust, Bromsgrove, UK
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van der Schaar J, Visser LNC, Bouwman FH, Ket JCF, Scheltens P, Bredenoord AL, van der Flier WM. Considerations regarding a diagnosis of Alzheimer's disease before dementia: a systematic review. Alzheimers Res Ther 2022; 14:31. [PMID: 35144684 PMCID: PMC8829985 DOI: 10.1186/s13195-022-00971-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/31/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The NIA-AA research framework proposes a purely biological definition of Alzheimer's disease (AD). This implies that AD can be diagnosed based on biomarker abnormalities, irrespective of clinical manifestation. While this brings opportunities, it also raises challenges. We aimed to provide an overview of considerations regarding the disclosure of AD pathology before the onset of dementia. METHODS A systematic literature review was conducted and reported according to PRISMA guidelines. We searched PubMed, Embase, APA PsycINFO, and Web of Science Core Collection (on 10 December 2020) for references on conveying AD biomarker results to individuals without dementia. Our query combined variations on the terms Alzheimer's disease, disclosure, or diagnosis, preclinical or prodromal, and biomarkers. Two reviewers independently screened the resulting 6860 titles and abstracts for eligibility and examined 162 full-text records for relevance. We included theoretical articles in English, on communicating amyloid and/or tau results to individuals with mild cognitive impairment, subjective cognitive decline, or normal cognition. MAXQDA-software was used for inductive data analysis. RESULTS We included 27 publications. From these, we extracted 26 unique considerations, which we grouped according to their primary relevance to a clinical, personal, or societal context. Clinical considerations included (lack of) validity, utility, and disclosure protocols. Personal considerations covered psychological and behavioral implications, as well as the right to (not) know. Finally, societal considerations comprised the risk of misconception, stigmatization, and discrimination. Overall, views were heterogeneous and often contradictory, with emphasis on harmful effects. CONCLUSIONS We found 26 diverse and opposing considerations, related to a clinical, personal, or societal context, which are relevant to diagnosing AD before dementia. The theoretical literature tended to focus on adverse impact and rely on common morality, while the motivation for and implications of biomarker testing are deeply personal. Our findings provide a starting point for clinicians to discuss biomarker-based diagnosis with their patients, which will become even more relevant in light of the conditional approval of a first disease-modifying drug for AD.
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Affiliation(s)
- Jetske van der Schaar
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
| | - Leonie N C Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Femke H Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
| | | | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
| | - Annelien L Bredenoord
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.,Department of Epidemiology & Data Sciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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12
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Kimmel HJ, Levine DA, Whitney RT, Forman J, Plassman BL, Fagerlin A, Welsh-Bohmer KA, Reale BK, Galecki AT, Blair E, Langa KM, Giordani B, Kollman C, Wang J, Zahuranec DB. A Mixed-Methods Study of the Impact of Mild Cognitive Impairment Diagnosis on Patient and Care Partner Perception of Health Risks. J Alzheimers Dis 2022; 85:1175-1187. [PMID: 34924384 PMCID: PMC8969329 DOI: 10.3233/jad-215155] [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: 11/15/2022]
Abstract
BACKGROUND Older patients (≥65 years) with mild cognitive impairment (MCI) are undertreated for cardiovascular disease (CVD). One reason for this disparity could be that patients with MCI might underestimate the chances of CVD and overestimate dementia. OBJECTIVE To compare conceptions of health risk between older patients with MCI and normal cognition (NC) and their care partners. METHODS We conducted a multi-center mixed-methods study of patient-care partner dyads completing written quantitative surveys (73% response rate; 127 dyads: 66 MCI and 61 NC) or semi-structured interviews (20 dyads: 11 MCI, and 9 NC). Surveys assessed two-year patient risks of dementia, heart attack, stroke, and fall. Interviews assessed similar health risks and reasons for risk perceptions. RESULTS On surveys, a similarly low proportion of MCI and NC patients felt they were at risk of stroke (5% versus 2%; p = 0.62) and heart attack (2% versus 0%; p = 0.99). More MCI than NC patients perceived dementia risk (26% versus 2%; p < 0.001). Care partners' survey findings were similar. Interviews generally confirmed these patterns and also identified reasons for future health concerns. For both MCI and NC dyads, personal experience with cognitive decline or CVD (personal or family history) increased concerns about each disease. Additionally, perceptions of irreversibility and lack of treatment for cognitive decline increased concern about dementia. CONCLUSION Less use of CVD treatments in MCI seems unlikely to be driven by differential perceptions of CVD risk. Future work to improve awareness of CVD risks in older patients and dementia risk in patients with MCI are warranted.
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Affiliation(s)
- Hannah J Kimmel
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
| | - Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Rachael T Whitney
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
| | - Jane Forman
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Brenda L Plassman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, UT and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, University of Utah, Salt Lake City, UT, USA
| | | | - Bailey K Reale
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
| | - Andrzej T Galecki
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA.,Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Emilie Blair
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M Langa
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Bruno Giordani
- Department of Psychiatry & Michigan Alzheimer's Disease Center, U-M, Ann Arbor, MI, USA
| | | | - Jing Wang
- Fudan University School of Nursing, Shanghai, China
| | - Darin B Zahuranec
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, USA
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13
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Fear about Alzheimer's disease among Israeli and German laypersons, persons with Mild Neurocognitive Disorder and their relatives: a qualitative study. Int Psychogeriatr 2021; 33:1019-1034. [PMID: 33046144 DOI: 10.1017/s1041610220003397] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Alzheimer's disease (AD), the most common type of dementia, is one of the most feared diseases, obstructing help-seeking, and leading to discrimination. While research interest in fear of developing AD is increasing, little is known about its characterization, triggers, and consequences, especially among different cultures. In this study, we aimed at exploring and characterizing AD fear as experienced by laypersons (LP), persons with Mild Neurocognitive Disorder (MND), and their relatives, in Israel and Germany. DESIGN A qualitative study using focus groups (FGs) and semi-structured interviews was used. Thematic content analysis was conducted to extract key themes. SETTING Israeli and German not yet diagnosed people. PARTICIPANTS The study included a total of 130 participants (63 Israeli and 67 German participants) representing 3 groups: LP (n = 82), persons with MND (n = 28), and relatives of persons with MND (n = 20). RESULTS Two overarching themes were identified across groups and countries: fear of developing AD and fear of stigmatization. Other types of fear, such as fear of a person with AD, fear about the impact of a diagnosis of AD on family members, fear of becoming a caregiver, and fear of losing one's self-determination because of developing AD, were specific to a group type or country. Different types of fear were awakened by different triggers, and were dealt with different coping strategies.
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14
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Liu Q, Zhong M, Yuan S, Niu C, Ma X. Clinical study of central cholinergic pathway damage in two mild cognitive impairment patients. Neurol Sci 2021; 42:4707-4717. [PMID: 34528182 PMCID: PMC8521601 DOI: 10.1007/s10072-021-05573-9] [Citation(s) in RCA: 3] [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: 05/13/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022]
Abstract
Objectives To explore the role of the central cholinergic system in amnestic mild cognitive impairment (aMCI) and mild vascular cognitive impairment (vMCI). Methods Twenty-five aMCI patients and 25 vMCI patients were enrolled in this study, and 25 healthy people were chosen as a control group. All participants performed a set of cognitive function scales and were subjected to a brain MRI. We analyzed differences in neuropsychological damage between groups, as well as the degree of brain atrophy and changes in the microstructure of central cholinergic pathways (CCP) in relation to effects on neuropsychological scores. Results (1) Regarding neuropsychological characteristics of the three groups, scores on the MoCA scale, immediate memory, delayed recall, cued recall, long time prolonged recognition, and CDR-SB of the control group were significantly better than those of the aMCI and vMCI groups. Scores on immediate memory, delayed memory, cued recall, long time delayed recognition, and Forward of Digital Span Test (FDST) in the aMCI group were lower than those in the vMCI group. Compared with the aMCI group, the vMCI group was significantly delayed in Trail Making Test (TMA)-A, TMT-B, and TMT B-A. There were no significant differences in HAMA, HAMD, MMSE, MoCA, the Boston Naming Test (BNT), language fluency or visual scale of posterior atrophy (Koedam score) between the vMCI and aMCI groups. (2) As for microstructure changes in the central cholinergic pathway, vMCI group had a decreased FA value in the cingulum (Cing) of the medial pathway, but an increased MD value in the external capsule (Excap) of the lateral pathway when compared to other two groups. Furthermore, the CingMD value of the vMCI group was higher than that of the control group, but the difference was not obvious when compared to the aMCI group. (3) Last, we researched microstructural changes to CCP, degree of brain atrophy, and neuropsychological scores by using partial correlation analysis for all participants. CingFA was negatively correlated with TMT-B, B-A, and FDST. CingMD was negatively correlated with FDST. ExcapFA was positively correlated with MMSE and Backward of BDST, while ExcapMD was negatively correlated with MMSE and MoCA. Claustrum (Claus)FA was positively related to MoCA and FDST, but was negatively related to TMT-A. ClausMD was negatively correlated with MoCA and language fluency. Koedam score was positively correlated with CDR-SB, ExcapMD, and ClausMD, but negatively correlated with MMSE score and inverse BDST. Conclusion The central cholinergic system is involved in the cognitive impairment of both aMCI and vMCI, and their mechanisms may be distinct. aMCI patients may present with primary CCP impairment while vMCI patients probably exhibit impairment secondary to vasogenic damage to the cholinergic system projection network. The lateral cholinergic pathway was more severely impaired than the medial pathway in vMCI patients, in addition to being associated with decreased executive and general cognitive functions. The damage to CCP was related to the degree of brain atrophy, and both may be involved in the development and progression of cognitive dysfunction.
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Affiliation(s)
- Qing Liu
- Department of Neurology, Guihang Guiyang Hospital, Guiyang, Guizhou, China.
| | - Ming Zhong
- Department of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Shiqi Yuan
- Department of Neurology, Guihang Guiyang Hospital, Guiyang, Guizhou, China
| | - Chen Niu
- Department of Neurology, Guihang Guiyang Hospital, Guiyang, Guizhou, China
| | - Xiaoying Ma
- Department of Neurology, Guihang Guiyang Hospital, Guiyang, Guizhou, China
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15
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Vandenberg AE, Drenkard C, Goldstein FC, Dunlop-Thomas C, Lim SS, Bowling CB, Plantinga LC. Cognitive problems and their clinical assessment in SLE: contrasting patient and provider views. Arthritis Care Res (Hoboken) 2021; 74:1468-1476. [PMID: 33734607 DOI: 10.1002/acr.24599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a complex chronic disease associated with reduced cognitive functioning. Patients with SLE report cognitive symptoms, but cognitive assessment is not routine and little is known about day-to-day cognitive problems and their effect on disease management. As part of a pilot exploring the use of a cognitive functioning report prototype for shared decision making in clinical encounters (Approaches to Positive Patient-Centered Experiences of Aging in Lupus study-APPEAL), we investigated the relevance of cognitive assessments performed using the NIH Toolbox among patients with SLE. METHODS We conducted four focus groups, two with SLE patients (n=18) and two with lupus providers (physicians and nurses; n=9) addressing cognitive issues and interest in communicating about cognition. We compared how NIH Toolbox cognitive domains (episodic memory; working memory; processing speed; attention and inhibitory control; cognitive flexibility) matched with patient- and provider-identified cognitive problems and needs. RESULTS Patients identified all NIH domains with rich experiential examples; providers identified fewer domains and offered less detail. An unanticipated additional domain was prospective memory, i.e., problems in remembering future actions. Use of technological aids (e.g., smart phone alerts) was mentioned by some patients, but not providers, and represent a potential opportunity for medical care. All participants expressed interest in discussing cognition in clinic. CONCLUSION Cognitive assessment using the NIH Cognitive Toolbox is relevant to this population, with the possible addition of a prospective memory assessment. Cognitive problems and indications of communication gaps suggest the appropriateness of more clinical communication about cognition in this population.
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Affiliation(s)
- Ann E Vandenberg
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, United States
| | - Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, United States.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Felicia C Goldstein
- Department of Neurology, Division of Neuropsychology, Emory University School of Medicine, Atlanta, GA, United States
| | - Charmayne Dunlop-Thomas
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, United States
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, United States.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Laura C Plantinga
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, United States.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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16
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Beatie BE, Mackenzie CS, Funk L, Davidson D, Koven L, Reynolds KA. Caregiver identity in care partners of persons living with mild cognitive impairment. DEMENTIA 2021; 20:2323-2339. [PMID: 33595336 PMCID: PMC8564256 DOI: 10.1177/1471301221994317] [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] [Indexed: 11/16/2022]
Abstract
Research on caregiver identity in the context of memory impairment has focused primarily
on more advanced stages of the cognitive impairment trajectory (e.g., dementia
caregivers), failing to capture the complex dynamics of early caregiver identity
development (e.g., MCI; mild cognitive impairment caregivers). The aim of this study was
to develop a nuanced understanding of how caregiver identity develops in family and
friends of persons living with MCI. Using constructivist grounded theory (ConGT), this
study explored caregiver identity development from 18 in-depth interviews with spouses
(n = 13), children (n = 3), and friends
(n = 2) of persons recently diagnosed with MCI. The overarching themes
influencing MCI caregiver identity development included MCI changes, care-related
experiences, “caregiver” interpretation, and approach/avoidance coping. These themes
influenced how participants primarily identified, represented as I am a caregiver,
I am not a caregiver, or liminality (i.e., between their
previous identity and a caregiver identity). Irrespective of their current
self-identification, all conveyed thinking about their “future self,” as providing more
intensive care. MCI caregiver identity development in family and friends is a fluid and
evolving process. Nearly all participants had taken on care tasks, yet the majority of
these individuals did not clearly identify as caregivers. Irrespective of how participants
identified, they were engaging in care, and would likely benefit from support with
navigating these changes and their new, ambiguous, and evolving roles.
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Affiliation(s)
- Brooke E Beatie
- Department of Psychology, 194379University of Manitoba, Winnipeg, Manitoba, Canada
| | - Corey S Mackenzie
- Department of Psychology, 194379University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura Funk
- Department of Sociology and Criminology, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dylan Davidson
- Department of Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley Koven
- Department of Clinical Health Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristin A Reynolds
- Department of Psychology, 12359University of Manitoba, Winnipeg, Manitoba, Canada
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17
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Riquelme-Galindo J, García-Sanjuán S, Lillo-Crespo M, Martorell-Poveda MA. Experience of People in Mild and Moderate Stages of Alzheimer’s Disease in Spain. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.4.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To analyze the meaning of dementia by those affected by it, and to give them a voice.
Material and methods: Descriptive phenomenology through interviews with people of both genders who are over 50 years old and living in Tarragona (Spain), with a diagnosis of mild or moderate dementia, mainly related to Alzheimer’s disease.
Results: Three main themes emerged: 1) normalization of memory loss in early stages as part of the natural aging process; 2) self-awareness of progressive memory decline, which is concealed from others, and 3) adaptation processes and strategies to coexist with their condition after diagnosis.
Conclusions: The most evident features were the lack of specialized infrastructures within the health system in terms of care, prevention programs, and early detection.
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18
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Individualized prognosis of cognitive decline and dementia in mild cognitive impairment based on plasma biomarker combinations. ACTA ACUST UNITED AC 2020; 1:114-123. [PMID: 37117993 DOI: 10.1038/s43587-020-00003-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/30/2020] [Indexed: 12/22/2022]
Abstract
We developed models for individualized risk prediction of cognitive decline in mild cognitive impairment (MCI) using plasma biomarkers of β-amyloid (Aβ), tau and neurodegeneration. A total of 573 patients with MCI from the Swedish BioFINDER study and the Alzheimer's Disease Neuroimaging Initiative (ADNI) were included in the study. The primary outcomes were longitudinal cognition and conversion to Alzheimer's disease (AD) dementia. A model combining tau phosphorylated at threonine 181 (P-tau181) and neurofilament light (NfL), but not Aβ42/Aβ40, had the best prognosis performance of all models (area under the curve = 0.88 for 4-year conversion to AD in BioFINDER, validated in ADNI), was stronger than a basic model of age, sex, education and baseline cognition, and performed similarly to cerebrospinal fluid biomarkers. A publicly available online tool for individualized prognosis in MCI based on our combined plasma biomarker models is introduced. Combination of plasma biomarkers may be of high value to identify individuals with MCI who will progress to AD dementia in clinical trials and in clinical practice.
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19
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Gibson A, Bardach SH, Jicha GA. Identifying Adaptive and Maladaptive Behaviors Following a Diagnosis of Mild Cognitive Impairment. Alzheimer Dis Assoc Disord 2020; 34:262-266. [PMID: 32218064 PMCID: PMC7483717 DOI: 10.1097/wad.0000000000000379] [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: 10/24/2022]
Abstract
INTRODUCTION Individual reactions to a diagnosis of mild cognitive impairment (MCI) can vary in a wide range of both adaptive and maladaptive responses. Understanding such reactions to diagnosis is important to maximize adaptive responses that can promote continued independence. METHODS In this pilot study, the Aging and Memory Quality of Life survey was developed to facilitate an understanding of adaptive and maladaptive behaviors results from a diagnosis of MCI. The Aging and Memory Quality of Life was administered to 45 individuals diagnosed with MCI and 45 cognitively normal participants serving as control subjects matched for age, sex, and education. Study partners were surveyed to collect corroborating and or discrepant observer responses. RESULTS Inconsistent with study partners' reporting, MCI subjects may be underreporting physical limitations, and overreporting medication compliance. MCI subjects identified challenges to managing financial affairs. DISCUSSION Developing strategies to circumvent the development of maladaptive behaviors could significantly reduce morbidity and mortality in MCI patients.
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Affiliation(s)
- Allison Gibson
- University of Kentucky, College of Social Work
- Sanders-Brown Center on Aging, Alzheimer’s Disease Center
| | - Shoshana H. Bardach
- University of Kentucky, College of Public Health, Graduate Center for Gerontology
- Sanders-Brown Center on Aging, Alzheimer’s Disease Center
| | - Gregory A. Jicha
- University of Kentucky, College of Medicine, Department of Neurology
- Sanders-Brown Center on Aging, Alzheimer’s Disease Center
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20
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Dooley J, Bailey C, Xanthopoulou P, Bass N, McCabe R. Communication and understanding of mild cognitive impairment diagnoses. Int J Geriatr Psychiatry 2020; 35:662-670. [PMID: 32103532 DOI: 10.1002/gps.5284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Communication of mild cognitive impairment (MCI) diagnoses is challenging due to its heterogeneity and unclear prognosis. AIM To identify how MCI is communicated and to explore the relationship with patient and companion understanding. METHOD Conversation analysis identified whether MCI was named and explained in 43 video recorded diagnosis feedback meetings. Afterward, patients and companions were asked to name the diagnosis to assess understanding. RESULTS Mild cognitive impairment was not named in 21% meetings. Symptoms were explained as (a) a result of vascular conditions (49%), (b) a stage between normal ageing and dementia (30%), or (c) caused by psychological factors (21%). Fifty-four percentage of prognosis discussions included mention of dementia. There was no association between symptom explanations and whether prognosis discussions included dementia. Fifty-seven percentage patients and 37% companions reported not having or not knowing their diagnosis after the meeting. They were more likely to report MCI when prognosis discussions included dementia. CONCLUSIONS Doctors offer three different explanations of MCI to patients. The increased risk of dementia was not discussed in half the diagnostic feedback meetings. This is likely to reflect the heterogeneity in the definition, cause and likely prognosis of MCI presentations. Clearer and more consistent communication, particularly about the increased risk of dementia, may increase patient understanding and enable lifestyle changes to prevent some people progressing to dementia.
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Affiliation(s)
- Jemima Dooley
- Faculty of Health Sciences, Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | - Nick Bass
- Division of Psychiatry, University College London, London, UK
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21
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Visser LNC, van Maurik IS, Bouwman FH, Staekenborg S, Vreeswijk R, Hempenius L, de Beer MH, Roks G, Boelaarts L, Kleijer M, van der Flier WM, Smets EMA. Clinicians' communication with patients receiving a MCI diagnosis: The ABIDE project. PLoS One 2020; 15:e0227282. [PMID: 31961882 PMCID: PMC6974141 DOI: 10.1371/journal.pone.0227282] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We aimed to explore clinicians' communication, including the discussion of diagnosis, cause, prognosis and care planning, in routine post-diagnostic testing consultations with patients with Mild Cognitive Impairment (MCI). METHODS Thematic content analysis was used to analyze audiotaped consultations in which 10 clinicians (eight neurologists and two geriatricians) from 7 memory clinics, disclosed diagnostic information to 13 MCI patients and their care partners. We assessed clinician-patient communication regarding diagnostic label, cause, prognosis and care planning to identify core findings. RESULTS Core findings were: clinicians 1) differed in how they informed about the MCI label; 2) tentatively addressed cause of symptoms; 3) (implicitly) steered against further biomarker testing; 4) rarely informed about the patient's risk of developing dementia; 5) often informed about the expected course of symptoms emphasizing potential symptom stabilization and/or improvement, and; 6) did not engage in a conversation on long-term (care) planning. DISCUSSION Clinicians' information provision about the underlying cause, prognosis and implications for long-term (care) planning in MCI could be more specific. Since most patients and care partners have a strong need to understand the patient's symptoms, and for information on the prognosis and implications for the future, clinicians' current approach may not match with those needs.
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Affiliation(s)
- Leonie N. C. Visser
- Department of Medical Psychology, Amsterdam Public Health research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ingrid S. van Maurik
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Femke H. Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Salka Staekenborg
- Department of Neurology, Tergooi Ziekenhuis, Blaricum, The Netherlands
| | - Ralph Vreeswijk
- Department of Clinical Geriatrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Liesbeth Hempenius
- Geriatric Center, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marlijn H. de Beer
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Gerwin Roks
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Leo Boelaarts
- Geriatric Department, NoordWest Ziekenhuis Groep, Alkmaar, The Netherlands
| | - Mariska Kleijer
- Department of Neurology, LangeLand Ziekenhuis, Zoetermeer, The Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ellen M. A. Smets
- Department of Medical Psychology, Amsterdam Public Health research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Visser LNC, Pelt SAR, Kunneman M, Bouwman FH, Claus JJ, Kalisvaart KJ, Hempenius L, de Beer MH, Roks G, Boelaarts L, Kleijer M, van der Flier WM, Smets EMA, Hillen MA. Communicating uncertainties when disclosing diagnostic test results for (Alzheimer's) dementia in the memory clinic: The ABIDE project. Health Expect 2019; 23:52-62. [PMID: 31638322 PMCID: PMC6978856 DOI: 10.1111/hex.12964] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 02/06/2023] Open
Abstract
Background The development of novel diagnostics enables increasingly earlier diagnosis of Alzheimer's disease (AD). Timely diagnosis may benefit patients by reducing their uncertainty regarding the cause of symptoms, yet does not always provide patients with the desired certainty. Objective To examine, using both quantitative and qualitative methods, uncertainty communicated by memory clinic clinicians in post‐diagnostic testing consultations with patients and their caregivers. Methods First, we identified all uncertainty expressions of 22 clinicians in audiotaped post‐diagnostic testing consultations with 78 patients. Second, we statistically explored relationships between patient/clinician characteristics and uncertainty expressions. Third, the transcribed uncertainty expressions were qualitatively analysed, determining the topic to which they pertained, their source and initiator/elicitor (clinicians/patients/caregivers). Results Within 57/78 (73%) consultations, clinicians expressed in total 115 uncertainties, of which 37% elicited by the patient or caregiver. No apparent relationships were found between patient/clinician characteristics and whether or not, and how often clinicians expressed uncertainty. Uncertainty expressions pertained to ten different topics, most frequently patient's diagnosis and symptom progression. Expressed uncertainty was mostly related to the unpredictability of the future and limits to available knowledge. Discussion and conclusions The majority of clinicians openly discussed the limits of scientific knowledge and diagnostic testing with patients and caregivers in the dementia context. Noticeably, clinicians did not discuss uncertainty in about one quarter of consultations. More evidence is needed on the beneficial and/or harmful effects on patients of discussing uncertainty with them. This knowledge can be used to support clinicians to optimally convey uncertainty and facilitate patients' uncertainty management.
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Affiliation(s)
- Leonie N C Visser
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sophie A R Pelt
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA.,Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Femke H Bouwman
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jules J Claus
- Department of Neurology, Tergooi Hospital, Blaricum, The Netherlands
| | - Kees J Kalisvaart
- Department of Clinical Geriatrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Liesbeth Hempenius
- Geriatric Center, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marlijn H de Beer
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Gerwin Roks
- Department of Neurology, ETZ Hospital, Tilburg, The Netherlands
| | - Leo Boelaarts
- Geriatric Department, NoordWest Ziekenhuis Groep, Alkmaar, The Netherlands
| | - Mariska Kleijer
- Department of Neurology, LangeLand Ziekenhuis, Zoetermeer, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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23
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Burnham SC, Loi SM, Doecke J, Fedyashov V, Dore V, Villemagne VL, Masters CL. The dawn of robust individualised risk models for dementia. Lancet Neurol 2019; 18:985-987. [PMID: 31526626 DOI: 10.1016/s1474-4422(19)30353-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/02/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Samantha C Burnham
- The Australian e-Health Research Centre, CSIRO Health & Biosecurity, Parkville, VIC 3052, Australia; Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical Sciences, Edith Cowan University, Joondalup, WA, Australia.
| | - Samantha M Loi
- Neuropsychiatry Unit, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - James Doecke
- The Australian e-Health Research Centre, CSIRO, Herston, QLD, Australia
| | - Victor Fedyashov
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia; ARC Training Centre in Cognitive Computing for Medical Technologies, The University of Melbourne, Parkville, VIC, Australia
| | - Vincent Dore
- The Australian e-Health Research Centre, CSIRO Health & Biosecurity, Parkville, VIC 3052, Australia; Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, VIC, Australia
| | - Victor L Villemagne
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, VIC, Australia
| | - Colin L Masters
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
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24
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Potential Fluid Biomarkers for the Diagnosis of Mild Cognitive Impairment. Int J Mol Sci 2019; 20:ijms20174149. [PMID: 31450692 PMCID: PMC6747411 DOI: 10.3390/ijms20174149] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023] Open
Abstract
Mild cognitive impairment (MCI) is characterized by a level of cognitive impairment that is lower than normal for a person’s age, but a higher function than that that observed in a demented person. MCI represents a transitional state between normal aging and dementia disorders, especially Alzheimer’s disease (AD). Much effort has been made towards determining the prognosis of a person with MCI who will convert to AD. It is now clear that cerebrospinal fluid (CSF) levels of Aβ40, Aβ42, total tau and phosphorylated tau are useful for predicting the risk of progression from MCI to AD. This review highlights the advantages of the current blood-based biomarkers in MCI, and discusses some of these challenges, with an emphasis on recent studies to provide an overview of the current state of MCI.
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25
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Portacolone E, Johnson JK, Covinsky KE, Halpern J, Rubinstein RL. The Effects and Meanings of Receiving a Diagnosis of Mild Cognitive Impairment or Alzheimer's Disease When One Lives Alone. J Alzheimers Dis 2019; 61:1517-1529. [PMID: 29376864 DOI: 10.3233/jad-170723] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND One third of older adults with cognitive impairment live alone and are at high risk for poor health outcomes. Little is known about how older adults who live alone experience the process of receiving a diagnosis of mild cognitive impairment (MCI) or Alzheimer's disease (AD). OBJECTIVE The aim of this study was to understand the effects and meanings of receiving a diagnosis of MCI or AD on the lived experience of older adults living alone. METHODS This is a qualitative study of adults age 65 and over living alone with cognitive impairment. Participants' lived experiences were elicited through ethnographic interviews and participant observation in their homes. Using a qualitative content analysis approach, interview transcripts and fieldnotes were analyzed to identify codes and themes. RESULTS Twenty-nine older adults and 6 members of their social circles completed 114 ethnographic interviews. Core themes included: relief, distress, ambiguous recollections, and not knowing what to do. Participants sometimes felt uplifted and relieved by the diagnostic process. Some participants did not mention having received a diagnosis or had only partial recollections about it. Participants reported that, as time passed, they did not know what to do with regard to the treatment of their condition. Sometimes they also did not know how to prepare for a likely worsening of their condition, which they would experience while living alone. CONCLUSION Findings suggest the need for more tailored care and follow-up as soon as MCI or AD is diagnosed in persons living alone.
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Affiliation(s)
- Elena Portacolone
- Institute for Health & Aging, University of California San Francisco, San Francisco, CA, USA
| | - Julene K Johnson
- Institute for Health & Aging, University of California San Francisco, San Francisco, CA, USA.,Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, USA
| | - Kenneth E Covinsky
- Division of Geriatric Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jodi Halpern
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Robert L Rubinstein
- Department of Sociology and Anthropology, University of Maryland Baltimore County, Baltimore, MD, USA
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26
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Abstract
Mild cognitive impairment (MCI) is a clinical condition conceptualized as a stage between normal cognition and dementia. To diagnose it requires subjective cognitive impairment, evidence of cognitive impairment on cognitive testing but no abnormality in a person's functioning and no evidence of dementia (American Psychiatric Association, 2013). There has been growing interest in the condition over the past two decades or so because people with MCI are much more likely than people with no cognitive impairment to progress to dementia (Roberts et al., 2013). However, a significant percentage of people with MCI will not progress to dementia and some will revert to having normal cognition. Rates of progression and reversion to normal cognition vary widely in different studies (Manly et al., 2008). People with MCI experience worry about their symptoms and this is partly alleviated by receiving a diagnosis of MCI and being reassured they do not have dementia (Gomersall et al., 2017). The benefits of diagnosis also include gaining a greater understanding of their symptoms and accessing clinical support but a significant amount of uncertainty remains with regards to the risk of progression and recipients of the diagnosis remain frustrated at the lack of treatments for MCI (Gomersall et al., 2017). There has been much interest in improving the prediction of progression to dementia from MCI but to date, the best predictors of progression remain structured clinical and functional assessments, with some additional benefit from measures of cortical volume/thickness from brain imaging (Korolev et al., 2016). As yet, however, there are no interventions that can prevent (Kane et al., 2017) or treat (Cooper et al., 2013) MCI so it seems set to remain an important clinical entity for the foreseeable future.
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