Nurse-led cognitive screening model for older adults in primary care

Research hotspots and nursing inspiration in research of older adults with subjective cognitive decline from 2003 to 2023: A bibliometric analysis

Objectives

There has been a significant increase in subjective cognitive decline (SCD) studies in older adults over the years. A bibliometric analysis was conducted to demonstrate the current hotspots and emerging trends in SCD research in older adults and provide references for further research in this field.

Methods

The study conducted a bibliometric analysis based on co-citation analysis. From the Web of Science Core Collection database, this study obtained 1,436 manuscripts regarding SCD in older adults published from 2003 to 2023. Software CiteSpace was used to analyse the results for countries, institutions, authors, journals, keywords, top-cited papers, and burst citations scientifically and intuitively.

Results

Our result showed an overall upward trend in the volume of publications on SCD in the elderly population, suggesting that the study of SCD in older adults has attracted the attention of researchers. The United States dominates this research field, followed by China and France. The top three institutions were the University of California System, Institut National de la Sante et de la Recherche Medicale (Inserm), and UDICE-French Research Universities. Frank Jessen, Han Ying, and Kathryn Ellis were the top three researchers. The top three cited journals were Neurology, Alzheimers & Dementia, and Journal of Alzheimer's Disease. The keywords clustering were "depression", "functional connectivity", "cognitive reserve", "cognitive function", "physical activity", "recommendations", "dementia prevention", " behavioral disorders", "primary care", "early diagnosis", and "community-based study". Keywords with the highest citation bursts include "physical activity", "framework", "preclinical Alzheimer's disease", "future dementia", and "late life depression".

Conclusions

Parallel to the growth trend, the range of research scopes and topics is expanding steadily, focusing on early screening and prevention, negative emotion, and symptom management, broadening researchers' perspectives, which can provide reference and guidance for nursing researchers to conduct research.

An Exploration of the Memory Performance in Older Adult Hearing Aid Users on the Integrated Digit-in-Noise Test

This study aimed to preliminarily investigate the associations between performance on the integrated Digit-in-Noise Test (iDIN) and performance on measures of general cognition and working memory (WM). The study recruited 81 older adult hearing aid users between 60 and 95 years of age with bilateral moderate to severe hearing loss. The Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) was used to screen older adults for mild cognitive impairment. Speech reception thresholds (SRTs) were measured using 2- to 5-digit sequences of the Mandarin iDIN. The differences in SRT between five-digit and two-digit sequences (SRT5-2), and between five-digit and three-digit sequences (SRT5-3), were used as indicators of memory performance. The results were compared to those from the Digit Span Test and Corsi Blocks Tapping Test, which evaluate WM and attention capacity. SRT5-2 and SRT5-3 demonstrated significant correlations with the three cognitive function tests (rs ranging from -.705 to -.528). Furthermore, SRT5-2 and SRT5-3 were significantly higher in participants who failed the MoCA-BC screening compared to those who passed. The findings show associations between performance on the iDIN and performance on memory tests. However, further validation and exploration are needed to fully establish its effectiveness and efficacy.

Exploring barriers to dementia screening and management services by general practitioners in China: a qualitative study using the COM-B model

BACKGROUND

Dementia has become a global public health problem, and general practitioners (GPs) play a key role in diagnosing and managing dementia. However, in Chinese primary care settings, dementia is underdiagnosed and inefficiently managed, and dementia screening and management services provided by GPs are suboptimal. The reasons underlying this gap are poorly understood. This study aimed to determine the barriers that hinder GPs from actively promoting dementia screening and management, and thereby provide insights for the successful promotion of dementia screening and management services in primary care.

METHODS

Purposive sampling was used. And focus groups and in-depth interviews were conducted face-to-face among GPs from community health service centers (CHSCs) in South China. Thematic analysis was used to identify barriers to screening and managing dementia and map them to the Capability/Opportunity/Motivation-Behavior model (COM-B model).

RESULTS

Fifty-two GPs were included. The COM-B model found nine barriers to implementing dementia screening and management services in primary healthcare: (1) poor capability: lack of systematic knowledge of dementia and inadequate dementia screening skills; (2) little opportunity: unclear pathways for referral, insufficient time for dementia screening and management, lack of dementia-specific leaders, and no guarantee of services continuity; (3) low motivation: outside of GP scope, worries associated with dementia stigma rooted in culture beliefs, and insufficient financial incentives.

CONCLUSIONS

Our study concluded that GPs were not yet ready to provide dementia screening and management services due to poor capability related to knowledge and skills of dementia, little opportunity associated with an unsupportive working environment, and low motivation due to unclear duty and social pressure. Accordingly, systematic implementation strategies should be taken, including standardized dementia training programs, standardized community-based dementia guidelines, expansion of primary care workforces, development of dedicated leaders, and the eradication of stigma attached to dementia to promote dementia screening and management services in primary care.

A systematic review and meta-analysis of studies on screening for mild cognitive impairment in primary healthcare

BACKGROUND

Cognitive disorders and dementia have an important effect on individual independence and orientation. According to the Alzheimer's Disease International (ADI) 75% of people with dementia are not diagnosed; this may be as high as 90% in some low- and middle-income countries. This systematic review and meta-analysis aimed to identify the test performance of screening tools and compare them pairwise. The findings of our study can support countries in planning to establish and care for mild cognitive impairment in primary health centers.

METHODS

Medline (PubMed), Scopus, Cochrane, Dare, All EBM Reviews, CRD (OVID), and Proquest were searched from 2012 to November 2021. The risk of bias was assessed through the QUADAS-2 instrument. Given the high heterogeneity between studies, a random-effects model was used to calculate the pooled effect sizes for diagnostic accuracy measures (sensitivity, specificity, and area under curve indices). I² test was used for assessing heterogeneity and predefined subgroup analyses were performed using participants' age, country's income, and sample size of studies.

RESULTS

A systematic search identified 18,132 records, of which, 20 studies were included in the quality assessment, and six were included in quantitative analysis. None of the studies had examined the feasibility or efficiency of mass screening. According to a pairwise comparison, IQCODE, AD8 and GPCOG showed equal or better diagnostic performance relative to the MMSE in terms of sensitivity and specificity. The random-effect model for the MMSE showed the pooled sensitivity equal to 0.73 (95% CI 0.57-0.90), the pooled specificity equal to 0.83 (95% CI 0.75-0.90), and the pooled AUC equal to 0.88 (95% CI 0.83-0.93).

CONCLUSION

Several benefits have been attached to short tests making them a suitable choice for use in primary healthcare settings. Considering factors such as accuracy, time of application, ease of scoring, and utilization charges, tests such as IQCODE, AD8, and GPCOG or appropriate combination with counterpart tools seem to be good alternatives to the use of the MMSE in primary care.

Cognitive Impairment and Associated Factors in Rural Elderly in North China

BACKGROUND

China has the largest population living with dementia globally and urban-rural differences are significant in prevalence, risk factors, and health resources. Epidemiologic studies on cognitive impairment in rural areas are limited in China and other low- and middle-income countries.

OBJECTIVE

This study investigated cognitive impairment and associated factors in rural elderly aged 65 years and over in China.

METHODS

In total, 1,250 participants from ten villages in North China were recruited from June to September, 2017. Face-to-face structured interviews were conducted for data collection. The interviews included socio-demographic information, health status, and psychological assessments. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination. A multivariate logistic regression model with backward method was employed to identify factors associated with cognitive impairment.

RESULTS

The positive rate of cognitive impairment among rural Chinese elderly aged 65 years and older was 42.9% (95% CI, 40.1-45.6). No significant differences were found in cognitive impairment by age or gender before the age of 75 years. Older age, lack of formal school education, reliance on the basic living allowance as the only income source, poor hearing and vision function, diabetes, and activities of daily living dependence were associated with higher rate of cognitive impairment, while tea consumption and fatty liver disease were associated with lower cognitive impairment rate.

CONCLUSION

A very high percentage of rural elderly in China had cognitive impairment. Education programs and prevention interventions targeting modifiable risk factors among high-risk populations should be developed through collective efforts involving all stakeholders.

Detecting dementia among older, ethnically diverse residents of rural subsidized housing

Rural, ethnically diverse residents face at least twice the risk of Alzheimer's disease than urban residents. Chronic diseases such as diabetes and hypertension which increase dementia risk are more prevalent in rural areas with less access to specialty providers. A home-based approach for increasing dementia detection and treatment rates was tested among rural residents of government-assisted independent living facilities (N = 139; 78% non-White, and 70% with health literacy below 5th grade). Of 28 residents identified at risk during cognitive screening, 25 agreed to further in-depth assessment by adult gerontological nurse practitioners (AGNP). Fifteen of 25 (60%) completing consequent primary provider referrals were diagnosed with dementia and receiving new care (statistically significant; [χ2(1) = 76.67, p < .001, Phi = 0.743]). Home-based dementia management through a community engagement approach can help to meet the Healthy People 2030 goals of earlier detection and treatment and reduce the length of costly institutionalizations.

Gender Differences in Cognitive Impairment among Rural Elderly in China

Elders in rural areas of developing countries are particularly vulnerable to cognitive impairment and gender disparities are notable. Yet, evidence related to gender differences in cognitive impairment in these settings is scarce. This study examined gender differences in cognitive impairment among elderly people aged 65 and above in rural China. A multi-site cross-sectional survey was conducted. In total, 550 males and 700 females were recruited. The Chinese version of the Mini-Mental Status Examination was applied for cognitive impairment screening. Demographic information, lifestyle factors, psychosocial factors, and health-related information were assessed. The prevalence of cognitive impairment was 40.0%in males and 45.1% in females, respectively. Females showed significant higher prevalence after age 75 (62.7% vs. 45.4%, p < 0.005). Older age, hearing impairment, and activities of daily living dependence were common factors associated with cognitive impairment in both females and males. For males, living in a neighborhood with poor social interactions and diabetes were risk factors, while tea consumption was a protective factor. For females, vision impairment and illiteracy were additional risk factors. Individualized interventions and standardized measurements of cognitive function should be developed to suit older populations living in rural and less-developed areas, through collective efforts involving all stakeholders and multidisciplinary teamwork.

Risk Factors and Neuropsychological Assessments of Subjective Cognitive Decline (plus) in Chinese Memory Clinic

Background

Since subjective cognitive decline (SCD) was standardized in 2014, many studies have investigated its features. However, the risk of SCD (plus) progressing to AD is much higher, and yet there have been few studies reporting the risk factors and neuropsychological assessment characteristics of SCD (plus).

Objective

To characterize SCD (plus) by comparing it with normal control (NC), amnesic mild cognitive impairment (aMCI), and Alzheimer Disease (AD) regarding their demographics, lifestyle, family history of dementia, multimorbidity and the neuropsychological assessments.

Methods

A total of 135 participants were recruited, including 23 NC, 30 SCD (plus), 45 aMCI and 37 AD. Descriptive statistics were provided. A logistic regression model was used to analyze the affecting factors of SCD (plus), and finally the Receiver Operating Characteristic (ROC) analysis was applied to distinguish between SCD (plus) and NC.

Results

(1) SCD (plus) group was younger than both the aMCI group and AD group. It consisted of more participants with mental work and higher body mass index (BMI) than the AD group. (2) Scores of Auditory Verbal Learning Test - Immediate recall (AVLT-IR) and AVLT-Long delayed recall (AVLT-LR) decreased in the following order: NC→SCD (plus)→aMCI→AD. (3) The Area Under Curve (AUC) for discriminating SCD (plus) and NC group was from 0.673 to 0.838.

Conclusion

Aging is an important risk factor of both NC progressing to SCD (plus), and SCD (plus) progressing to aMCI or AD. In addition to aging, lower education level and lower BMI were significantly associated with greater odds of SCD (plus) progressing to aMCI or AD patients, whereas mental work was a protective factor of SCD (plus) progressing to AD. Finally, AVLT is a sensitive indicator of the cognitive decline and impairment in SCD (plus) in relative to normal controls.

Diagnosing dementia and cognitive dysfunction in the elderly in primary health care: A systematic review

Dementia is a public health issue making the screening and diagnosing of dementia and its prodromal phases in all health settings imperative.

OBJECTIVE

using PRISMA, this systematic review aimed to identify how low-, middle-, and high-income countries establish dementia and cognitive dysfunction diagnoses in primary health care.

METHODS

studies from the past five years in English, Spanish, and Portuguese were retrieved from Scopus, PubMed, Embase, Lilacs, Scielo, and Web of Science. Of 1987 articles, 33 were selected for analysis.

RESULTS

only three articles were from middle-income countries and there were no studies from low-income countries. The most used instrument was the Mini-Mental State Examination (MMSE). Mild Cognitive Impairment (MCI) and dementia criteria were based on experts' recommendation as well as on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD-10), respectively.

CONCLUSION

differences between these criteria among high- and middle-income countries were observed.

Prevalence, Risk Factors, and Complaints Screening Tool Exploration of Subjective Cognitive Decline in a Large Cohort of the Chinese Population

BACKGROUND

Substantial studies have reported the prevalence and the affecting factors of subjective cognitive decline (SCD). The complaints screening scale has also been used for probing. However, little is known in China.

OBJECTIVE

To investigate the prevalence and risk factors of SCD, and explore an SCD complaints screening scale in China.

METHODS

Stratified cluster random sampling was conducted. 2,689 residents aged 60-80 years completed questionnaire 1. 814 residents were included for clinical and neuropsychological evaluations. Two standards were used to make the diagnosis of mild cognitive impairment (MCI) and SCD, and a preliminary screening rate comparison was carried out. Finally, we assessed the risk factors of SCD and the correlation between the SCD-questionnaire 9 (SCD-Q9) and the Auditory Verbal Learning Test-Long Delay Free Recall (AVLT-LR).

RESULTS

1) Standard 1 (ADNI2): the prevalence of SCD was 18.8% (95% CI = 14.7-22.9%) and zero conformed to six criteria (SCD plus). 2) Standard 2 (Jak/Bondi): the prevalence of SCD was 14.4% (95% CI = 10.7-18.1%). 3) Standard 1 had a relatively higher "false" positive rate, whereas Standard 2 had higher "false" negative rate. 4) Age, low education, fewer close friends, and daily drinking were independent risk factors for SCD progressing to MCI. 5) Total points of SCD-Q9 were negatively correlated to the value of AVLT-LR.

CONCLUSIONS

The prevalence of SCD is high in the ShunYi District in Beijing, China. Age, low education, less social support, and daily drinking are independent risk factors. The brief SCD-Q9 can be used as a reference.