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Harding E, Sullivan MP, Camic PM, Yong KXX, Stott J, Crutch SJ. Exploring experiential differences in everyday activities - A focused ethnographic study in the homes of people living with memory-led Alzheimer's disease and posterior cortical atrophy. J Aging Stud 2024; 69:101226. [PMID: 38834246 DOI: 10.1016/j.jaging.2024.101226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 03/15/2024] [Accepted: 03/24/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Supporting ageing in place, quality of life and activity engagement are public health priorities for people living with dementia, but little is known about the needs and experiences of community-dwelling people with rarer forms of dementia with lesser known symptoms. Posterior cortical atrophy (PCA) is a rare form of dementia usually caused by Alzheimer's disease but which is characterised by diminished visual processing (rather than a dominant memory problem), which poses challenges for maintaining independence and accessing appropriate support. METHODS This study used a comparative qualitative design and focussed ethnographic methods to explore experiential differences in activity engagement for 10 people with the most common, memory-led presentation of Alzheimer's disease and 10 people with posterior cortical atrophy within their everyday home environments. RESULTS While the data collection revealed much rich variation in individual and contextual factors, some tentative high-level differences in the experiences of everyday activities could be drawn out, seemingly attributable to the different diagnoses' differing dominant symptoms. These included people with posterior cortical atrophy being less likely to use environmental cues to initiate activities, and more likely to withhold from asking for support because of preserved insight into the impact of this on carers. This lack of initiation of activities could be misinterpreted as apathy. People with posterior cortical atrophy also were discouraged from engaging in activities by disorientation within the home, and difficulties localising, identifying and manipulating objects. People with the more common, memory-led presentation of Alzheimer's disease exhibited more memory-based difficulties with engaging with activities such as forgetting planned activities, where to locate the items required for an activity and the steps involved. Despite these distinct symptom-led challenges, all participants and their family members demonstrated resourcefulness and resilience in making creative adaptations to support continued engagement in everyday activities, supporting the widely reported management strategies of people with dementia of the Alzheimer's type more generally. CONCLUSIONS These findings offer helpful insights into some the differing impacts dementia related visual and memory impairments can have on everyday activity engagement, which will be helpful for others navigating these challenges and the health and social care practitioners working with people affected by these conditions. The findings also highlight the vast individual variation in the multitude of individual and contextual factors involved in everyday activity engagement, and suggest important areas for future work utilising methods which are similarly high in ecological validity and accessibility as the home-based focussed ethnographic methods utilised here.
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Affiliation(s)
- Emma Harding
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK.
| | - Mary Pat Sullivan
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, Nipissing, ON, Canada
| | - Paul M Camic
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Keir X X Yong
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
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Fonseca BHDS, de Andrade PHS, Henrique MESA, Baggio JADO, Bazan R, de Souza LAPS, Luvizutto GJ. Perception of verticality in the post-COVID-19 condition correlates to infection severity. J Cent Nerv Syst Dis 2023; 15:11795735231195693. [PMID: 38025401 PMCID: PMC10655649 DOI: 10.1177/11795735231195693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background SARS-CoV-2 infection affects multiple systems, including musculoskeletal, neurological, and respiratory systems. Changes associated with physical inactivity due to prolonged hospitalization can affect the functional capacity of individuals with long coronavirus disease 2019 (COVID-19) or post-COVID-19 condition and may cause changes in some postural control functions, such as verticality. Objectives This study aimed to evaluate the perception of verticality in individuals with long COVID. Design Cross-sectional study. Methods This study included 60 participants with post-COVID-19 condition divided into 2 groups: hospitalized group (n = 24), those hospitalized owing to SARS-CoV-2 infection; and non-hospitalized group (n = 36), those infected with SARS-CoV-2 but not hospitalized. All participants were examined using a post-COVID-19 functional status (PCFS), sit-to-stand test, grip strength assessment, painful and tactile sensory assessments, visual acuity assessment, and vestibular assessment. Verticality perception was evaluated using the subjective visual vertical (SVV) and subjective haptic vertical (SHV) tests. In both tests, the absolute values (positive values only) and true values (positive and negative values) were considered. To verify potential confounders that could influence the verticality of the results, logistic regression models were used for categorical variables and multiple linear regressions were used for continuous variables. For analysis between groups, the independent samples test (Mann-Whitney U test) was used. Results There were no confounders between clinical variables and verticality in either group. There was a significant increase in absolute SVV (mean deviation [MD]: 2.83; P < .0001) and true SVV (MD: -4.18; P = .005) in the hospitalized group compared to the non-hospitalized group. Furthermore, there was a significant increase in the true SHV (MD: -3.6; P = .026) in the hospitalized group compared to that in the non-hospitalized group. Conclusion Less accurate visual and haptic verticality perception task performance was observed in hospitalized patients with post-COVID-19 condition.
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Affiliation(s)
| | | | | | | | - Rodrigo Bazan
- Department of Neurology, Psychology, and Psychiatry, Botucatu Medical School, Botucatu, Brazil
| | | | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro, Uberaba, Brazil
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Best J, Chapleau M, Rabinovici GD. Posterior cortical atrophy: clinical, neuroimaging, and neuropathological features. Expert Rev Neurother 2023; 23:227-236. [PMID: 36920752 DOI: 10.1080/14737175.2023.2190885] [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: 03/16/2023]
Abstract
INTRODUCTION Posterior Cortical Atrophy (PCA) is a neurodegenerative disorder characterized by impairment of higher-order visual processing in the setting of progressive atrophy of the parietal and occipital lobes. The underlying pathology is variable but most commonly Alzheimer's disease. The majority of individuals develop symptoms before 65 years of age; however, delayed diagnosis is common due to misattribution of symptoms to ocular rather than cortical pathology. AREAS COVERED The purpose of this review is to provide readers with an in-depth analysis of Posterior Cortical Atrophy syndrome, including clinical, imaging, pathological, and genetic features, management, and treatments. EXPERT OPINION Most patients present initially with a relatively pure visuoperceptual-visuospatial syndrome, though other cognitive domains become affected over time. Structural neuroimaging demonstrates parieto-occipital or temporo-occipital predominant atrophy. Cerebrospinal fluid Alzheimer's disease biomarkers, or amyloid/tau PET imaging can help evaluate for underlying Alzheimer's disease, which is the most common underlying neuropathology. The cornerstone of management is focused on nonpharmacologic measures. Early etiologic diagnosis is important with the arrival of disease-modifying therapies, especially for Alzheimer's disease.
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Affiliation(s)
- John Best
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Marianne Chapleau
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.,Departments of Neurology, Radiology & Biomedical Imaging, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
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Yong KXX, Graff-Radford J, Ahmed S, Chapleau M, Ossenkoppele R, Putcha D, Rabinovici GD, Suarez-Gonzalez A, Schott JM, Crutch S, Harding E. Diagnosis and Management of Posterior Cortical Atrophy. Curr Treat Options Neurol 2023; 25:23-43. [PMID: 36820004 PMCID: PMC9935654 DOI: 10.1007/s11940-022-00745-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 02/10/2023]
Abstract
Purpose of review The study aims to provide a summary of recent developments for diagnosing and managing posterior cortical atrophy (PCA). We present current efforts to improve PCA characterisation and recommendations regarding use of clinical, neuropsychological and biomarker methods in PCA diagnosis and management and highlight current knowledge gaps. Recent findings Recent multi-centre consensus recommendations provide PCA criteria with implications for different management strategies (e.g. targeting clinical features and/or disease). Studies emphasise the preponderance of primary or co-existing Alzheimer's disease (AD) pathology underpinning PCA. Evidence of approaches to manage PCA symptoms is largely derived from small studies. Summary PCA diagnosis is frequently delayed, and people are likely to receive misdiagnoses of ocular or psychological conditions. Current treatment of PCA is symptomatic - pharmacological and non-pharmacological - and the use of most treatment options is based on small studies or expert opinion. Recommendations for non-pharmacological approaches include interdisciplinary management tailored to the PCA clinical profile - visual-spatial - rather than memory-led, predominantly young onset - and psychosocial implications. Whilst emerging disease-modifying treatments have not been tested in PCA, an accurate and timely diagnosis of PCA and determining underlying pathology is of increasing importance in the advent of disease-modifying therapies for AD and other albeit rare causes of PCA.
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Affiliation(s)
- Keir X. X. Yong
- Dementia Research Centre, UCL Queen Square Institute of Neurology, Box 16, Queen Square, London, WC1N 3BG UK
| | | | - Samrah Ahmed
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire UK
| | - Marianne Chapleau
- Memory and Aging Center, University of California San Francisco, San Francisco, CA USA
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Netherlands
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Deepti Putcha
- Frontotemporal Disorders Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Gil D. Rabinovici
- Department of Neurology, Radiology, and Biomedical Imaging, University of California San Francisco, San Francisco, CA USA
| | - Aida Suarez-Gonzalez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, Box 16, Queen Square, London, WC1N 3BG UK
| | - Jonathan M. Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, Box 16, Queen Square, London, WC1N 3BG UK
| | - Sebastian Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, Box 16, Queen Square, London, WC1N 3BG UK
| | - Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, Box 16, Queen Square, London, WC1N 3BG UK
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Requena-Komuro MC, Jiang J, Dobson L, Benhamou E, Russell L, Bond RL, Brotherhood EV, Greaves C, Barker S, Rohrer JD, Crutch SJ, Warren JD, Hardy CJ. Remote versus face-to-face neuropsychological testing for dementia research: a comparative study in people with Alzheimer's disease, frontotemporal dementia and healthy older individuals. BMJ Open 2022; 12:e064576. [PMID: 36428012 PMCID: PMC9702828 DOI: 10.1136/bmjopen-2022-064576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES We explored whether adapting neuropsychological tests for online administration during the COVID-19 pandemic was feasible for dementia research. DESIGN We used a longitudinal design for healthy controls, who completed face-to-face assessments 3-4 years before remote assessments. For patients, we used a cross-sectional design, contrasting a prospective remote cohort with a retrospective face-to-face cohort matched for age/education/severity. SETTING Remote assessments were conducted using video-conferencing/online testing platforms, with participants using a personal computer/tablet at home. Face-to-face assessments were conducted in testing rooms at our research centre. PARTICIPANTS The remote cohort comprised 25 patients (n=8 Alzheimer's disease (AD); n=3 behavioural variant frontotemporal dementia (bvFTD); n=4 semantic dementia (SD); n=5 progressive non-fluent aphasia (PNFA); n=5 logopenic aphasia (LPA)). The face-to-face patient cohort comprised 64 patients (n=25 AD; n=12 bvFTD; n=9 SD; n=12 PNFA; n=6 LPA). Ten controls who previously participated in face-to-face research also took part remotely. OUTCOME MEASURES The outcome measures comprised the strength of evidence under a Bayesian framework for differences in performances between testing environments on general neuropsychological and neurolinguistic measures. RESULTS There was substantial evidence suggesting no difference across environments in both the healthy control and combined patient cohorts (including measures of working memory, single-word comprehension, arithmetic and naming; Bayes Factors (BF)01 >3), in the healthy control group alone (including measures of letter/category fluency, semantic knowledge and bisyllabic word repetition; all BF01 >3), and in the combined patient cohort alone (including measures of working memory, episodic memory, short-term verbal memory, visual perception, non-word reading, sentence comprehension and bisyllabic/trisyllabic word repetition; all BF01 >3). In the control cohort alone, there was substantial evidence in support of a difference across environments for tests of visual perception (BF01=0.0404) and monosyllabic word repetition (BF01=0.0487). CONCLUSIONS Our findings suggest that remote delivery of neuropsychological tests for dementia research is feasible.
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Affiliation(s)
- Maï-Carmen Requena-Komuro
- Dementia Research Centre, University College London, London, UK
- Kidney Cancer Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica Jiang
- Dementia Research Centre, University College London, London, UK
| | - Lucianne Dobson
- Dementia Research Centre, University College London, London, UK
| | - Elia Benhamou
- Dementia Research Centre, University College London, London, UK
- Cognition and Brain Sciences Unit, Cambridge University, Cambridge, UK
| | - Lucy Russell
- Dementia Research Centre, University College London, London, UK
| | - Rebecca L Bond
- Dementia Research Centre, University College London, London, UK
| | | | | | - Suzie Barker
- Dementia Research Centre, University College London, London, UK
| | | | | | - Jason D Warren
- Dementia Research Centre, University College London, London, UK
| | - Chris Jd Hardy
- Dementia Research Centre, University College London, London, UK
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