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Ho HT, Guo NW, Pai MC. The application of a neuropsychological measure of executive working memory in older adults with memory impairment. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1605-1614. [PMID: 33794709 DOI: 10.1080/23279095.2021.1901707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The component of working memory that the frontal cortex subserves is frequently characterized as the executive working memory (EWM). This study applied a neuropsychological measure of EWM (NPM-EWM) in older adults with memory impairment to investigate the EWM. Thirty-two older adults from the community were recruited as older healthy controls (OHCs), and 58 older adults from a memory clinic were diagnosed with mild cognitive impairment (MCI) and mild dementia (MD). Significant differences were found among the three groups in the Clinical Dementia Rating (CDR), the Chinese version of Mini-Mental State Examination (MMSE-C), and the Cognitive Abilities Screening Instrument (CASI). The NPM-EWM was applied by using the learning task of the Comprehensive Nonverbal Memory Test Battery, where the 7 scores were divided into two categories: mnemonic capacity and executive error. All OHCs, more than 50% MCI, and less than 25% of MD patients passed the NPM-EWM. The MCI-passed and MD-passed subgroups showed similar mnemonic capacity and executive errors, and both the subgroups had significantly worse performance than the OHC group. The MD-passed subgroup had a higher Hamilton Depression Rating Scale (HDRS) score than did the MD-failed subgroup. The MCI-failed subgroup had a higher Hierarchy of Care Required (HCR) level in instrumental activities of daily living (IADL) than did the MCI-passed subgroup. These findings indicated that applying the NPM-EWM for older adults with memory impairment may offer precise and tailored care to a whole person, especially for the MCI patients with poorer EWM and the MD patients with relatively intact EWM.
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Affiliation(s)
- Hsiao-Ting Ho
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Wen Guo
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Chyi Pai
- Division of Behavioral Neurology, Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan.,Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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Robinson RL, Rentz DM, Bruemmer V, Scott Andrews J, Zagar A, Kim Y, Schwartz RL, Ye W, Fillit HM. Observation of Patient and Caregiver Burden Associated with Early Alzheimer's Disease in the United States: Design and Baseline Findings of the GERAS-US Cohort Study1. J Alzheimers Dis 2020; 72:279-292. [PMID: 31561360 PMCID: PMC6839598 DOI: 10.3233/jad-190430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Alzheimer’s disease (AD) is one of the costliest diseases in the United States. Objective: To describe aspects of real-world patient and caregiver burden in patients with clinician-diagnosed early AD, including mild cognitive impairment (MCI) and mild dementia (MILD) due to AD. Methods: Cross-sectional assessment of GERAS-US, a 36-month cohort study of patients seeking care for early AD. Eligible patients were categorized based on study-defined categories of MCI and MILD and by amyloid positivity [+] or negativity [–] within each severity cohort. Demographic characteristics, health-related outcomes, medical history, and caregiver burden by amyloid status are described. Results: Of 1,198 patients with clinician-diagnosed early AD, 52% were amyloid[+]. For patients in both cohorts, amyloid[–] was more likely to occur in those with: delayed time to an AD-related diagnosis, higher rates of depression, poorer Bath Assessment of Subjective Quality of Life in Dementia scores, and Hispanic/Latino ethnicity (all p < 0.05). MILD[–] patients (versus MILD[+]) were more medically complex with greater rates of depression (55.7% versus 40.4%), sleep disorders (34.3% versus 26.5%), and obstructive pulmonary disease (11.8% versus 6.6%); and higher caregiver burden (Zarit Burden Interview) (all p < 0.05). MILD[+] patients had lower function according to the Functional Activities Questionnaire (p < 0.001), yet self-assessment of cognitive complaints across multiple measures did not differ by amyloid status in either severity cohort. Conclusions: Considerable patient and caregiver burden was observed in patients seeking care for memory concerns. Different patterns emerged when both disease severity and amyloid status were evaluated underscoring the need for further diagnostic assessment and care for patients. Study Registry: H8A-US-B004; ClinicalTrials.gov: NCT02951598.
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Affiliation(s)
| | - Dorene M Rentz
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Yongin Kim
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Howard M Fillit
- Geriatric Medicine, Palliative Care and Neuroscience, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Alzheimer's Drug Discovery Foundation, New York, NY, USA
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Banning LCP, Janssen EPCJ, Hamel REG, de Vugt M, Köhler S, Wolfs CAG, Oosterveld SM, Melis RJF, Olde Rikkert MGM, Kessels RPC, Pijnenburg YAL, Koene T, van der Flier WM, Scheltens P, Visser PJ, Verhey FRJ, Aalten P, Ramakers IHGB. Determinants of Cross-Sectional and Longitudinal Health-Related Quality of Life in Memory Clinic Patients Without Dementia. J Geriatr Psychiatry Neurol 2020; 33:256-264. [PMID: 31645191 PMCID: PMC7361660 DOI: 10.1177/0891988719882104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To identify determinants within 3 different domains (ie, somatic comorbidities, cognitive functioning, and neuropsychiatric symptoms [NPS]) of health-related quality of life (HRQoL) over time in memory clinic patients without dementia. METHODS This longitudinal multicenter cohort study with a 3-year observation period recruited 315 individuals (age: 69.8 ± 8.6, 64.4% males, Mini-Mental State Examination score 26.9 ± 2.6). A multivariable explanatory model was built using linear mixed effects models (forward selection per domain) to select determinants for self-perceived HRQoL over time, as measured by the EuroQoL-5D visual analogue scale (EQ VAS). RESULTS Mean HRQoL at study entry was 69.4 ± 15.6. The presence of agitation, appetite and eating abnormalities, and eyes/ears/nose (ie, sensory impairment) comorbidities were associated with a change in HRQoL over time. Agitation was most strongly associated with HRQoL over time. CONCLUSIONS The association of somatic comorbidities and NPS in memory clinic patients with course of HRQoL shows that these should receive more awareness, detection, and monitoring by clinicians.
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Affiliation(s)
- Leonie C. P. Banning
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Eveline P. C. J. Janssen
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands,Mondriaan Department of Old Age Psychiatry, Heerlen, the Netherlands
| | | | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Claire A. G. Wolfs
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Saskia M. Oosterveld
- Department of Geriatrics & Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rene J. F. Melis
- Department of Geriatrics & Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatrics & Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roy P. C. Kessels
- Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands,Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, the Netherlands
| | - Yolande A. L. Pijnenburg
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands
| | - Ted Koene
- Department of Medical Psychology and Neuroscience Campus Amsterdam, VUmc Alzheimer Center, VUmc Medical Center, Amsterdam, the Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands,Department of Epidemiology & Biostatistics, VUmc Medical Center, Amsterdam, the Netherlands
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands
| | - Frans R. J. Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Inez H. G. B. Ramakers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Inez H. G. B. Ramakers, Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.
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Iizuka T, Kameyama M. Metabolic correlate of memory-deficit awareness in dementia with Lewy bodies: Implication in cortical midline structure. Psychiatry Res Neuroimaging 2017; 269:43-47. [PMID: 28938220 DOI: 10.1016/j.pscychresns.2017.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/29/2017] [Accepted: 09/08/2017] [Indexed: 11/16/2022]
Abstract
The neural substrate of memory-deficit awareness has been studied in mild cognitive impairment and Alzheimer's disease (AD). However, little is known about that in dementia with Lewy bodies (DLB). To determine the neural substrates of memory-deficit awareness in DLB, we investigated the relationship between awareness of memory-deficit and glucose metabolism in DLB. Thirty-four patients with DLB were assessed by 18F-FDG-PET and dopamine transporter (DAT)-SPECT. The awareness was evaluated using an awareness index that represents the discrepancy between objective and subjective memory scores. The association between awareness index and FDG uptake was analyzed using SPM12. Awareness index was significantly lower in DLB than in individuals with normal cognition and was associated with glucose metabolism in the bilateral posterior cingulate cortex and right orbitofrontal cortex. Moreover, the awareness index positively correlated with the cingulate island sign ratio but not with striatal DAT density. The findings suggested that the awareness of memory-deficit in DLB was to some extent impaired and its neural substrate was located in cortical midline structure. The concomitant AD-type pathology might have influenced memory-deficit awareness in DLB.
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Affiliation(s)
- Tomomichi Iizuka
- Center for Dementia, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 24-1-3, Matsuyama, Kiyose-City, Tokyo 204-8522, Japan.
| | - Masashi Kameyama
- Division of Nuclear Medicine, Department of Radiology School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Department of Radiology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
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De Carolis A, Cipollini V, Corigliano V, Comparelli A, Sepe-Monti M, Orzi F, Ferracuti S, Giubilei F. Anosognosia in people with cognitive impairment: association with cognitive deficits and behavioral disturbances. Dement Geriatr Cogn Dis Extra 2015; 5:42-50. [PMID: 25852731 PMCID: PMC4361910 DOI: 10.1159/000367987] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS To investigate, in a group of subjects at an early stage of cognitive impairment, the relationship between anosognosia and both cognitive and behavioral symptoms by exploring the various domains of insight. METHODS One hundred and eight subjects affected by cognitive impairment were consecutively enrolled. The level of awareness was evaluated by means of the Clinical Insight Rating Scale (CIRS). Psychiatric symptoms were evaluated using the Italian version of the Neuropsychiatric Inventory (NPI), whereas memory (memory index, MI) and executive (executive index, EI) functions were explored using a battery of neuropsychological tests and qualified by means of a single composite cognitive index score for each function. RESULTS A significant positive correlation between the total NPI score and global anosognosia score was found. Furthermore, both the MI and EI scores were lower in subjects with anosognosia than in those without anosognosia (p < 0.001 and p < 0.007, respectively). When the single domains of the CIRS were considered, anosognosia of reason of visit correlated with the EI score (r = -0.327, p = 0.01) and night-time behavioral disturbances (r = 0.225; p = 0.021); anosognosia of cognitive deficit correlated with depression (r = -0.193; p = 0.049) and the MI score (r = -0.201; p = 0.040); anosognosia of functional deficit correlated with the MI score (r = -0.257; p = 0.008), delusions (r = 0.232; p = 0.015) and aberrant motor behavior (r = 0.289; p = 0.003); anosognosia of disease progression correlated with the MI score (r = -0.236; p = 0.015), agitation (r = 0.247; p = 0.011), aberrant motor behavior (r = 0.351; p = 0.001) and night-time behavioral disturbances (r = 0.216; p = 0.027). CONCLUSIONS Our study suggests that, in the early stage of cognitive impairment, anosognosia is associated with both cognitive deficits and behavioral disorders according to the specific functional anatomy of the symptoms.
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Affiliation(s)
- Antonella De Carolis
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Virginia Cipollini
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Valentina Corigliano
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Anna Comparelli
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Micaela Sepe-Monti
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesco Orzi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Stefano Ferracuti
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Franco Giubilei
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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