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Sung P, Lim-Soh J, Lee JML, Chan A. Stress and Loneliness Among Family Caregivers of Older Persons With Cognitive Impairment: The Mediating Role of Social Isolation and the Moderating Role of Personal Mastery. J Aging Health 2024:8982643241262374. [PMID: 38881150 DOI: 10.1177/08982643241262374] [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: 06/18/2024]
Abstract
OBJECTIVES Relatively little attention has been paid to the underlying processes and conditions leading to loneliness among caregivers of older persons with cognitive impairment (PCI). Drawing upon the caregiver stress-process model and the social relationship expectations framework, this study examined the mediating role of social isolation and the moderating role of caregiver personal mastery in the association between PCI memory and behavioral problems and caregiver loneliness. METHODS Structural equation modeling was applied to cross-sectional data from 266 caregivers in Singapore. RESULTS Caregiver-reported PCI memory and behavioral problems were associated with increased levels of caregiver loneliness. Caregiver social isolation partially mediated the association and caregiver personal mastery moderated the association. DISCUSSION Caregivers with low mastery were more likely to experience loneliness due in part to social isolation resulting from their PCI's memory and behavioral problems. Tailored interventions should address caregiver social isolation and foster caregiver personal mastery.
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Affiliation(s)
- Pildoo Sung
- Department of Sociology, Hong Kong Baptist University, Hong Kong
| | - Jeremy Lim-Soh
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - June May-Ling Lee
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - Angelique Chan
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Sung P, Chan A, Lim-Soh J. Feeling Alone Together: Loneliness in Older Adults with Cognitive Impairment and Their Family Caregivers with Low Mastery. Dement Geriatr Cogn Disord 2024; 53:66-73. [PMID: 38354725 PMCID: PMC11098021 DOI: 10.1159/000536644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Loneliness in older persons with cognitive impairment (PCI) may beget loneliness in their family caregivers, depending on buffering resources caregivers possess. This study examined the association between loneliness in older PCI and loneliness experienced by their family caregivers, and the moderating role of caregiver mastery in this association. METHODS Dyadic data from 135 PCI and their family caregivers in Singapore were analyzed using multivariable regression. Loneliness was measured using a three-item UCLA loneliness scale. Mastery was assessed using a seven-item Pearlin instrument. RESULTS Multivariable regression showed that PCI loneliness and caregiver loneliness were weakly associated, taking other covariates into account. Notably, a significant interaction between PCI loneliness and caregiver mastery was observed, indicating that PCI loneliness was associated with caregiver loneliness only when caregivers had low mastery. CONCLUSION Lonely PCI may share their feelings of loneliness with their caregivers, and this can lead to loneliness among caregivers if they have low mastery. Promoting caregiver mastery may help reduce caregiver loneliness, directly and indirectly as a buffer against PCI loneliness.
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Affiliation(s)
- Pildoo Sung
- Department of Sociology, Hong Kong Baptist University, Hong Kong, Hong Kong SAR
| | - Angelique Chan
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Jeremy Lim-Soh
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
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Brundage K, Holtzer R. Presence and Persistence of Perceived Subjective Cognitive Complaints and Incident Mild Cognitive Impairments Among Community-Residing Older Adults. Am J Geriatr Psychiatry 2023; 31:1140-1148. [PMID: 37516657 DOI: 10.1016/j.jagp.2023.07.001] [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: 03/05/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES To examine whether Subjective Cognitive Complaints (SCCs) predicted incident mild cognitive impairment (MCI). DESIGN Prospective Study. SETTING Central Control of Mobility and Aging (CCMA), a cohort study of community-residing older adults. PARTICIPANTS Participants were dementia-free community-residing older adults. MEASUREMENTS SCCs were assessed at the baseline and via bi-monthly structured phone interviews during the first year using the Ascertain Dementia 8 (AD8). Nonpersistent status required one or two SCCs endorsements and Persistent status required three or more SCCs endorsements. Outcome, presence of mild cognitive impairments (MCI) was determined by established case conference diagnostic procedures. Participants were followed annually. Generalized estimating equations (GEE), logistic model type, were used to determine the odds of developing MCI during follow-up. SCCs served as the three-level predictor (no/nonpersistent/persistent) and cognitive status (MCI versus normal) as the binary outcome. Analyses were adjusted for age, sex, education, race, health status, depressive symptoms, and global cognition. RESULTS The sample (n=454; mean age=75.67 ± 6.43; %female=55.3) included 245 participants who reported no SCCs, 156 who reported 1-2 SCCs, and 53 who reported 3 or more SCCs. Sixty-eight participants developed MCI during follow-up. Results showed that compared to no SCCs, persistent SCCs, and nonpersistent SCCs were significantly associated with increased odds of developing MCI during follow-up. CONCLUSIONS The presence of SCCs regardless of their persistence was associated with increased odds of developing MCI even when adjusting for objectively-assessed cognitive performance.
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Affiliation(s)
- Katie Brundage
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY.
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Tanwani R, Danquah MO, Butris N, Saripella A, Yan E, Kapoor P, Englesakis M, Tang-Wai DF, Tartaglia MC, He D, Chung F. Diagnostic accuracy of Ascertain Dementia 8-item Questionnaire by participant and informant-A systematic review and meta-analysis. PLoS One 2023; 18:e0291291. [PMID: 37699028 PMCID: PMC10497164 DOI: 10.1371/journal.pone.0291291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The Ascertain Dementia 8-item Questionnaire (AD8) is a screening tool for cognitive impairment that can be administered to older persons and/or their informants. OBJECTIVES To evaluate the diagnostic accuracy and compare the predictive parameters of the informant and participant-completed Ascertain Dementia 8-item Questionnaire (iAD8 and pAD8, respectively) in older adults with cognitive impairment. METHODS/DESIGN We searched ten electronic databases (including MEDLINE (Ovid), Embase) from tool inception to March 2022. We included studies with patients ≥60 years old that were screened for cognitive impairment using AD8 in any healthcare setting. Predictive parameters were assessed against reference standards to estimate accuracy and diagnostic ability using bivariate random-effects meta-analyses. We used QUADAS-2 criteria to assess risk of bias. RESULTS A cut-off of ≥2/8 was used to classify mild cognitive impairment (MCI), dementia, and cognitive impairment (MCI or dementia). Seven studies using the iAD8 (n = 794) showed a sensitivity of 80% and specificity of 79% to detect MCI. Nine studies using the iAD8 (n = 2393) established 91% sensitivity and 64% specificity to detect dementia. To detect MCI using the pAD8, four studies (n = 836) showed 57% sensitivity and 71% specificity. To detect dementia using the pAD8, four studies (n = 3015) demonstrated 82% sensitivity and 75% specificity. Recurring high or unclear risk of bias was noted in the domains of "Index test" and "reference standard". CONCLUSIONS The diagnostic accuracy of iAD8 is superior to that of pAD8 when screening for cognitive impairment. The AD8 may be an acceptable alternative to screen for cognitive impairment in older adults when there are limitations to formal testing.
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Affiliation(s)
- Rajiv Tanwani
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mercy O. Danquah
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nina Butris
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ellene Yan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Paras Kapoor
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | - David F. Tang-Wai
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David He
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Frances Chung
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Taylor-Rowan M, Nafisi S, Owen R, Duffy R, Patel A, Burton JK, Quinn TJ. Informant-based screening tools for dementia: an overview of systematic reviews. Psychol Med 2023; 53:580-589. [PMID: 34030753 DOI: 10.1017/s0033291721002002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Informant-based questionnaires may have utility for cognitive impairment or dementia screening. Reviews describing the accuracy of respective questionnaires are available, but their focus on individual questionnaires precludes comparisons across tools. We conducted an overview of systematic reviews to assess the comparative accuracy of informant questionnaires and identify areas where evidence is lacking. METHODS We searched six databases to identify systematic reviews describing diagnostic test accuracy of informant questionnaires for cognitive impairment or dementia. We pooled sensitivity and specificity data for each questionnaire and used network approaches to compare accuracy estimates across the differing tests. We used grading of recommendations, assessment, development and evaluation (GRADE) to evaluate the overall certainty of evidence. Finally, we created an evidence 'heat-map', describing the availability of accurate data for individual tests in different populations and settings. RESULTS We identified 25 reviews, consisting of 93 studies and 13 informant questionnaires. Pooled analysis (37 studies; 11 052 participants) ranked the eight-item interview to ascertain dementia (AD8) highest for sensitivity [90%; 95% credible intervals (CrI) = 82-95; 'best-test' probability = 36]; while the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) was most specific (81%; 95% CrI = 66-90; 'best-test' probability = 29%). GRADE-based evaluation of evidence suggested certainty was 'low' overall. Our heat-map indicated that only AD8 and IQCODE have been extensively evaluated and most studies have been in the secondary care settings. CONCLUSIONS AD8 and IQCODE appear to be valid questionnaires for cognitive impairment or dementia assessment. Other available informant-based cognitive screening questionnaires lack evidence to justify their use at present. Evidence on the accuracy of available tools in primary care settings and with specific populations is required.
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Affiliation(s)
- Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Sara Nafisi
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Rhiannon Owen
- Swansea University Medical School, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Robyn Duffy
- Older People's Psychology Service, NHS Greater Glasgow and Clyde, Glasgow G12 0XH, UK
| | - Amit Patel
- Swansea University Medical School, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Jennifer K Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
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Sung P, May-Ling Lee J, Chan A. Lonely in a Crowd: Social Isolation Profiles and Caregiver Burden Among Family Caregivers of Community-Dwelling Older Adults With Cognitive Impairment. J Aging Health 2022; 35:419-429. [PMID: 36330754 DOI: 10.1177/08982643221137939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives This study identified distinct social isolation profiles among caregivers, each formed by varied combinations of social disconnectedness and loneliness, and examined if and how the profiles were associated with caregiver burden. Methods Latent class analysis and multivariable regression were applied to data from 266 caregivers of community-dwelling older Singaporeans with cognitive impairment. Results Two caregiver social isolation profiles were identified: strongly connected, not lonely (86%), and moderately connected, lonely (14%). Moderately connected and lonely caregivers tended to perceive a higher level of burden than strongly connected and not lonely caregivers. Moderately connected and lonely caregivers were also more likely to be burdened by their care recipients’ poor health than their connected and not lonely counterparts. Discussion Caregivers who feel “lonely in a crowd” are vulnerable to caregiving stress and burden. Tailored interventions, such as cognitive behavioral therapy, are needed to reduce the loneliness of moderately connected caregivers.
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Affiliation(s)
- Pildoo Sung
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - June May-Ling Lee
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - Angelique Chan
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Met and Unmet Needs of Older Adults With Cognitive Impairment, and Burden and Benefits of Their Family Caregivers. Alzheimer Dis Assoc Disord 2022; 36:300-306. [PMID: 36183419 DOI: 10.1097/wad.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/29/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study examined the association between met and unmet needs of older adults with cognitive impairment living in the community and unique types of caregiving experience, each comprising different levels of caregiving burden and benefits. METHODS Latent class analysis and multivariable regression were applied to data on 266 caregivers of community-dwelling Singaporean older adults, aged 60 years and above, with cognitive impairment who participated in a community-based dementia care study in 2018. RESULTS Three unique types of caregiving experience were identified: satisfied (low burden and high benefits; 54% of caregivers), dissatisfied (low burden and low benefits; 35%), and intensive (high burden and high benefits; 11%). Met needs were positively associated with satisfied caregiving experience (vs. dissatisfied caregiving experience), and both met and unmet needs were positively associated with intensive caregiving experience (vs. dissatisfied caregiving experience). Specifically, caregivers tended to have satisfied caregiving experience if older adults' care needs in daytime activities or mobility were met. DISCUSSION Fulfillment of unmet needs of older adults with cognitive impairment is associated with a satisfied caregiver experience characterized by lower caregiver burden and greater caregiver benefits. Identification of and tailored interventions for unmet care needs of older adults will likely promote satisfied caregiving experience.
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Wasef S, Laksono I, Kapoor P, Tang-Wei D, Gold D, Saripella A, Riazi S, Islam S, Englesakis M, Wong J, Chung F. Screening for subjective cognitive decline in the elderly via subjective cognitive complaints and informant-reported questionnaires: a systematic review. BMC Anesthesiol 2021; 21:277. [PMID: 34753428 PMCID: PMC8579566 DOI: 10.1186/s12871-021-01493-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Subjective cognitive decline may represent at-risk persons progressing to mild cognitive impairment (MCI), which can be exacerbated by effects of anesthesia and surgery. The objective of this systematic review is to identify the most common questions in subjective cognitive complaint and informant-reported questionnaires used in assessing cognitive impairment of elderly patients that are correlated with standardized tests for cognitive impairment screening. METHODS We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database, Emcare Nursing, Web of Science, Scopus, CINAHL, ClinicalTrials.Gov, and ICTRP between September 20, 2005 to August 31, 2020. We included studies that evaluated subjective cognitive complaints and informant-reported questions in elderly patients. RESULTS AND CONCLUSION A total of 28,407 patients were included from 22 studies that assessed 21 subjective complaint questionnaires and nine informant-reported questionnaires. The most common subjective cognitive complaints were those assessing anterograde memory, closely followed by perceptual-motor function and executive function. The most common informant-reported questions were those assessing executive function, temporal orientation, and anterograde memory. Questions assessing learning and memory were most associated with results from standardized tests assessing cognitive impairment. Assessing learning and memory plays a key role in evaluating subjective cognitive decline in elderly patients. Delivering subjective cognitive complaints questions to elderly patient preoperatively may aid in screening for those exhibiting cognitive signs, and in turn are at risk of postoperative complications. Thus, the results from this review contribute to knowledge for healthcare professionals regarding the use of subjective cognitive complaints and informant-reported complaints in preoperative settings.
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Affiliation(s)
- Sara Wasef
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Isabelle Laksono
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Paras Kapoor
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Tang-Wei
- Department of Neurology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Gold
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sheila Riazi
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sazzadul Islam
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
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Liew TM. Active case finding of dementia in ambulatory care settings: a comparison of three strategies. Eur J Neurol 2020; 27:1867-1878. [PMID: 32441837 PMCID: PMC7680283 DOI: 10.1111/ene.14353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/17/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE To reduce the diagnostic gap of dementia, three strategies can be employed for case finding of cognitive impairment in ambulatory care settings, namely using informant report, brief cognitive test or a combination of informant report and brief cognitive test. The right strategy to adopt across different healthcare settings remains unclear. This diagnostic study compared the performance of the three strategies for detecting dementia (primary aim), as well as for detecting both mild cognitive impairment (MCI) and dementia (secondary aim). METHODS Participants aged ≥65 years (n = 11 057) were recruited from Alzheimer's Disease Centers across the USA. Participants provided data on an informant report (Functional Activities Questionnaire), brief cognitive test (four-item short variant of Montreal Cognitive Assessment) and a combined measure with informant report and brief cognitive test (sum of Functional Activities Questionnaire and Montreal Cognitive Assessment short variant). They also received standardized assessments (clinical history, physical examination and neuropsychological testing) to diagnose MCI and dementia. Areas under the receiver operating characteristic curve (AUCs) of the three strategies were compared using the DeLong method, with AUC > 90% indicating excellent performance. RESULTS All three strategies had excellent performance in detecting dementia, although informant report [AUC, 95.9%; 95% confidence intervals (CI), 95.4-96.3%] was significantly better than brief cognitive test (AUC, 93.0%; 95% CI, 92.4-93.6%) and the combined measure had the best performance (AUC, 97.0%; 95% CI, 96.7-97.4%). However, to detect both MCI and dementia, only the combined measure had excellent performance (AUC, 93.0%; 95% CI, 92.5-93.4%), whereas stand-alone informant report or brief cognitive test performed suboptimally (AUC < 90%). Performance of the three strategies was not affected by participants' age, educational attainment or underlying prevalence of MCI and dementia. CONCLUSIONS For case finding of dementia in ambulatory care settings, informant reports would suffice as first-line measures and brief cognitive tests may optionally be added on, in services with available resources, to further improve the accuracy of detection. For case finding of both MCI and dementia, a combination of informant reports and brief cognitive tests remains the most appropriate strategy.
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Affiliation(s)
- Tau Ming Liew
- Department of Psychiatry, Singapore General Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore
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Wu EM, El Ahmadieh TY, Kafka B, Caruso JP, Neeley OJ, Plitt AR, Aoun SG, Olson D, Ruchinskas RA, Cullum CM, Welch BG, Batjer HH, White JA. Clinical outcomes of normal pressure hydrocephalus in 116 patients: objective versus subjective assessment. J Neurosurg 2020; 132:1757-1763. [PMID: 30978684 DOI: 10.3171/2019.1.jns181598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 01/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Objective assessment tests are commonly used to predict the response to ventriculoperitoneal (VP) shunting in patients with normal pressure hydrocephalus (NPH). Whether subjective reports of improvement after a lumbar drain (LD) trial can predict response to VP shunting remains controversial. The goal in this study was to compare clinical characteristics, complication rates, and shunt outcomes of objective and subjective LD responders who underwent VP shunt placement. METHODS This was a retrospective review of patients with NPH who underwent VP shunt placement after clinical improvement with the LD trial. Patients who responded after the LD trial were subclassified into objective LD responders and subjective LD responders. Clinical characteristics, complication rates, and shunt outcomes between the 2 groups were compared with chi-square test of independence and t-test. RESULTS A total of 116 patients received a VP shunt; 75 were objective LD responders and 41 were subjective LD responders. There was no statistically significant difference in patient characteristics between the 2 groups, except for a shorter length of stay after LD trial seen with subjective responders. The complication rates after LD trial and VP shunting were not significantly different between the 2 groups. Similarly, there was no significant difference in shunt response between objective and subjective LD responders. The mean duration of follow-up was 1.73 years. CONCLUSIONS Reports of subjective improvement after LD trial in patients with NPH can be a reliable predictor of shunt response. The currently used objective assessment scales may not be sensitive enough to detect subtle changes in symptomatology after LD trial.
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Affiliation(s)
- Eva M Wu
- 1School of Medicine, The University of Texas Southwestern Medical Center
| | - Tarek Y El Ahmadieh
- 2Department of Neurological Surgery, The University of Texas Southwestern Medical Center
| | - Benjamin Kafka
- 2Department of Neurological Surgery, The University of Texas Southwestern Medical Center
| | - James P Caruso
- 2Department of Neurological Surgery, The University of Texas Southwestern Medical Center
| | - Om J Neeley
- 2Department of Neurological Surgery, The University of Texas Southwestern Medical Center
| | - Aaron R Plitt
- 2Department of Neurological Surgery, The University of Texas Southwestern Medical Center
| | - Salah G Aoun
- 2Department of Neurological Surgery, The University of Texas Southwestern Medical Center
| | - Daiwai Olson
- 2Department of Neurological Surgery, The University of Texas Southwestern Medical Center
- 3Department of Neurology & Neurotherapeutics, Zale Lipshy Hospital, The University of Texas Southwestern Medical Center; and
| | - Robert A Ruchinskas
- 3Department of Neurology & Neurotherapeutics, Zale Lipshy Hospital, The University of Texas Southwestern Medical Center; and
- 4Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - C Munro Cullum
- 3Department of Neurology & Neurotherapeutics, Zale Lipshy Hospital, The University of Texas Southwestern Medical Center; and
- 4Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Babu G Welch
- 2Department of Neurological Surgery, The University of Texas Southwestern Medical Center
| | - H Hunt Batjer
- 2Department of Neurological Surgery, The University of Texas Southwestern Medical Center
| | - Jonathan A White
- 2Department of Neurological Surgery, The University of Texas Southwestern Medical Center
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Hendry K, Green C, McShane R, Noel‐Storr AH, Stott DJ, Anwer S, Sutton AJ, Burton JK, Quinn TJ. AD-8 for detection of dementia across a variety of healthcare settings. Cochrane Database Syst Rev 2019; 3:CD011121. [PMID: 30828783 PMCID: PMC6398085 DOI: 10.1002/14651858.cd011121.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dementia assessment often involves initial screening, using a brief tool, followed by more detailed assessment where required. The AD-8 is a short questionnaire, completed by a suitable 'informant' who knows the person well. AD-8 is designed to assess change in functional performance secondary to cognitive change. OBJECTIVES To determine the diagnostic accuracy of the informant-based AD-8 questionnaire, in detection of all-cause (undifferentiated) dementia in adults. Where data were available, we described the following: the diagnostic accuracy of the AD-8 at various predefined threshold scores; the diagnostic accuracy of the AD-8 for each healthcare setting and the effects of heterogeneity on the reported diagnostic accuracy of the AD-8. SEARCH METHODS We searched the following sources on 27 May 2014, with an update to 7 June 2018: ALOIS (Cochrane Dementia and Cognitive Improvement Group), MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), BIOSIS Previews (Thomson Reuters Web of Science), Web of Science Core Collection (includes Conference Proceedings Citation Index) (Thomson Reuters Web of Science), CINAHL (EBSCOhost) and LILACS (BIREME). We checked reference lists of relevant studies and reviews, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on the AD-8 to try to find additional studies. We developed a sensitive search strategy and used standardised database subject headings as appropriate. Foreign language publications were translated. SELECTION CRITERIA We selected those studies which included the AD-8 to assess for the presence of dementia and where dementia diagnosis was confirmed with clinical assessment. We only included those studies where the AD-8 was used as an informant assessment. We made no exclusions in relation to healthcare setting, language of AD-8 or the AD-8 score used to define a 'test positive' case. DATA COLLECTION AND ANALYSIS We screened all titles generated by electronic database searches, and reviewed abstracts of potentially relevant studies. Two independent assessors checked full papers for eligibility and extracted data. We extracted data into two-by-two tables to allow calculation of accuracy metrics for individual studies. We then created summary estimates of sensitivity, specificity and likelihood ratios using the bivariate approach and plotting results in receiver operating characteristic (ROC) space. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool. MAIN RESULTS From 36 papers describing AD-8 test accuracy, we included 10 papers. We utilised data from nine papers with 4045 individuals, 1107 of whom (27%) had a clinical diagnosis of dementia. Pooled analysis of seven studies, using an AD-8 informant cut-off score of two, indicated that sensitivity was 0.92 (95% confidence interval (CI) 0.86 to 0.96); specificity was 0.64 (95% CI 0.39 to 0.82); the positive likelihood ratio was 2.53 (95% CI 1.38 to 4.64); and the negative likelihood ratio was 0.12 (95% CI 0.07 to 0.21). Pooled analysis of five studies, using an AD-8 informant cut-off score of three, indicated that sensitivity was 0.91 (95% CI 0.80 to 0.96); specificity was 0.76 (95% CI 0.57 to 0.89); the positive likelihood ratio was 3.86 (95% CI 2.03 to 7.34); and the negative likelihood ratio was 0.12 (95% CI 0.06 to 0.24).Four studies were conducted in community settings; four were in secondary care (one in the acute hospital); and one study was in primary care. The AD-8 has a higher relative sensitivity (1.11, 95% CI 1.02 to 1.21), but lower relative specificity (0.51, 95% CI 0.23 to 1.09) in secondary care compared to community care settings.There was heterogeneity across the included studies. Dementia prevalence rate varied from 12% to 90% of included participants. The tool was also used in various different languages. Among all the included studies there was evidence of risk of bias. Issues included the selection of participants, conduct of index test, and flow of assessment procedures. AUTHORS' CONCLUSIONS The high sensitivity of the AD-8 suggests it can be used to identify adults who may benefit from further specialist assessment and diagnosis, but is not a diagnostic test in itself. This pattern of high sensitivity and lower specificity is often suited to a screening test. Test accuracy varies by setting, however data in primary care and acute hospital settings are limited. This review identified significant heterogeneity and risk of bias, which may affect the validity of its summary findings.
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Affiliation(s)
- Kirsty Hendry
- University of GlasgowInstitute of Cardiovascular and Medical SciencesNew Lister BuildingGlasgow Royal InfirmaryGlasgowUKG4 OSF
| | - Claire Green
- University of GlasgowInstitute of Cardiovascular and Medical SciencesNew Lister BuildingGlasgow Royal InfirmaryGlasgowUKG4 OSF
| | - Rupert McShane
- University of OxfordRadcliffe Department of MedicineJohn Radcliffe HospitalLevel 4, Main Hospital, Room 4401COxfordOxfordshireUKOX3 9DU
| | - Anna H Noel‐Storr
- University of OxfordRadcliffe Department of MedicineJohn Radcliffe HospitalLevel 4, Main Hospital, Room 4401COxfordOxfordshireUKOX3 9DU
| | - David J Stott
- University of GlasgowInstitute of Cardiovascular and Medical SciencesNew Lister BuildingGlasgow Royal InfirmaryGlasgowUKG4 OSF
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Alex J Sutton
- University of LeicesterDepartment of Health Sciences2nd Floor (Room 214e),Adrian BuildingLeicesterUKLE1 7RH
| | - Jennifer K Burton
- University of GlasgowAcademic Geriatric Medicine, Institute of Cardiovascular and Medical SciencesNew Lister Building, Glasgow Royal InfirmaryGlasgowUKG4 0SF
| | - Terry J Quinn
- University of GlasgowInstitute of Cardiovascular and Medical SciencesNew Lister BuildingGlasgow Royal InfirmaryGlasgowUKG4 OSF
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Duggan MC, Morrell ME, Chandrasekhar R, Marra A, Frimpong K, Nair DR, Girard TD, Pandharipande PP, Ely EW, Jackson JC. A Brief Informant Screening Instrument for Dementia in the ICU: The Diagnostic Accuracy of the AD8 in Critically Ill Adults Suspected of Having Pre-Existing Dementia. Dement Geriatr Cogn Disord 2019; 48:241-249. [PMID: 32259825 PMCID: PMC9528182 DOI: 10.1159/000490379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM The diagnostic accuracy of brief informant screening instruments to detect dementia in critically ill adults is unknown. We sought to determine the diagnostic accuracy of the 2- to 3-min Ascertain Dementia 8 (AD8) completed by surrogates in detecting dementia among critically ill adults suspected of having pre-existing dementia by comparing it to the Clinical Dementia Rating Scale (CDR). METHODS This substudy of BRAIN-ICU included a subgroup of 75 critically ill medical/surgical patients determined to be at medium risk of having pre-existing dementia (Informant Questionnaire on Cognitive Decline in the Elderly [IQCODE] score ≥3.3). We calculated the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and AUC for the standard AD8 cutoff of ≥2 versus the reference standard CDR score of ≥1 for mild dementia. RESULTS By the CDR, 38 patients had very mild or no dementia and 37 had mild dementia or greater. For diagnosing mild dementia, the AD8 had a sensitivity of 97% (95% CI 86-100), a specificity of 16% (6-31), a PPV of 53% (40-65), an NPV of 86% (42-100), and an AUC of 0.738 (0.626-0.850). CONCLUSIONS Among critically ill patients judged at risk for pre-existing dementia, the 2- to 3-min AD8 is highly sensitive and has a high NPV. These data indicate that the brief tool can serve to rule out dementia in a specific patient population.
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Affiliation(s)
- Maria C. Duggan
- Geriatric Research Education and Clinical Center (GRECC), Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA;,Division of Geriatric Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Madeline E. Morrell
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Rameela Chandrasekhar
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Annachiara Marra
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA;,Department of Neurosciences, Reproductive and Odontostomatological Sciences, Department of Public Health, University of Naples, Naples, Italy
| | - Kwame Frimpong
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA;,Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Deepanjali R. Nair
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy D. Girard
- Geriatric Research Education and Clinical Center (GRECC), Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA;,Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA;,Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pratik P. Pandharipande
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA;,Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - E. Wesley Ely
- Geriatric Research Education and Clinical Center (GRECC), Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA;,Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA;,Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C. Jackson
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA;,Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA;,Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA;,Research Service, Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
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Chen HH, Sun FJ, Yeh TL, Liu HE, Huang HL, Kuo BIT, Huang HY. The diagnostic accuracy of the Ascertain Dementia 8 questionnaire for detecting cognitive impairment in primary care in the community, clinics and hospitals: a systematic review and meta-analysis. Fam Pract 2018; 35:239-246. [PMID: 29045636 PMCID: PMC5965102 DOI: 10.1093/fampra/cmx098] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background The prevalence of cognitive impairment is increasing due to the aging population, and early detection is essential clinically. The Ascertain Dementia 8 (AD8) questionnaire is a brief informant-based measure recently developed to assess early cognitive impairment, however, its overall diagnostic performance is controversial. The objective of this meta-analysis was to assess the diagnostic accuracy of the AD8 for cognitive impairment. Methods All relevant studies were collected from databases including MEDLINE, EMBASE and the Cochrane Library up to April 2017. We used QUADAS-2 to assess the methodological quality after the systematic search. The accuracy data and potential confounding variables were extracted from the eligible studies which included those in English and non-English. All analyses were performed using the Midas module in Stata 14.0 and Meta-DiSc 1.4 software. Results Seven relevant studies including 3728 subjects were collected, and classified into two subgroups according to the severity of cognitive impairment. The overall sensitivity (0.72, 0.91) was superior to specificity (0.67, 0.78). The pooled negative likelihood ratio (0.17, 0.13) was better than the positive likelihood ratio (2.52, 3.94). The areas under the summary receiver operating characteristic curve were 0.83 and 0.92, respectively. Meta-regression analysis showed that location (community versus non-community) may be the source of heterogeneity. The average administration time was less than 3 minutes. Conclusion Our findings suggest that the AD8 is a competitive tool for clinically screening cognitive impairment and has an optimal administration time in the busy primary care setting. Subjects with an AD8 score ≧2 should be highly suspected to have cognitive impairment and a further definite diagnosis is needed.
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Affiliation(s)
- Hsin-Hao Chen
- Family Medicine Department, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Tzu-Lin Yeh
- Family Medicine Department, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Hsueh-Erh Liu
- Degree Program in Healthcare Industry, Chang Gung University, Taoyuan City, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Rheumatology, Chang Gung Memorial Hospital, LinKou, Taiwan
- Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Benjamin Ing-Tiau Kuo
- Laboratory of Epidemiology and Biostatics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Yi Huang
- Laboratory of Epidemiology and Biostatics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
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