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Tippett DC, Neophytou K, Tao Y, Gallegos J, Morrow C, Onyike CU, Tsapkini K. Long-term, home-based transcranial direct current stimulation coupled with computerized cognitive training in frontotemporal dementia: A case report. J Cent Nerv Syst Dis 2024; 16:11795735241258435. [PMID: 38835997 PMCID: PMC11149448 DOI: 10.1177/11795735241258435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 05/02/2024] [Indexed: 06/06/2024] Open
Abstract
We present the case of a 62-year-old woman with probable behavioral variant of frontotemporal dementia (bvFTD) with cognitive/language deficits who demonstrated improved performance on cognitive/language testing and in functional tasks following long-term, home-based transcranial direct current stimulation (tDCS) coupled with computerized cognitive training (CCT). The patient underwent home-based tDCS (anode on the left prefrontal cortex and cathode on the right homologue) for 46 sessions over 10 weeks along with CCT. On post-treatment testing, the patient improved by 3 points on the Mini-Mental State Exam (MMSE) (23 to 26). She also showed improvement on several cognitive/language tasks, such as immediate recall of single words and word pairs, total accurate words in sentence repetition, delayed recall, semantic processing, and sentence level comprehension. There was no decline in several other cognitive and language tasks. Family members reported subjective improvements in expressiveness, communication, and interaction with others as well as increased attention to grooming and style which contrasted with her pre-treatment condition. This report suggests that home-based tDCS combined with CCT for an extended period may slow decline, and improve cognitive/language performance and everyday function in FTD.
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Affiliation(s)
- Donna C Tippett
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kyriaki Neophytou
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yuan Tao
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica Gallegos
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher Morrow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kyrana Tsapkini
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Liampas I, Dimitriou N, Siokas V, Messinis L, Nasios G, Dardiotis E. Cognitive trajectories preluding the onset of different dementia entities: a descriptive longitudinal study using the NACC database. Aging Clin Exp Res 2024; 36:119. [PMID: 38780681 PMCID: PMC11116253 DOI: 10.1007/s40520-024-02769-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To describe the 10-year preclinical cognitive trajectories of older, non-demented individuals towards the onset of the four most prevalent types of dementia, i.e., Alzheimer's disease(AD), Lewy body(LBD), vascular(VD) and frontotemporal dementia(FTD). METHODS Our analysis focused on data from older (≥ 60years) NACC (National Alzheimer's Coordinating Center) participants. Four distinct presymptomatic dementia groups (AD-LBD-VD-FTD) and a comparison group of cognitively unimpaired(CU) participants were formed. Comprehensive cognitive assessments involving verbal episodic memory, semantic verbal fluency, confrontation naming, mental processing speed - attention and executive function - cognitive flexibility were conducted at baseline and on an approximately yearly basis. Descriptive analyses (adjusted general linear models) were performed to determine and compare the yearly cognitive scores of each group throughout the follow-up. Exploratory analyses were conducted to estimate the rates of cognitive decline. RESULTS There were 3343 participants who developed AD, 247 LBD, 108 FTD, 155 VD and 3398 composed the CU group. Participants with AD performed worse on episodic memory than those with VD and LBD for about 3 to 4 years prior to dementia onset (the FTD group documented an intermediate course). Presymptomatic verbal fluency and confrontation naming trajectories differentiated quite well between the FTD group and the remaining dementia entities. Participants with incident LBD and VD performed worse than those with AD on executive functions and mental processing speed-attention since about 5 years prior to the onset of dementia, and worse than those with FTD more proximally to the diagnosis of the disorder. CONCLUSIONS Heterogeneous cognitive trajectories characterize the presymptomatic courses of the most prevalent dementia entities.
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Affiliation(s)
- Ioannis Liampas
- Department of Neurology, School of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo Hill, Larissa, 41100, Greece.
| | - Nefeli Dimitriou
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, 45500, Greece
| | - Vasileios Siokas
- Department of Neurology, School of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo Hill, Larissa, 41100, Greece
| | - Lambros Messinis
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, 45500, Greece
| | - Efthimios Dardiotis
- Department of Neurology, School of Medicine, University Hospital of Larissa, University of Thessaly, Mezourlo Hill, Larissa, 41100, Greece
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3
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Aiello EN, Solca F, Torre S, Gentile F, Scheveger F, Olivero M, Colombo E, Maranzano A, Manzoni M, Morelli C, Doretti A, Verde F, Silani V, Ticozzi N, Poletti B. Frontotemporal-spectrum disorders and functional independence in non-demented ALS patients. Neurol Sci 2024; 45:1087-1095. [PMID: 37773576 PMCID: PMC10858065 DOI: 10.1007/s10072-023-07074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/10/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The present study aimed at determining whether, net of motor confounders, neuropsychological features affect functional independence (FI) in activities of daily living (ADLs) in non-demented amyotrophic lateral sclerosis (ALS) patients. METHODS N = 88 ALS patients without frontotemporal dementia were assessed for FI-Katz's Basic ADL Scale (BADL) and Lawton-Brody's Instrumental ADL Scale (IADL)-, cognition-Edinburgh Cognitive and Behavioural ALS Screen (ECAS)-and behaviour-Beaumont Behavioural Inventory and Dimensional Apathy Scale. The association between cognitive and behavioural measures and BADL/IADL scores was assessed by covarying for demographics, anxiety and depression levels, disease duration and motor confounders-i.e. ALS Functional Rating Scale-Revised (ALSFRS-R) scores, progression rate and both King's and Milano-Torino stages. RESULTS Higher scores on the ECAS-Language were associated with higher IADL scores (p = 0.005), whilst higher apathetic features-as measured by the Dimensional Apathy Scale (DAS)-were inversely related to the BADL (p = 0.003). Whilst IADL scores were related to all ECAS-Language tasks, the DAS-Initiation was the only subscale associated with BADL scores. Patients with abnormal ECAS-Language (p = 0.023) and DAS (p = 0.008) scores were more functionally dependent than those without. DISCUSSION Among non-motor features, language changes and apathetic features detrimentally affect FI in non-demented ALS patients.
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Affiliation(s)
- Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Francesco Gentile
- Neurology Residency Program, Università Degli Studi Di Milano, Milan, Italy
| | | | - Marco Olivero
- Neurology Residency Program, Università Degli Studi Di Milano, Milan, Italy
| | - Eleonora Colombo
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Alessio Maranzano
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Martina Manzoni
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea - La Nostra Famiglia, Bosisio Parini, Lecco, Italy
| | - Claudia Morelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Alberto Doretti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, MI, Italy.
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy.
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Chatzidimitriou E, Ioannidis P, Aretouli E, Papaliagkas V, Moraitou D. Correlates of Functional Impairment in Patients with the Behavioral Variant of Frontotemporal Dementia: A PRISMA-Compliant Systematic Review. Int J Mol Sci 2023; 24:13810. [PMID: 37762113 PMCID: PMC10531075 DOI: 10.3390/ijms241813810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The behavioral variant of frontotemporal dementia (bvFTD) has a devastating effect on multiple domains of daily living. The purpose of this PRISMA-compliant systematic review is to summarize the most important factors associated with functional impairment in this clinical group by critically analyzing the existing literature spanning the period from 2000 to 2023. To be included in the review, a study had to investigate any kind of correlates of functional status in bvFTD patients, using a previously validated instrument of functional assessment. Out of 40 articles assessed for eligibility, 18 met the inclusion criteria. The anatomical pattern of cerebral atrophy at baseline appeared to be the strongest predictor of the rate of functional decline over time, with the frontal-dominant anatomical subtype being associated with a faster rate of functional impairment. Additionally, executive dysfunction as well as apathy appeared to contribute significantly to functional disability in bvFTD patients. A comparative examination of bvFTD in relation to other clinical subtypes of FTD and other types of dementia in general suggests that it is the predominant atrophy of the frontal lobes along with the subsequent unique combination of cognitive and neuropsychiatric manifestations that account for the pronounced functional limitations observed in these individuals, even from the early stages of the disease.
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Affiliation(s)
- Electra Chatzidimitriou
- Laboratory of Psychology, Department of Cognition, Brain and Behavior, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece;
- Laboratory of Neurodegenerative Diseases, Center of Interdisciplinary Research and Innovation (CIRI-AUTH), Balcan Center, Buildings A & B, 57001 Thessaloniki, Greece
| | - Panagiotis Ioannidis
- B’ Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki (AUTH), 54124 Thessaloniki, Greece
| | - Eleni Aretouli
- Department of Psychology, School of Social Sciences, University of Ioannina, 45500 Ioannina, Greece
| | - Vasileios Papaliagkas
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, Alexandrion University Campus, 57400 Thessaloniki, Greece
| | - Despina Moraitou
- Laboratory of Psychology, Department of Cognition, Brain and Behavior, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece;
- Laboratory of Neurodegenerative Diseases, Center of Interdisciplinary Research and Innovation (CIRI-AUTH), Balcan Center, Buildings A & B, 57001 Thessaloniki, Greece
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Martínez-Pernía D, Olavarría L, Fernández-Manjón B, Cabello V, Henríquez F, Robert P, Alvarado L, Barría S, Antivilo A, Velasquez J, Cerda M, Farías G, Torralva T, Ibáñez A, Parra MA, Gilbert S, Slachevsky A. The limitations and challenges in the assessment of executive dysfunction associated with real-world functioning: The opportunity of serious games. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-17. [PMID: 36827177 PMCID: PMC11177293 DOI: 10.1080/23279095.2023.2174438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Nowadays, there is a broad range of methods for detecting and evaluating executive dysfunction ranging from clinical interview to neuropsychological evaluation. Nevertheless, a critical issue of these assessments is the lack of correspondence of the neuropsychological test's results with real-world functioning. This paper proposes serious games as a new framework to improve the neuropsychological assessment of real-world functioning. We briefly discuss the contribution and limitations of current methods of evaluation of executive dysfunction (paper-and-pencil tests, naturalistic observation methods, and Information and Communications Technologies) to inform on daily life functioning. Then, we analyze what are the limitations of these methods to predict real-world performance: (1) A lack of appropriate instruments to investigate the complexity of real-world functioning, (2) the vast majority of neuropsychological tests assess well-structured tasks, and (3) measurement of behaviors are based on simplistic data collection and statistical analysis. This work shows how serious games offer an opportunity to develop more efficient tools to detect executive dysfunction in everyday life contexts. Serious games provide meaningful narrative stories and virtual or real environments that immerse the user in natural and social environments with social interactions. In those highly interactive game environments, the player needs to adapt his/her behavioral performance to novel and ill-structured tasks which are suited for collecting user interaction evidence. Serious games offer a novel opportunity to develop better tools to improve diagnosis of the executive dysfunction in everyday life contexts. However, more research is still needed to implement serious games in everyday clinical practice.
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Affiliation(s)
- David Martínez-Pernía
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
| | - Loreto Olavarría
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Victoria Cabello
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Biomedical Science Institute, Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Fernando Henríquez
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Biomedical Science Institute, Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Laboratory for Cognitive and Evolutionary Neuroscience (LaNCE), Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Philippe Robert
- Cognition Behavior Technology (CoBTeK) Lab, FRIS-Université Côte d'Azur, Nice, France
| | - Luís Alvarado
- Departamento de Psiquiatría y Salud Mental Norte, Universidad de Chile, Santiago, Chile
| | - Silvia Barría
- Departamento de Ciencias Neurologicas Oriente, Facultad de Medicina, Universidad de Chile, and Servicio de Neurología, Hospital del Salvador, Santiago, Chile
| | - Andrés Antivilo
- Departamento de Ciencias Neurologicas Oriente, Facultad de Medicina, Universidad de Chile, and Servicio de Neurología, Hospital del Salvador, Santiago, Chile
| | - Juan Velasquez
- Facultad de Ciencias Físicas y Matemáticas, Web Intelligence Center, Universidad de Chile, Santiago, Chile
- Department of Industrial Engineering, Faculty of Physical and Mathematical Sciences, Instituto Sistemas Complejos de Ingeniería (ISCI), University of Chile, Santiago, Chile
| | - Mauricio Cerda
- Integrative Biology Program, Institute of Biomedical Sciences, and Center for Medical Informatics and Telemedicine, Faculty of Medicine, and Biomedical Neuroscience Institute, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Gonzalo Farías
- Department of Neurology North, Faculty of Medicine, University of Chile, Santiago, Chile
- Center for advanced clinical research (CICA), Hospital Clínico Universidad de Chile, Chile
| | - Teresa Torralva
- Institute of Cognitive and Translational Neuroscience (INCYT), Instituto de Neurología Cognitiva Foundation, Favaloro University, Buenos Aires, Argentina
| | - Agustín Ibáñez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
- Trinity College Dublin (TCD), Dublin, Ireland
| | - Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Sam Gilbert
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Biomedical Science Institute, Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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Chatzidimitriou E, Ioannidis P, Moraitou D, Konstantinopoulou E, Aretouli E. The cognitive and behavioral correlates of functional status in patients with frontotemporal dementia: A pilot study. Front Hum Neurosci 2023; 17:1087765. [PMID: 36923586 PMCID: PMC10009888 DOI: 10.3389/fnhum.2023.1087765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
Objective: Frontotemporal dementia (FTD) impinges significantly on cognition, behavior, and everyday functioning. Goal of the present study is the detailed description of behavioral disturbances and functional limitations, as well as the investigation of associations between cognition, behavior, and functional impairment among FTD patients. Given the importance of maintaining a satisfying functional status as long as possible, this study also aims to identify the cognitive correlates of compensatory strategy use in this clinical group. Methods: A total of 13 patients diagnosed with FTD (behavioral variant FTD = 9, non-fluent variant primary progressive aphasia = 3, semantic dementia = 1) were administrated a broad range of neuropsychological tests for the assessment of different cognitive abilities. Behavioral symptomatology and performance on everyday activities were rated with informant-based measures. Descriptive statistics were used for the delineation of behavioral and functional patterns, whereas stepwise multiple regression analyses were performed to identify associations between cognition, behavior, and functional status. Results: Negative symptoms, especially apathy, were found to predominate in the behavior of FTD patients. Instrumental tasks, such as housework and leisure activities, appeared to be the most impaired functional domains. Working memory was the strongest cognitive correlate of performance across various domains of everyday functioning, whereas working memory along with short-term verbal memory accounted for a great proportion of variance in compensatory strategy use. Behavioral disturbances and especially negative symptoms were also found to contribute significantly to functional impairment in FTD. Conclusions: Executive dysfunction, as well as behavioral disturbances contribute significantly to functional disability in FTD. Early interventions tailored at these domains may have the potential to improve functional outcomes and delay the rate of functional decline among FTD patients.
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Affiliation(s)
- Electra Chatzidimitriou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Ioannidis
- B Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despina Moraitou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Konstantinopoulou
- Laboratory of Cognitive Neuroscience, School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Aretouli
- School of Psychology, University of Ioannina, Ioannina, Greece
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Benge JF, Artz J, Kiselica A. The ecological validity of the Uniform Data Set 3.0 neuropsychological battery in individuals with mild cognitive impairment and dementia. Clin Neuropsychol 2022; 36:1453-1470. [PMID: 33103615 PMCID: PMC8071839 DOI: 10.1080/13854046.2020.1837246] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Ecological validity refers to the ability of neuropsychological measures to predict real world performance. Questions remain as to the ecological validity of commonly used measures, particularly regarding their relationships to global versus specific activities of daily living among those with neurodegenerative disease. We explored these issues through the lens of the Uniform Data Set 3.0 Neuropsychological battery (UDS3NB) in individuals with mild cognitive impairment and dementia. Method: UDS3NB and informant rated Functional Activities Questionnaire scales were evaluated from 2,253 individuals with mild cognitive impairment and dementia. Ordinal regression equations were used to explore the relationships of demographic and cognitive variables with overall and specific instrumental activities of daily living. Results: Delayed recall for visual and verbal material, and performance on trail making tests were consistent predictors of global and specific functions. Specific skills (i.e. naming or figure copy) showed differential relationships with specific activities, while phonemic fluency was not related to any particular activity. Conclusions: Measures in the UDS3NB predicted activities of daily living in individuals with MCI and dementia, providing initial support for the ecological validity of these tests. Specifically, measures that tap core deficits of Alzheimer's disease, such as delayed recall and sequencing/shifting, are consistent predictors of performance in daily tasks.
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Affiliation(s)
- Jared F. Benge
- Department of Neurology, Baylor Scott and White Health, Temple, TX
- Plummer Movement Disorder Center, BSWH Health, Temple, TX
- Texas A&M College of Medicine, Temple, TX
| | | | - Andrew Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO
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Schwertner E, Pereira JB, Xu H, Secnik J, Winblad B, Eriksdotter M, Nägga K, Religa D. Behavioral and Psychological Symptoms of Dementia in Different Dementia Disorders: A Large-Scale Study of 10,000 Individuals. J Alzheimers Dis 2022; 87:1307-1318. [PMID: 35491774 PMCID: PMC9198804 DOI: 10.3233/jad-215198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: The majority of individuals with dementia will suffer from behavioral and psychological symptoms of dementia (BPSD). These symptoms contribute to functional impairment and caregiver burden. Objective: To characterize BPSD in Alzheimer’s disease (AD), vascular dementia (VaD), mixed (Mixed) dementia, Parkinson’s disease dementia (PDD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and unspecified dementia in individuals residing in long-term care facilities. Methods: We included 10,405 individuals with dementia living in long-term care facilities from the Swedish registry for cognitive/dementia disorders (SveDem) and the Swedish BPSD registry. BPSD was assessed with the Neuropsychiatric Inventory - Nursing Home Version (NPI-NH). Multivariate logistic regression models were used to evaluate the associations between dementia diagnoses and different BPSDs. Results: The most common symptoms were aberrant motor behavior, agitation, and irritability. Compared to AD, we found a lower risk of delusions (in FTD, unspecified dementia), hallucinations (FTD), agitation (VaD, PDD, unspecified dementia), elation/euphoria (DLB), anxiety (Mixed, VaD, unspecified dementia), disinhibition (in PDD), irritability (in DLB, FTD, unspecified dementia), aberrant motor behavior (Mixed, VaD, unspecified dementia), and sleep and night-time behavior changes (unspecified dementia). Higher risk of delusions (DLB), hallucinations (DLB, PDD), apathy (VaD, FTD), disinhibition (FTD), and appetite and eating abnormalities (FTD) were also found in comparison to AD. Conclusion: Although individuals in our sample were diagnosed with different dementia disorders, they all exhibited aberrant motor behavior, agitation, and irritability. This suggests common underlying psychosocial or biological mechanisms. We recommend prioritizing these symptoms while planning interventions in long-term care facilities.
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Affiliation(s)
- Emilia Schwertner
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Department of Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Joana B. Pereira
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Department of Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Hong Xu
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Department of Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Juraj Secnik
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Department of Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Bengt Winblad
- Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Maria Eriksdotter
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Department of Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
| | - Dorota Religa
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Department of Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
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9
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Morrow CB, Leoutsakos JMS, Onyike CU. Functional Disabilities and Psychiatric Symptoms in Primary Progressive Aphasia. Am J Geriatr Psychiatry 2022; 30:372-382. [PMID: 34412935 PMCID: PMC9103777 DOI: 10.1016/j.jagp.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study are to describe the chronology of functional disabilities in primary progressive aphasia (PPA), and to examine associations between psychiatric comorbidities and functional disabilities. METHODS We conducted a retrospective data analysis using subjects enrolled at Alzheimer's Disease Research Centers between 2005 and 2019. Data were obtained from the National Alzheimer's Coordinating Center database. We included subjects whose primary diagnosis was PPA. Functional status was coded as a binary variable for the following functions: ambulation, transaction skills, verbal communication, meal preparation, and self-care. Behavioral data derived from the Neuropsychiatric Inventory Questionnaire. Descriptive statistics and cox proportional hazard analyses were used to characterize the emergence of disabilities and their association with psychiatric comorbidities. RESULTS Data included 91 subjects with a clinical dementia rating scale of zero at baseline. At the initial visit, no individuals had impairments in self-care, while 7% had impairments in transactions, 3% in ambulation, and 2% in meal preparation. Ninety-three percent had language impairments at the onset of the study, and all by visit 4. By visit 5, 41% of patients had impairments in ambulation and in self-care, 49% were impaired in meal preparation and 70% had impairment in transactions. The presence of anxiety, depression, sleep disturbance and psychosis were all significantly associated with an increased risk for multiple functional disabilities. CONCLUSION These findings provide clinicians with guidance for forecasting disabilities and targeting interventions in PPA.
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Affiliation(s)
- Christopher B. Morrow
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns University Hopkins School of Medicine, Baltimore, MD
| | - Jeannie-Marie Sheppard Leoutsakos
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns University Hopkins School of Medicine, Baltimore, MD; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Chiadi U. Onyike
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns University Hopkins School of Medicine, Baltimore, MD
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10
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Giebel C, Robertson S, Beaulen A, Zwakhalen S, Allen D, Verbeek H. "Nobody Seems to Know Where to Even Turn To": Barriers in Accessing and Utilising Dementia Care Services in England and The Netherlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212233. [PMID: 34831989 PMCID: PMC8622725 DOI: 10.3390/ijerph182212233] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Accessing post-diagnostic care can be difficult for people with dementia and their informal carers. Little is known, however, about the determinants of barriers to access, and how these might vary between countries. The aim of this study was to explore potential inequalities in access to formal dementia care services between England and the Netherlands, specifically from more disadvantaged areas. METHODS This was a mixed-methods study, involving semi-structured qualitative interviews and a carer questionnaire. People with dementia and informal carers were recruited by clinicians. The postal survey was co-produced with people with dementia, informal carers, and health care professionals. The survey asked carers about their own and their relatives with dementia's, social support service usage and financing; as well as how they were made aware of services and whether they required more support. Qualitative transcripts were analysed by two researchers in each country using thematic analysis. RESULTS A total of 103 carer questionnaires were received by post and 13 interviews were conducted with people with dementia and family carers between January 2020 and April 2020. Many services were accessed via self-funding. Thematic analysis generated five core themes: Health literacy; Having faith and lack of faith; Service suitability; Structural issues surrounding service provision; and Financing care. One major difference between both country's systems of care were the case manager and network support which people with dementia and carers benefitted from in the Netherlands, which was rarely the case in the UK. CONCLUSIONS People with dementia and informal carers need to be supported better in accessing formal dementia care services in both the UK and the Netherlands, whilst some learning can be taken to improve access.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool L69 3GL, UK
- NIHR ARC NWC, Liverpool L69 3GL, UK;
- Correspondence:
| | | | - Audrey Beaulen
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands; (A.B.); (S.Z.); (H.V.)
| | - Sandra Zwakhalen
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands; (A.B.); (S.Z.); (H.V.)
| | | | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands; (A.B.); (S.Z.); (H.V.)
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11
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Moeller S, Sridhar J, Martersteck A, Coventry C, Kuang A, Zhang H, Weintraub S, Mesulam MM, Rogalski E. Functional decline in the aphasic variant of Alzheimer's disease. Alzheimers Dement 2021; 17:1641-1648. [PMID: 33829622 DOI: 10.1002/alz.12331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/29/2021] [Accepted: 02/18/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) is a clinical dementia syndrome associated with frontotemporal lobar degeneration (FTLD) or Alzheimer's disease (AD). Impairment in activities of daily living is essential for dementia diagnosis, yet less is known about the neuropathologic impact on functional decline in PPA, especially over time. METHODS Activities of Daily Living Questionnaire (ADLQ) ratings were compared by suspected underlying pathology between 17 PPAAβ+ and 11 PPAAβ- participants at 6-month intervals for 2 years using a linear mixed-effects model. A general linear model examined associations between functional decline and cortical thickness at baseline. RESULTS Groups did not differ in demographics or aphasia severity at baseline, yet overall and subdomain scores of the ADLQ were significantly worse for PPAAβ+ compared to PPAAβ- (P = .015) at each interval across 18 months. DISCUSSION Functional decline appears more pronounced and disrupts more aspects of life activities for individuals with non-semantic PPA with suspected AD versus non-AD neuropathology.
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Affiliation(s)
- Stacey Moeller
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jaiashre Sridhar
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adam Martersteck
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christina Coventry
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alan Kuang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hui Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - M-Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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12
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Beyond language impairment: Profiles of apathy in primary progressive aphasia. Cortex 2021; 139:73-85. [PMID: 33836304 DOI: 10.1016/j.cortex.2021.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/28/2020] [Accepted: 02/27/2021] [Indexed: 11/22/2022]
Abstract
Primary progressive aphasia (PPA) is characterised by predominant language and communication impairment. However, behavioural changes, such as apathy, are increasingly recognised. Apathy is defined as a reduction in motivation and goal-directed behaviour. Recent theoretical models have suggested that apathy can be delineated into multiple dimensions: executive apathy (i.e., deficits in maintaining goals and organisation), emotional apathy (i.e., emotional blunting and indifference) and initiation apathy (i.e., reduced self-initiation). Whether the nature of apathy differs between clinical variants of PPA, and across early and late disease stages, remains to be established. Here, carers/informants of 20 semantic variant PPA (svPPA), 15 non-fluent variant PPA (nfvPPA), 16 logopenic variant PPA (lvPPA) and 25 healthy older controls completed the Dimensional Apathy Scale to quantify executive, emotional and initiation apathy. Voxel-based morphometry was used to identify associations between dimensions of apathy and regions of grey matter intensity decrease. Our behavioural results showed greater executive and initiation apathy in late svPPA than in late nfvPPA patients, while late svPPA had greater emotional apathy than both late nfvPPA and late lvPPA groups. Executive and initiation apathy were significantly higher than premorbid levels in all PPA subtypes, while elevated emotional apathy was only seen in early and late svPPA. Distinct neural correlates were identified across apathy dimensions. Executive apathy correlated with grey matter intensity of the left dorsolateral prefrontal and inferior parietal cortices; emotional apathy with the left medial prefrontal, insular and cerebellar regions; and initiation apathy with right parietal areas. Our findings are the first to reveal evidence of the dimensional nature of apathy in PPA, with different clinical signatures observed for each subtype. From a clinical standpoint, these results will inform the development of targeted interventions for specific aspects of apathy which emerge in PPA.
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13
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Giebel CM, Knopman D, Mioshi E, Khondoker M. Distinguishing Frontotemporal Dementia From Alzheimer Disease Through Everyday Function Profiles: Trajectories of Change. J Geriatr Psychiatry Neurol 2021; 34:66-75. [PMID: 32054376 PMCID: PMC7423644 DOI: 10.1177/0891988720901791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Different dementia syndromes display different patterns of everyday functioning. This article explored different patterns of functioning at baseline and trajectories of change in behavioral variant frontotemporal dementia (bvFTD) and Alzheimer disease (AD). METHODS Data from the Uniform Data Set of the National Alzheimer's Coordinating Centre were employed. The Functional Assessment Questionnaire assessed functioning at up to 7 follow-up visits. Independent t tests assessed variations in functioning between syndromes at baseline. Linear mixed-effect modeling explored longitudinal functional trajectories between syndromes. RESULTS Data from 3351 patients (306 bvFTD and 3,045AD) were analyzed. At baseline, patients with bvFTD performed all daily activities poorer than AD dementia. Linear mixed models showed a significant effect of syndrome and time on functioning, and evidence of interaction between syndrome and time, with bvFTD showing a steeper decline for using the stove and travel. CONCLUSIONS Findings can help in the effective care planning of everyday functioning for bvFTD and AD dementia.
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Affiliation(s)
- Clarissa M. Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom,NIHR ARC NWC, Liverpool, United Kingdom
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Mizanur Khondoker
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom,Mizanur Khondoker, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.
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14
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Mulkey MA, Munro CL. Calming the Agitated Patient: Providing Strategies to Support Clinicians. MEDSURG NURSING : OFFICIAL JOURNAL OF THE ACADEMY OF MEDICAL-SURGICAL NURSES 2021; 30:9-13. [PMID: 34092999 PMCID: PMC8171292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Agitation is a symptom of many medical and psychiatric disorders that can manifest along a spectrum of severity. Agitation often delays treatment onset, potentially impacting morbidity and mortality, and may require emergency interventions. Management of acute agitation centers around three main goals: early recognition and treatment of the underlying etiology, rapid control of the behavior, and prevention of harm to the patient and personnel. Nurses should increase use of validated techniques, including frequent and sufficient reality orientation, validation therapy, and strategies that improve the individual's quality of life.
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Affiliation(s)
- Malissa A Mulkey
- UNC-REX Hospital, Raleigh, NC; and Post-Doctoral Research Fellow, Indiana University-Purdue University, Indianapolis, IN
| | - Cindy L Munro
- School of Nursing, Miami University, Coral Gables, FL
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15
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Giebel C, Zwakhalen S, Louise Sutcliffe C, Verbeek H. Exploring the abilities of performing complex daily activities in dementia: the effects of supervision on remaining independent. Aging Ment Health 2020; 24:1288-1294. [PMID: 30990082 DOI: 10.1080/13607863.2019.1603283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The aim of this study was to explore the remaining abilities of people with dementia (PwD) in performing daily activities.Method: Informal carers of community-residing PwD were recruited across England via mail out and carer support groups. Carers completed the revised Interview for Deteriorations in Daily Living Activities in Dementia 2 to rate the PwD's initiative and performance of daily activities. Six complex instrumental activities of daily living (IADLs) were selected: shopping, preparing a hot drink, using the telephone, preparing a cold meal, house work, and engaging in social activities, all of which were broken down into three sub-tasks. Data were analysed using Chi-square tests and linear regression analysis, assessing the contributions of hours of IADL care, hours of supervision, and dementia stage for each activity.Results: 581 carers of people with mild, moderate, and severe dementia completed the questionnaire. The ability to perform individual activities deteriorated from mild to moderate to severe dementia, with PwD remaining the most able to perform subtasks of preparing a hot drink and a cold meal. Subtask performance varied across activities, with some better maintained than others across severity stages. Linear regression models showed that hours of supervising PwD explained a greater proportion of the variance of each IADL than IADL care hours.Conclusion: PwD should be supervised to continue engaging in activities, thereby avoiding performing everything for the PwD. Findings can have implications for PwD living in nursing homes, and future research should explore the remaining IADL abilities of nursing home residents.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland.,NIHR CLAHRC NWC, Liverpool, United Kingdom of Great Britain and, Northern Ireland
| | - Sandra Zwakhalen
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Caroline Louise Sutcliffe
- Personal Social Services Research Unit, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Hilde Verbeek
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
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16
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Abstract
Dementia is characterized by a decline in memory, language, problem-solving and in other cognitive domains that affect a person's ability to perform everyday activities and social functioning. It is consistently agreed that cognitive impairment is an important risk factor for developing functional disabilities in patients with dementia. Functional status can be conceptualized as the ability to perform self-care, self- maintenance and physical activity. A person with dementia usually requires help with more complex tasks, such as managing bills and finances, or simply maintaining a household. Good functional performance is fundamental for elderly people to maintain independency and avoid institutionalization. The purpose of this review is to describe functional changes in demented patients, evaluating the variability in subgroups of dementias.
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Affiliation(s)
- Gabriele Cipriani
- MD,Versilia Hospital, Neurology Unit, Lido di Camaiore (Lu), Italy.,MD, Versilia Hospital, Psychiatry Unit, Lido di Camaiore (Lu), Italy
| | - Sabrina Danti
- PhD, Clinical and Health Psychology Unit, Hospital of Pontedera, Pontedera (PI), Italy
| | - Lucia Picchi
- PsyD, Clinical Psychology Unit, Hospital of Leghorn, Leghorn (LI), Italy
| | - Angelo Nuti
- MD,Versilia Hospital, Neurology Unit, Lido di Camaiore (Lu), Italy
| | - Mario Di Fiorino
- MD, Versilia Hospital, Psychiatry Unit, Lido di Camaiore (Lu), Italy
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17
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Mulkey MA, Everhart DE, Hardin SR. Fronto-temporal dementia: a case study and strategies and support for caregivers. Br J Community Nurs 2019; 24:544-549. [PMID: 31674230 DOI: 10.12968/bjcn.2019.24.11.544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fronto-temporal dementia, also known as fronto-temporal lobular degeneration, is the second most common form of early-onset dementia with a prevalence equal to Alzheimer's dementia. Behavioural variant fronto-temporal dementia primarily involves the frontal and temporal lobes of the brain. Myelination of nerve fibres in these areas allow for highly synchronized action potential timing. Diagnosis is often significantly delayed because symptoms are insidious and appear as personality and behavioural changes such as lack of inhibition, apathy, depression, and being socially inappropriate rather than exhibiting marked memory reductions. In this article, a case study illustrates care strategies and family education. Management of severe behavioural symptoms requires careful evaluation and monitoring. Support is especially important and beneficial in the early to middle stages of dementia when nursing home placement may not be required based on the individual's condition.
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Affiliation(s)
- Malissa A Mulkey
- Neuroscience Clinical Nurse Specialist, Center for Advanced Practice, Duke University Hospital, Durham, North Carolina, USA
| | - D Erik Everhart
- Interim Director and Professor, Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Sonya R Hardin
- Dean and Professor, School of Nursing, University of Louisville, Louisville, Kentucky, USA
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Abstract
Dementia is defined as loss of intellectual functions, including thinking, remembering, and reasoning. Cognitive deficits are severe enough to interfere with an individual's daily functioning. Frontotemporal dementia (FTD) is a result of degeneration of the frontal and/or temporal lobes of the brain. FTD is a leading cause of early-onset dementia in approximately 10% of dementia cases. FTD presents in the fourth and fifth decades as progressive changes in personality, affect, and behavior. The etiology of FTD is unknown; treatment focuses on behavioral and symptom management. Early recognition of FTD and knowledge of interventional strategies are needed to support families and caregivers.
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Affiliation(s)
- Malissa Mulkey
- Advanced Clinical Practice, Duke University Hospital, 2301 Erwin RD, DUMC 3677, Durham, NC 27710, USA.
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19
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Abstract
UNLABELLED ABSTRACTObjectives:Finance management skills deteriorate early on in dementia, and can influence the ability to maintain control over personal affairs. The aim of this study was to assess the contributions of different types of cognition and motor functioning to finance management. DESIGN Cross-sectional analysis using secondary data. SETTING Community living. PARTICIPANTS Baseline data from the Uniform Data Set from the National Alzheimer's Coordinating Centers were obtained and extracted up until December 2016. MEASUREMENTS Measures on everyday functioning (Functional Assessment Questionnaire) and cognition (memory, executive functioning, and language), the Clinical Dementia Rating scale, and questions on Parkinsonian motor symptoms (gait disturbance, falls, tremors, and slowness) were included. Data were analyzed using bivariate correlation and linear regression analyses. RESULTS A total of 9,383 participants were included in the analysis (Alzheimers disease (AD) = 8,201; behavioral variant fronto-temporal dementia (bvFTD) = 796; Dementia with Lewy Bodies (DLB) = 386). Cognition and motor functioning varied significantly across AD, bvFTD, and DLB, with poorer motor functioning and poorer finance management skills in DLB than in AD and bvFTD. In the regression models, slowness, verbal fluency, executive functioning, and language, followed by age, gender, and diagnosis accounted for 13.8% of the variation in managing bills, and for 11.4% of the variation in managing taxes. CONCLUSION Maintaining finance management abilities for as long as possible is important for people with dementia, to avoid potential financial exploitation. Findings from this study highlight avenues to pursue to delay deterioration in managing bills and taxes, and help maintain financial control.
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20
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Yassuda MS, Lima da Silva TB, O'Connor CM, Mekala S, Alladi S, Bahia VS, Amaral-Carvalho V, Guimaraes HC, Caramelli P, Balthazar MLF, Damasceno B, Brucki SMD, Nitrini R, Hodges JR, Piguet O, Mioshi E. Apathy and functional disability in behavioral variant frontotemporal dementia. Neurol Clin Pract 2018; 8:120-128. [PMID: 29708208 DOI: 10.1212/cpj.0000000000000429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 01/29/2018] [Indexed: 12/13/2022]
Abstract
Background Behavioral variant frontotemporal dementia (bvFTD) has profound consequences on patients and their families. In this multicenter study, we investigated the contribution of cognitive and neuropsychiatric factors to everyday function at different levels of overall functional impairment. Methods In a retrospective cross-sectional study, 109 patients with bvFTD from 4 specialist frontotemporal dementia centers (Australia, England, India, and Brazil) were included. The measures administered evaluated everyday function (Disability Assessment for Dementia [DAD]), dementia staging (Clinical Dementia Rating [CDR]), general cognition (Addenbrooke's Cognitive Examination-revised [ACE-R]), and neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]). Patients were then subdivided according to functional impairment on the DAD into mild, moderate, severe, and very severe subgroups. Three separate multiple linear regression analyses were run, where (1) total DAD, (2) basic activities of daily living (BADL), and (3) instrumental activities of daily living (IADL) scores were dependent variables; ACE-R total score and selected NPI domains (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) were used as independent variables. Age, sex, education, and country of origin were controlled for in the analyses. Results Cognitive deficits were similar across the mild, moderate, and severe subgroups but significantly worse in the very severe subgroup. NPI domain scores (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) did not differ across the DAD subgroups. In the multiple regression analyses, a model including ACE-R and NPI apathy explained 32.5% of the variance for total DAD scores. For IADL, 35.6% of the variance was explained by the ACE-R only. No model emerged for BADL scores. Conclusions Cognitive deficits and apathy are key contributors to functional disability in bvFTD but factors underlying impairment in BADLs remain unclear. Treatments targeting reduction of disability need to address apathy and cognitive impairment to ensure greater efficacy, especially in regards to IADLs.
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Affiliation(s)
- Mônica S Yassuda
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Thais B Lima da Silva
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Claire M O'Connor
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Shailaja Mekala
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Suvarna Alladi
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Valeria S Bahia
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Viviane Amaral-Carvalho
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Henrique C Guimaraes
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Paulo Caramelli
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Marcio L F Balthazar
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Benito Damasceno
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Sonia M D Brucki
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Ricardo Nitrini
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - John R Hodges
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Olivier Piguet
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- Neurology Department (MSY, TBLdS, VSB, SMDB, RN), University of São Paulo, Brazil; Ageing, Work & Health Research Unit (CMO), Faculty of Health Sciences, University of Sydney, Australia; Nizam's Institute of Medical Sciences (SM, SA), Hyderabad, India; Cognitive and Behavioral Neurology Research Group (VA-C, HCG, PC), Faculdade de Medicina and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte; Department of Neurology (MLFB, BD), University of Campinas, São Paulo, Brazil; ARC Centre of Excellence in Cognition and its Disorders (JRH, OP, EM), University of New South Wales; Neuroscience Research Australia (JRH, OP), Randwick; and School of Health Sciences (EM), University of East Anglia, Norwich, UK
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Social and cognitive control skills in long-life occupation activities modulate the brain reserve in the behavioural variant of frontotemporal dementia. Cortex 2018; 99:311-318. [DOI: 10.1016/j.cortex.2017.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/18/2017] [Accepted: 12/07/2017] [Indexed: 12/21/2022]
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Giebel CM, Sutcliffe C. Initiating activities of daily living contributes to well-being in people with dementia and their carers. Int J Geriatr Psychiatry 2018; 33:e94-e102. [PMID: 28467006 DOI: 10.1002/gps.4728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Problems with everyday functioning are linked to reduced well-being in people with dementia (PwD) and their carers. However, previous research has almost solely investigated the performance of everyday activities, and global functioning without analysing individual activities. This study explored how deficits in initiating and performing individual activities were associated with carer burden and poorer quality of life of carers and PwD. METHODS Carers of people with mild dementia were recruited via 10 National Health Service Trusts, as well as through attending six carer support groups. Carers were asked to complete the revised Interview for Deteriorations in Daily Living Activities in Dementia 2 (R-IDDD2), and measures on carer burden, well-being, and person with dementia well-being. Data were analysed using correlation analysis. RESULTS Two hundred and seventy-two carers completed the R-IDDD2. Carers were grouped into those with low or high ratings of well-being based on the mean scores. All but three activities on the initiative and/or performance scale were significantly associated with carer burden and carer and PwD quality of life. Engaging in hobbies and maintaining an active social life were most strongly associated with carer and PwD well-being. Initiating computer use, driving, and medication management were not related to carer burden. CONCLUSIONS Findings from this study can have direct implications for improving care management early in the disease. Post-diagnostic support needs to provide more opportunities for PwD, and their carers, to engage in social groups, whilst interventions targeted at living well with dementia need to particularly improve the initiative of engaging in individual hobbies. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Clarissa M Giebel
- School of Health Sciences, University of East Anglia, Norwich, UK.,Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Caroline Sutcliffe
- Personal Social Services Research Unit, The University of Manchester, Manchester, UK
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