Race and Personal Exposure to AD Influence Projected Memory Failure Attributions and Help-Seeking Behaviors

OBJECTIVES

Examine race and personal exposure to Alzheimer's Disease (AD) on projected memory failure attributions and medical help-seeking thresholds of pre-morbid adults. The goal is to better understand race discrepancies in help-seeking for those potentially at risk for early-onset AD.

METHODS

498 adults aged 40 to 65 (M = 52.27), screened for current memory failure, completed an online questionnaire exploring their help-seeking intentions and threshold, attributions of hypothetical memory failures, and level of AD concern.

RESULTS

Non-Hispanic Whites (n = 248) were significantly more concerned about AD than African Americans (n = 250) (p =.027). Personal exposure to AD moderated the impact of race on memory failure attributions (p =.036), so that personal exposure was more influential for African Americans. Those who were more likely to attribute hypothetical memory failures to AD had lower projected thresholds for seeking a medical evaluation (p =.010). Memory failure attribution emerged as a potential mediator of the impact of race on projected help-seeking behaviors (p =.057).

CONCLUSIONS

African Americans were more influenced by personal experience when considering the causes of hypothetical memory failures.

CLINICAL IMPLICATIONS

Healthcare providers should emphasize to African American families the value of early AD detection and treatment in terms of quality of life for both patient and caregiver.

Does Elevated Alcohol Consumption Delay the Diagnostic Assessment of Cognitive Impairment among Older Adults?

Introduction

The time from symptom debut to assessment of cognitive impairment (TSA) is usually substantial, and many factors can influence the length of this interval. Our objective was to discern whether elevated alcohol consumption is associated with TSA.

Methods

Alcohol consumption was measured among 3,236 older Norwegians assessed for cognitive impairment. Elevated consumption was defined as drinking 4–7 times a week. TSA was defined as the number of months between symptom debut and assessment. The association between alcohol consumption and TSA was examined with a multiple regression analysis controlled for sociodemographic and clinical covariates.

Results

Mean (SD) and median TSA were 34.8 (35.8) and 24.0 months, respectively. Elevated alcohol consumption was not associated with TSA. Longer TSA was associated with being male, having a high education level, being retired or unemployed, being single, having low scores on the Mini-Mental State Examination (MMSE) or Personal Activities of Daily Living (PADL), having high subsyndrome scores of depression or agitation on The Neuropsychiatric Inventory − Questionnaire (NPI-Q), or having a spouse/cohabitant as the designated next of kin.

Conclusion

This study indicates that elevated alcohol consumption does not influence TSA. Possible explanations are discussed, but further research is needed to determine the effect of alcohol definitively. We did identify other novel characteristics associated with TSA which may be important in minimizing the risk of delayed cognitive assessments and should be kept in mind when considering assessment.

Conceptualization, measurement and correlates of dementia worry: A scoping review

PURPOSE

The combination of a growing population of older adults and increasing prevalence and awareness of dementia diagnoses suggests that dementia worry may also intensify. As a relatively new area of investigation, the dementia worry literature is growing, but variability in definitions and measurement continue. A scoping review was conducted to gather and examine existing research, as well as assist in guiding future studies in this area. The review focused on characterizing the conceptualization, measurement, and correlates of dementia worry.

METHODS

Using PubMed, CINAHL, AgeLine, and PsycINFO, a search of literature concerning dementia worry was completed.

RESULTS

A total of 45 articles examining dementia worry fulfilled the inclusion criteria. Most studies were cross-sectional (n = 39), quantitative (n = 38), and conducted in the United States (n = 22). Inconsistencies in the conceptualization, measurement, and correlates examined make it difficult to determine the meaning and true levels of dementia worry.

CONCLUSIONS

Recent attention to dementia worry has increased awareness of the basic concept and its correlates. However, the lack of unity in the definition and measurement of dementia worry impedes advancement in this research area, as well as in establishing its clinical significance.

BrainWorks: A Comparative Effectiveness Trial to Examine Alzheimer's Disease Education for Community-Dwelling African Americans

OBJECTIVES

To test a culturally tailored intervention to improve Alzheimer's disease (AD) literacy among African Americans.

DESIGN

A 3-arm randomized comparative effectiveness trial.

SETTING

Community sites in Los Angeles, CA.

PARTICIPANTS

193 African American community-dwelling adults, ages 45 to 95 years old.

INTERVENTION

All groups attended BrainWorks Live, a culturally tailored, 60-minute talk show and received standard printed educational materials on AD. From there: a) the BrainWorks Live group received no further contact until the post-test; b) one intervention group received a 1-month, culturally tailored, unidirectional, daily text-message program; and c) a second intervention group received daily text messages based on the printed educational materials that the general public would receive. AD literacy was measured at baseline and one month post intervention.

MEASUREMENTS

Alzheimer's disease literacy and demographic and health covariates.

RESULTS

At one month, participants who received culturally tailored text messages had the highest increase in AD literacy levels, followed by those in the BrainWorks Live arm. Participants who received general text messages had a lower overall increase in AD literacy levels compared to the other arms, but had higher mean AD literacy levels than the BrainWorks Live arm. There was a significantly greater increase in AD literacy levels among participants who received culturally tailored text messages compared with those who attended BrainWorks Live only. There were no other statistically significant differences between arms.

CONCLUSIONS

AD literacy among African Americans can be improved after only one month through culturally competent, economically feasible educational formats.

Development of a Multidimensional Measure to Examine Fear of Dementia

Persons with and without a family history of dementia report concerns for developing this syndrome; yet, less is known about the specific aspects of dementia that are feared. The Fear of Dementia (FOD) scale was created to assess these concerns. This study examined the psychometric properties of the FOD scale using a sample of middle-aged and older adults ( N = 734). We then explored the factor structure of the scale 2 years later using a smaller sample from the first study ( N = 226). Three factors emerged, highlighting several main areas of concern: Burden and Loss, Quality of Life, and Perceived Social and Cognitive Loss. Preliminary data suggest that the FOD scale is a reliable and valid instrument for assessing the multidimensional nature of the concern about developing dementia. Attention to what specifically is feared may help further our understanding of health behaviors, coping, and targeted supports.

Do Worries About Cognitive Functioning and Concerns About Developing Alzheimer’s Disease Affect Psychological Well-Being?

Objective: The objective of this study is to determine if cognitive worries affect psychological well-being, if these effects are long-term, and if such concerns affect well-being more so among persons with a parent having Alzheimer’s disease (AD). Method: We used structural equation models with three waves of data collected from persons ages 40 to 60 at T1. We created summative scores on five indicators of concerns about cognitive functioning and worries about dementia. Well-being measures included depression, life satisfaction, stress, and mastery. Results: We found (a) cognitive worries at Waves 1, 2, and 3 were generally associated with lower levels of psychological well-being at each of these waves; (b) there was no evidence of long-term, lagged effects, and (c) these relationships were statistically similar across groups of adult children and controls. Discussion: Because concerns about cognitive functioning and developing AD are pervasive among middle-aged and older persons, practitioners should be aware of their potentially deleterious effect on psychological well-being.

Subjective Memory Complaints: Symptoms and Outcome in Different Research Settings

Subjective memory complaints (SMC) are important and may, in certain individuals, herald the onset of neurodegenerative diseases such Alzheimer's disease. However, they are very common and in some individuals will result from mood disorders/personality factors or systemic illnesses. Research has been hampered by the wide variety of criteria and neuropsychological tests used to define this disorder. Different terminology has also hindered the ability to generate generalizable results. We evaluate how subjects with SMC are defined within different research settings (community, primary care, and memory clinic), their rates of progression to mild cognitive impairment and dementia, and how individuals within these contexts differ in terms of complaints, personal characteristics, and help-seeking behavior.

Experience of Dementia-related Anxiety in Middle-aged Female Caregivers for Family Members with Dementia: A Phenomenological Study

PURPOSE

In Korea, most elderly with dementia receive care from family members, yet little research is available on the experience of dementia-related anxiety in middle-aged female caregivers for a family member with dementia. The purpose of this study was to describe the lived experience of dementia-related anxiety in middle-aged female caregivers for family members with dementia.

METHODS

A descriptive phenomenological study was conducted. A purposive sampling strategy was used to recruit participants. Twelve middle-aged women (40-59 years, mean age = 51.90 years) who were family caregivers were interviewed from February 2014 to August 2014. Data were collected through semistructured interviews and analyzed using Giorgi's method.

RESULTS

The essential structure of the phenomenon was a fear of losing self-identity. The main essence was represented by six components: keenly feeling the effects of aging because of memory deficit, continuous comparison of the family member's behavior with that of the participant's, Finding it painful to see a family member with dementia as he/she does not know how this will end, not knowing the conclusion of the disease process, reducing the risk of dementia, and trying to change one's lifestyle from what it used to be in the past.

CONCLUSIONS

The study provides the essential structure of the experience on dementia-related anxiety that caregivers of a family member with dementia have. The findings could help healthcare providers and researchers have better understanding of dementia-related anxiety and give more attention to the caregivers to relieve their anxiety.

Help-seeking for dementia: a systematic review of the literature

BACKGROUND

Help-seeking (HS) for dementia presents a great challenge, especially because a timely and appropriate HS process might be associated with better outcomes for the person with dementia, their caregivers, and society. A clear understanding of the HS concept and its measurement in the area of dementia might improve the effectiveness of the process.

AIMS

The aims of our systematic review were: (1) to systematically obtain and evaluate the relevant literature on HS and dementia; and (2) to summarize current research findings and draw conclusions for future research and clinical care in this area.

METHOD

A systematic review of the literature on HS and dementia was conducted up till June 2013.

RESULTS

From the 478 retrieved articles, 48 were included in the review. Conceptually, the studies examined professional and nonprofessional sources of help; showed preference for seeking help from close relatives followed by primary health caregivers; and identified inadequate knowledge and stigmatic beliefs as the main barriers to HS. The majority of the studies did not rely on a theoretical framework.

CONCLUSIONS

Although the body of literature in the area of HS and dementia is growing, several conceptual and methodological limitations still have to be resolved to advance knowledge in the area.

From forgetfulness to dementia: clinical and commissioning implications of diagnostic experiences

BACKGROUND

The National Dementia Strategy in England stressed the importance of earlier diagnosis of dementia. In-depth knowledge of the experiences of patients using such services remains an evidence gap.

AIM

To increase understanding of the experiences of people developing dementia and of their carers, to inform practice and decision making.

DESIGN AND SETTING

A retrospective and prospective qualitative interview study of participants recruited from four memory clinics in London, the north-west and the north-east of England.

METHOD

Purposive sampling was used to recruit 27 individuals with memory problems and 26 supporters and carers. Interviews explored referral pathways, assessment processes, disclosure of the diagnosis, experiences of being prescribed medication to help with symptoms, and issues of risk and decision making.

RESULTS

Few participants experienced the process of memory assessment as patient centred. Where assessment processes were lengthy and drawn out, participants experienced considerable uncertainty. Many experienced tests and assessments as distressing, sometimes in settings that were perceived as alarming or potentially stigmatising by association. Information provision and communication were variable and practitioners were not always thought to help people to make sense of their experiences.

CONCLUSION

The transition from the early stages of cognitive impairment is not straightforward. There is potentially much uncertainty and waiting. Primary care practitioners may be better able to provide tailored support to individuals and their carers during this time if they are aware of what patients are anticipating and are informed about the diagnostic 'journey' by the insights of those who have experienced it.

The Fear of Alzheimer's Disease Scale: a new measure designed to assess anticipatory dementia in older adults

BACKGROUND

As the prevalence of Alzheimer's disease (AD) is rapidly increasing, apprehension about developing the degenerative disease (anticipatory dementia or fear of developing AD) has become a topic of interest. However, most studies of anticipatory dementia have utilized brief, nonvalidated measures to explore older adults' apprehension. As such, there is a significant need for a psychometrically sound instrument to measure this fear.

METHODS

The current study utilized 101 older adults ages 65 to 91 to develop and validate an important new scale, the Fear of Alzheimer's Disease Scale (FADS). Construct validity of the FADS was assessed with the State-Trait Anxiety Inventory-Form Y (STAI-Y).

RESULTS

Analyses revealed a three-factor model for the FADS (i.e., General Fear, Physical Symptoms, and Catastrophic Attitude) and an α of 0.94 for the entire measure, indicating good internal consistency. The FADS demonstrated good construct validity, as it was significantly correlated with both the state and trait subscales of the STAI-Y, with the trait subscale yielding the highest correlation.

CONCLUSION

The FADS is a reliable and valid instrument and is the first of its kind available to directly address anticipatory dementia among a general population of older adults.

Why don't older adults with subjective memory complaints seek help?

BACKGROUND

Subjective memory complaints (SMCs) are common among older adults, often causing significant distress and showing strong relationships to future cognitive decline. However, low rates of help-seeking for memory complaints are well documented. Little is known about the reasons behind the decision to seek or not to seek help with memory problems. The common-sense model of illness perception proposes that the beliefs people hold about their health underlie help-seeking behaviour. The present study investigated factors underlying the decision to seek help in people with SMCs within the framework of the common-sense model of illness perception.

METHODS

Cognition, illness perceptions, coping styles, depression and anxiety were assessed in 98 adults with SMCs, aged 50 years and above, including 60 attending a memory clinic and 38 non-help-seekers.

RESULTS

Objective cognitive performance did not differ between participants who had sought help and those who had not. Logistic regression revealed that illness perceptions including social comparison and causal attributions predict help-seeking behaviour. More general coping style did not predict help-seeking. Furthermore, participants who had sought help were more likely to have had a close relative with dementia.

CONCLUSIONS

The results suggest that beliefs about memory, rather than objective cognitive impairment, are associated with the decision to seek help for SMCs. The findings suggest that providing education regarding memory problems, in particular challenging causal attributions, may help to encourage help-seeking in people with SMCs and improve care in the early stages of dementia.

When cognitive evaluation does not disclose a neurologic disorder: experience of a university behavioral neurology clinic

OBJECTIVE

We examined clinical features, referral patterns, and diagnostic outcome of patients receiving cognitive evaluation in a behavioral neurology clinic who had no neurologic disorder.

BACKGROUND

Cognitive complaints may indicate Alzheimer Disease (AD) or many other conditions. Accurate early evaluation of these complaints is critical, and appropriate subspecialty clinic referral has public health policy implications.

METHOD

This retrospective medical records review included 342 consecutive patients seen at the Neurobehavior Clinic of the University of Colorado Hospital from July 2006 through June 2008. All patients received an initial diagnosis by a clinic attending and subsequent consensus diagnosis by 3 subspecialists board certified in Behavioral Neurology & Neuropsychiatry.

RESULTS

Among the 342 patients, 68% had a neurologic disorder, the most common of which was probable AD (17%). The remainder had nonneurologic diagnoses: 20% had a psychiatric diagnosis, 7% had no neuropsychiatric disorder, and 5% had a medical diagnosis. Of those with nonneurologic diagnoses, 65% were referred by primary care providers, and the most common symptom was memory loss (72%). In the psychiatric subgroup, depression was the most frequent diagnosis (56%). All normal individuals had concern about cognitive decline. In the medical subgroup, medication effect was the most frequent diagnosis (50%).

CONCLUSIONS

Probable AD was the most common neurologic diagnosis, but 32% of the referred patients had no neurologic disorder, and most of these individuals had a psychiatric cause for cognitive complaints. These results highlight the need for policies promoting more effective use of subspecialty clinics dedicated to neurologic disorders of cognition.

Translating dementia research into practice

There is a gap between the knowledge obtained in dementia research and the practical use of it. This review examines the concept of knowledge translation (KT) and the process of translating research into practice in the field of dementia. KT in dementia practice involves key players including researchers, educators, clinicians, policy-makers, the general public and consumers who act within a multidimensional network, disseminating findings widely to effect changes in community awareness, clinical practice and health policy. Challenges include the volume of dementia research; difficulties in determining who is responsible for KT; the problems of premature KT; the lack of resources to perform KT; the paucity of research about effective KT strategies; and the characteristics of the dementia care workforce. Key features of effective KT include a simple compelling message; use of interpersonal contact and roles; a practical framework with an emphasis on "know-how"; and the provision of resources and support. More effective dementia KT will require a commitment by key players to engage in the process, a better understanding of effective KT strategies, adequate resources, and judicious selection of appropriate evidence-based information.

Perceptions of risk and prevention of dementia in the healthy elderly

OBJECTIVES

(1) To determine the attitudes and perceptions of the elderly with regard to dementia. (2) To correlate these beliefs with demographic variables of age, sex, intelligence scores and social class.

METHOD

A postal questionnaire survey of a sample of 562 subjects of the Manchester University Age and Cognitive Performance longitudinal study group.

RESULTS

The response rate was 95%. Most responders (69%) did not worry about dementia, although they were more likely to think about it if they had a family member with dementia (p < 0.005). There is no link between social class, sex, intelligence scores and age with regard to worries and concerns of dementia. The majority of responders (82%) took action to maintain their health but demonstrated poor awareness of risks or protective factors for dementia.

CONCLUSION

The elderly on the whole were not fearful of dementia or of acquiring it. There was poor awareness of risks or protective factors for dementia.