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Belder CRS, Marshall CR, Jiang J, Mazzeo S, Chokesuwattanaskul A, Rohrer JD, Volkmer A, Hardy CJD, Warren JD. Primary progressive aphasia: six questions in search of an answer. J Neurol 2024; 271:1028-1046. [PMID: 37906327 PMCID: PMC10827918 DOI: 10.1007/s00415-023-12030-4] [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: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023]
Abstract
Here, we review recent progress in the diagnosis and management of primary progressive aphasia-the language-led dementias. We pose six key unanswered questions that challenge current assumptions and highlight the unresolved difficulties that surround these diseases. How many syndromes of primary progressive aphasia are there-and is syndromic diagnosis even useful? Are these truly 'language-led' dementias? How can we diagnose (and track) primary progressive aphasia better? Can brain pathology be predicted in these diseases? What is their core pathophysiology? In addition, how can primary progressive aphasia best be treated? We propose that pathophysiological mechanisms linking proteinopathies to phenotypes may help resolve the clinical complexity of primary progressive aphasia, and may suggest novel diagnostic tools and markers and guide the deployment of effective therapies.
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Affiliation(s)
- Christopher R S Belder
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, UCL Queen Square Institute of Neurology, University College London, London, UK
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Salvatore Mazzeo
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Anna Volkmer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK.
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Gonçalves A, Mendes A, Damásio J, Vila-Chã N, Boleixa D, Leal B, Cavaco S. DRD3 Predicts Cognitive Impairment and Anxiety in Parkinson's Disease: Susceptibility and Protective Effects. JOURNAL OF PARKINSON'S DISEASE 2024; 14:313-324. [PMID: 38363619 PMCID: PMC10977366 DOI: 10.3233/jpd-230292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
Background A possible genetic contribution of dopamine D3 receptor (DRD3) to cognitive impairment in Parkinson's disease (PD) has yet to be investigated. Objective To explore the effects of rs6280 (Ser9Gly) genotype on PD patients' cognitive performance and to clarify possible interactions with psychopathology. Methods Two hundred and fifty-three consecutive PD patients underwent neurological and neuropsychological evaluations, which included: Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn & Yahr scale (H&Y), Dementia Rating Scale-2 (DRS-2), and Hospital Anxiety and Depression Scale (HADS). rs6280 polymorphism was genotyped for all PD patients and for 270 ethnically matched healthy volunteers (HC). Non-parametric group comparisons and logistic regressions were used for data analyses. Results rs6280 genotype did not differ between PD and HC groups. PD patients with rs6280 CC genotype had more impaired cognitive performance (i.e., <1st percentile of demographically adjusted norms) on DRS-2 subscales Initiation/Perseveration and Construction than those with TT genotype. These associations remained statistically significant when other covariates (e.g., demographic features, disease duration, severity of motor symptoms in OFF and ON states, anti-parkinsonian medication, and psychopathology symptoms) were taken into consideration. PD patients with rs6280 TC had less anxiety (i.e., HADS Anxiety≥11) than those with TT (p = 0.012). This association was also independent of other covariates. Conclusions Study findings suggest that rs6280 CC genotype predisposes to executive dysfunction and visuoconstructional deficits, whereas the heterozygous genotype protects from anxiety in PD. These effects do not appear to be dependent of one another. rs6280 is not a genotypic susceptibility factor for PD.
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Affiliation(s)
- Alexandra Gonçalves
- Neuropsychology Service, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alexandre Mendes
- Neurology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- ITR – Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Joana Damásio
- Neurology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Nuno Vila-Chã
- Neurology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- ITR – Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Daniela Boleixa
- Departamento de Patologia e Imunologia Molecular, Immunogenetics Laboratory, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Bárbara Leal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- ITR – Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
- Departamento de Patologia e Imunologia Molecular, Immunogenetics Laboratory, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Sara Cavaco
- Neuropsychology Service, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- ITR – Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
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Hardy CJD, Taylor‐Rubin C, Taylor B, Harding E, Gonzalez AS, Jiang J, Thompson L, Kingma R, Chokesuwattanaskul A, Walker F, Barker S, Brotherhood E, Waddington C, Wood O, Zimmermann N, Kupeli N, Yong KXX, Camic PM, Stott J, Marshall CR, Oxtoby NP, Rohrer JD, Volkmer A, Crutch SJ, Warren JD. Symptom-led staging for semantic and non-fluent/agrammatic variants of primary progressive aphasia. Alzheimers Dement 2024; 20:195-210. [PMID: 37548125 PMCID: PMC10917001 DOI: 10.1002/alz.13415] [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: 03/30/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Here we set out to create a symptom-led staging system for the canonical semantic and non-fluent/agrammatic variants of primary progressive aphasia (PPA), which present unique diagnostic and management challenges not well captured by functional scales developed for Alzheimer's disease and other dementias. METHODS An international PPA caregiver cohort was surveyed on symptom development under six provisional clinical stages and feedback was analyzed using a mixed-methods sequential explanatory design. RESULTS Both PPA syndromes were characterized by initial communication dysfunction and non-verbal behavioral changes, with increasing syndromic convergence and functional dependency at later stages. Milestone symptoms were distilled to create a prototypical progression and severity scale of functional impairment: the PPA Progression Planning Aid ("PPA-Squared"). DISCUSSION This work introduces a symptom-led staging scheme and functional scale for semantic and non-fluent/agrammatic variants of PPA. Our findings have implications for diagnostic and care pathway guidelines, trial design, and personalized prognosis and treatment for PPA. HIGHLIGHTS We introduce new symptom-led perspectives on primary progressive aphasia (PPA). The focus is on non-fluent/agrammatic (nfvPPA) and semantic (svPPA) variants. Foregrounding of early and non-verbal features of PPA and clinical trajectories is featured. We introduce a symptom-led staging scheme for PPA. We propose a prototype for a functional impairment scale, the PPA Progression Planning Aid.
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Affiliation(s)
- Chris J. D. Hardy
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Cathleen Taylor‐Rubin
- Uniting War Memorial HospitalSydneyAustralia
- Faculty of MedicineHealth and Human SciencesMacquarie UniversitySydneyAustralia
| | - Beatrice Taylor
- Centre for Medical Image ComputingDepartment of Computer ScienceUCLLondonUK
| | - Emma Harding
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | | | - Jessica Jiang
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | | | | | - Anthipa Chokesuwattanaskul
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- Division of NeurologyDepartment of Internal MedicineKing Chulalongkorn Memorial HospitalBangkokThailand
- Cognitive Clinical and Computational Neuroscience Research UnitFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | - Suzie Barker
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Emilie Brotherhood
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Claire Waddington
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Olivia Wood
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Nikki Zimmermann
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUCLLondonUK
| | - Keir X. X. Yong
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Paul M. Camic
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Joshua Stott
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- ADAPT LabResearch Department of ClinicalEducational and Health PsychologyUCLLondonUK
| | | | - Neil P. Oxtoby
- Centre for Medical Image ComputingDepartment of Computer ScienceUCLLondonUK
| | - Jonathan D. Rohrer
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Anna Volkmer
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- Psychology and Language Sciences (PALS)UCLLondonUK
| | | | - Jason D. Warren
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
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Hardy CJD, Taylor-Rubin C, Taylor B, Harding E, Gonzalez AS, Jiang J, Thompson L, Kingma R, Chokesuwattanaskul A, Walker F, Barker S, Brotherhood E, Waddington C, Wood O, Zimmermann N, Kupeli N, Yong KXX, Camic PM, Stott J, Marshall CR, Oxtoby NP, Rohrer JD, Volkmer A, Crutch SJ, Warren JD. Symptom-led staging for primary progressive aphasia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.13.23286972. [PMID: 36993460 PMCID: PMC10055437 DOI: 10.1101/2023.03.13.23286972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The primary progressive aphasias (PPA) present complex and diverse challenges of diagnosis, management and prognosis. A clinically-informed, syndromic staging system for PPA would take a substantial step toward meeting these challenges. This study addressed this need using detailed, multi-domain mixed-methods symptom surveys of people with lived experience in a large international PPA cohort. We administered structured online surveys to caregivers of patients with a canonical PPA syndromic variant (nonfluent/agrammatic (nvPPA), semantic (svPPA) or logopenic (lvPPA)). In an 'exploratory' survey, a putative list and ordering of verbal communication and nonverbal functioning (nonverbal thinking, conduct and wellbeing, physical) symptoms was administered to 118 caregiver members of the UK national PPA Support Group. Based on feedback, we expanded the symptom list and created six provisional clinical stages for each PPA subtype. In a 'consolidation' survey, these stages were presented to 110 caregiver members of UK and Australian PPA Support Groups, and refined based on quantitative and qualitative feedback. Symptoms were retained if rated as 'present' by a majority (at least 50%) of respondents representing that PPA syndrome, and assigned to a consolidated stage based on majority consensus; the confidence of assignment was estimated for each symptom as the proportion of respondents in agreement with the final staging for that symptom. Qualitative responses were analysed using framework analysis. For each PPA syndrome, six stages ranging from 1 ('Very mild') to 6 ('Profound') were identified; earliest stages were distinguished by syndromic hallmark symptoms of communication dysfunction, with increasing trans-syndromic convergence and dependency for basic activities of daily living at later stages. Spelling errors, hearing changes and nonverbal behavioural features were reported at early stages in all syndromes. As the illness evolved, swallowing and mobility problems were reported earlier in nfvPPA than other syndromes, while difficulty recognising familiar people and household items characterised svPPA and visuospatial symptoms were more prominent in lvPPA. Overall confidence of symptom staging was higher for svPPA than other syndromes. Across syndromes, functional milestones were identified as key deficits that predict the sequence of major daily life impacts and associated management needs. Qualitatively, we identified five major themes encompassing 15 subthemes capturing respondents' experiences of PPA and suggestions for staging implementation. This work introduces a prototypical, symptom-led staging scheme for canonical PPA syndromes: the PPA Progression Planning Aid (PPA 2 ). Our findings have implications for diagnostic and care pathway guidelines, trial design and personalised prognosis and treatment for people living with these diseases.
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Affiliation(s)
- Chris JD Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Cathleen Taylor-Rubin
- Uniting War Memorial Hospital, Sydney, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Beatrice Taylor
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Aida Suarez Gonzalez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | | | | | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Suzie Barker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Claire Waddington
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Olivia Wood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Nikki Zimmermann
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Keir XX Yong
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Paul M Camic
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Josh Stott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- ADAPTlab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | | | - Neil P. Oxtoby
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Anna Volkmer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- Psychology and Language Sciences (PALS), UCL, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
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Brice S, Reyes S, Jabouley A, Machado C, Rogan C, Gastellier N, Alili N, Guey S, Jouvent E, Hervé D, Tezenas du Montcel S, Chabriat H. Trajectory Pattern of Cognitive Decline in Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy. Neurology 2022; 99:e1019-e1031. [PMID: 35705499 PMCID: PMC9519251 DOI: 10.1212/wnl.0000000000200805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The course and pattern of cognitive decline in ischemic cerebral small vessel disease remain poorly characterized. We analyzed the trajectory pattern of cognitive decline from age 25 to 75 years in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). METHODS We applied latent process mixed models to data obtained from patients with CADASIL who were repeatedly scored during their follow-up using 16 selected clinical scales or cognitive tests. RESULTS The modeled evolutions of these scores obtained from 1,243 observations in 265 patients recruited at the French National Referral Centre (50.1 years on average and 45.3% men) showed wide and heterogeneous variations in amplitude along the age-related progression of the disease. Although the Backward Digit Span remained essentially stable, a linear deterioration of scores obtained using the Symbol Digit Numbers or Number of Errors of Trail Making Test B was detected from 25 to 75 years. By contrast, the largest score changes were observed at midlife using the Digit Cancellation Task. All other tests related to executive functions, memory performances, or global cognitive efficiency showed a rate of change accelerating especially at the advanced stage of the disease. Male gender and the presence of gait disorders or of some disability at baseline were found to predict earlier or large changes of 4 scores (Index of Sensitivity to Cueing, Delayed Total Recall, Initiation/Perseveration, and Barthel Index) in a subgroup of individuals distinct from the rest of the sample. DISCUSSION Cognitive alterations develop heterogeneously during the progression of CADASIL and vary largely according to the stage of the disease. These results suggest that not only the target population and study duration but also the stage of disease progression should be considered in preparing future clinical trials aimed at reducing cognitive decline in any such condition.
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Affiliation(s)
- Sandrine Brice
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France
| | - Sonia Reyes
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France
| | - Aude Jabouley
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France
| | - Carla Machado
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France
| | - Christina Rogan
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France
| | - Nathalie Gastellier
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France
| | - Nassira Alili
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France
| | - Stephanie Guey
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France
| | - Eric Jouvent
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France
| | - Dominique Hervé
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France
| | - Sophie Tezenas du Montcel
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France
| | - Hugues Chabriat
- From the Sorbonne Université (S.B., S.T.d.M.), INSERM, Unité Mixte de Recherche 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique; Sorbonne Université (S.B., S.T.M.), INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix; Département de Neurologie et Centre Neurovasculaire Translationnel (S.R., A.J., C.M., C.R., N.G., N.A., S.G., E.J., D.H., H.C.), Centre de Référence CERVCO, FHU NeuroVasc, Hôpital Lariboisière, AP-HP, Université de Paris; and INSERM (S.G., E.J., D.H., H.C.), Unité Mixte de Recherche 1161, Paris, France.
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DiGasbarro D, Midden A, Van Haitsma K, Meeks S, Mast B. Reliability and Validity of the Adult Hope Scale among Nursing Home Residents with and without Cognitive Impairment. Clin Gerontol 2020; 43:340-349. [PMID: 31453758 PMCID: PMC7133019 DOI: 10.1080/07317115.2019.1656696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: The current study aims to examine the reliability and validity of the Adult Hope Scale among older adults with and without cognitive impairment who were recently admitted to a nursing home.Methods: Sixty-four recently admitted nursing home residents, 32 of whom had cognitive impairment, were administered the Adult Hope Scale and measures of concurrent and divergent validity.Results: In this sample, the Adult Hope Scale demonstrated good to excellent reliability. The Adult Hope Scale also correlated as expected with measures of concurrent and divergent validity, thus supporting the validity of the scale to measure hope in older adults despite level of cognitive functioning.Conclusions: This study shows that the Adult Hope Scale is a reliable and valid measure of hope in this sample of older adults with and without cognitive impairment who were recently admitted to a nursing home. Given the small sample size, additional research on the psychometric properties of the utility of the Adult Hope Scale in older adults with and without cognitive impairment is warranted.Clinical Implications: These preliminary findings allow future researchers and clinicians to consider administration of the Adult Hope Scale to individuals with and without cognitive impairment living in long-term care facilities. Gathering additional data on the psychometrics of this measure will enable new directions in research involving self-report measures for older adults with cognitive impairment, and in the development of interventions involving hope to improve physical and mental health in long-term care residents.
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Affiliation(s)
- Diana DiGasbarro
- Department of Psychological and Brain Sciences, The University of Louisville, Louisville, KY, USA
| | - Allison Midden
- Department of Psychological and Brain Sciences, The University of Louisville, Louisville, KY, USA.,Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Kimberly Van Haitsma
- Program for Person Centered Living Systems of Care, The Pennsylvania State University College of Nursing, University Park, USA
| | - Suzanne Meeks
- Department of Psychological and Brain Sciences, The University of Louisville, Louisville, KY, USA
| | - Benjamin Mast
- Department of Psychological and Brain Sciences, The University of Louisville, Louisville, KY, USA
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Young DKW, Ng PYN, Kwok T, Ho F, Cheng D, Mak V, Lau A. The effects of an expanded cognitive stimulation therapy model on the improvement of cognitive ability of elderly with mild stage Dementia living in a community - a randomized waitlist controlled trial. Aging Ment Health 2019; 23:855-862. [PMID: 29781725 DOI: 10.1080/13607863.2018.1471586] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE This research study aims to evaluate the effectiveness of an expanded cognitive stimulation therapy (CST) model that combines a CST group and tai chi on improving the cognitive ability of community-dwelling Chinese elderly with mild stage dementia (EwMD). METHOD A randomized waitlist controlled trial design was adopted in this study. The treatment group participated in a structured CST group followed by tai chi twice a week, with a total of 14 sessions throughout the study period. The waitlist control group received treatment as usual at the initial stage and expanded CST model at a later stage. The Chinese Mattis Dementia Rating Scale (DRS) and the Chinese Mini Mental State Examination (MMSE) were used to assess the cognitive ability of EwMD in the pre- and post- treatment periods. RESULTS At baseline, the treatment group (n = 51) and control group (n = 50) did not differ significantly in any demographic or clinical variables. Overall, the participants had a mean baseline MMSE score of 20.67 (SD = 2.30). The 2 × 2 repeated measures ANCOVA demonstrated that the treatment group was significantly more effective than the control group in improving the MMSE score (F = 12.31, p< .01) with a moderate effect size (partial eta square = .11) after controlling for group difference in age, gender, education, and having a diagnosis of dementia. CONCLUSION The present study demonstrates the effectiveness of the expanded CST model on the improvement of cognitive ability of community-dwelling EwMD. More research is needed to further investigate this intervention model across cultures and societies.
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Affiliation(s)
| | - Petrus Yat-Nam Ng
- a Department of Social Work , Hong Kong Baptist University , Hong Kong
| | - Timothy Kwok
- b Department of Medicine (Geriatric division) , Chinese University of Hong Kong , Hong Kong
| | - Florence Ho
- c Jockey Club Centre for Positive Ageing , Hong Kong
| | - Daphne Cheng
- a Department of Social Work , Hong Kong Baptist University , Hong Kong
| | - Vivan Mak
- c Jockey Club Centre for Positive Ageing , Hong Kong
| | - Andrew Lau
- c Jockey Club Centre for Positive Ageing , Hong Kong
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8
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Young DKW. Multicomponent intervention combining a cognitive stimulation group and tai chi to reduce cognitive decline among community-dwelling older adults with probable dementia: A multi-center, randomized controlled trial. DEMENTIA 2018; 19:2073-2089. [PMID: 30486656 DOI: 10.1177/1471301218814637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This research study aims to evaluate the effectiveness of a multicomponent intervention that combines a cognitive stimulation group and tai chi to reduce cognitive decline among community-dwelling Chinese older adults with probable dementia. METHODS A multi-center, randomized controlled trial design was adopted in this study. In addition to treat as usual, the treatment group (n = 41) participated in a structured cognitive stimulation group followed by tai chi twice a week, with a total of 14 sessions held during the study period. The control group (n = 39) received treat as usual. Mattis Dementia Rating Scale and Mini-Mental State Examination were used for assessing the cognitive abilities of participants in the pre- and post-treatment periods. RESULTS A 2 × 2 repeated measures analysis of covariance demonstrated that the treatment group was more effective than the control group on improving Dementia Rating Scale score (F = 7.45, p < .01) with a moderate effect size (partial eta square = .09) and Mini-Mental State Examination score (F = 9.96, p < .01) with a moderate to large effect size (partial eta square = .12) after controlling for age, gender, educational level, marital status, and number of physical illnesses. CONCLUSION The present study demonstrates the effectiveness of the multicomponent intervention on improving cognitive ability among community-dwelling older adults with probable dementia, suggesting that the multicomponent intervention can facilitate early identification, assessment, and treatment for community-dwelling older adults with probable dementia.
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Sapkota S, Ramirez J, Stuss DT, Masellis M, Black SE. Clinical dementia severity associated with ventricular size is differentially moderated by cognitive reserve in men and women. ALZHEIMERS RESEARCH & THERAPY 2018; 10:89. [PMID: 30185213 PMCID: PMC6123907 DOI: 10.1186/s13195-018-0419-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/07/2018] [Indexed: 01/08/2023]
Abstract
Background Interindividual differences in cognitive reserve (CR) are associated with complex and dynamic clinical phenotypes observed in cognitive impairment and dementia. We tested whether (1) CR early in life (E-CR; measured by education and IQ), (2) CR later in life (L-CR; measured by occupation), and (3) CR panel (CR-P) with the additive effects of E-CR and L-CR, act as moderating factors between baseline ventricular size and clinical dementia severity at baseline and across 2 years. We further examined whether this moderation is differentially represented by sex. Methods We examined a longitudinal model using patients (N = 723; mean age = 70.8 ± 9.4 years; age range = 38–90 years; females = 374) from the Sunnybrook Dementia Study. The patients represented Alzheimer’s disease (n = 439), mild cognitive impairment (n = 77), vascular cognitive impairment (n = 52), Lewy body disease (n = 30), and frontotemporal dementia (n = 125). Statistical analyses included (1) latent growth modeling to determine how clinical dementia severity changes over 2 years (measured by performance on the Dementia Rating Scale), (2) confirmatory factor analysis to establish a baseline E-CR factor, and (3) path analysis to predict dementia severity. Baseline age (continuous) and Apolipoprotein E status (ɛ4−/ɛ4+) were included as covariates. Results The association between higher baseline ventricular size and dementia severity was moderated by (1) E-CR and L-CR and (2) CR-P. This association was differentially represented in men and women. Specifically, men in only the low CR-P had higher baseline clinical dementia severity with larger baseline ventricular size. However, women in the low CR-P showed the (1) highest baseline dementia severity and (2) fastest 2-year decline with larger baseline ventricular size. Conclusions Clinical dementia severity associated with ventricular size may be (1) selectively moderated by complex and additive CR networks and (2) differentially represented by sex. Trials registration ClinicalTrials.gov, NCT01800214. Registered on 27 February 2013. Electronic supplementary material The online version of this article (10.1186/s13195-018-0419-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shraddha Sapkota
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M6-192, Toronto, ON, M4N 3M5, Canada.
| | - Joel Ramirez
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M6-192, Toronto, ON, M4N 3M5, Canada
| | - Donald T Stuss
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M6-192, Toronto, ON, M4N 3M5, Canada.,Departments of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliot Building, 3-805, Toronto, ON, M5G 2C4, Canada.,Department of Psychology, University of Toronto, 100 St. George Street, 4th Floor, Sidney Smith Hall, Toronto, ON, M5S 3G3, Canada.,Rotman Research Institute of Baycrest Centre, 3560 Bathurst Street, Toronto, ON, M6H 4A6, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M6-192, Toronto, ON, M4N 3M5, Canada.,Department of Medicine (Neurology), University of Toronto, 190 Elizabeth Street, R. Fraser Elliot Building, 3-805, Toronto, ON, M5G 2C4, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M6-192, Toronto, ON, M4N 3M5, Canada.,Department of Medicine (Neurology), University of Toronto, 190 Elizabeth Street, R. Fraser Elliot Building, 3-805, Toronto, ON, M5G 2C4, Canada
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10
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Boycheva E, Contador I, Fernández-Calvo B, Ramos-Campos F, Puertas-Martín V, Villarejo-Galende A, Bermejo-Pareja F. Spanish version of the Mattis Dementia Rating Scale-2 for early detection of Alzheimer's disease and mild cognitive impairment. Int J Geriatr Psychiatry 2018; 33:832-840. [PMID: 28332732 DOI: 10.1002/gps.4707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 02/13/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We aimed to analyse the clinical utility of the Mattis Dementia Rating Scale (MDRS-2) for early detection of Alzheimer's disease (AD) and amnestic mild cognitive impairment (MCI) in a sample of Spanish older adults. METHODS A total of 125 participants (age = 75.12 ± 6.83, years of education =7.08 ± 3.57) were classified in three diagnostic groups: 45 patients with mild AD, 37 with amnestic MCI-single and multiple domain and 43 cognitively healthy controls (HCs). Reliability, criterion validity and diagnostic accuracy of the MDRS-2 (total and subscales) were analysed. The MDRS-2 scores, adjusted by socio-demographic characteristics, were calculated through hierarchical multiple regression analysis. RESULTS The global scale had adequate reliability (α = 0.736) and good criterion validity (r = 0.760, p < .001) with the Mini-Mental State Examination. The optimal cut-off point between AD patients and HCs was 124 (sensitivity [Se] = 97% and specificity [Sp] = 95%), whereas 131 (Se = 89%, Sp = 81%) was the optimal cut-off point between MCI and HCs. An optimal cut-off point of 123 had good Se (0.97), but poor Sp (0.56) to differentiate AD and MCI groups. The Memory and Initiation/Perseveration subscales had the highest discriminative capacity between the groups. CONCLUSIONS The MDRS-2 is a reliable and valid instrument for the assessment of cognitive impairment in Spanish older adults. In particular, optimal capacity emerged for the detection of early AD and MCI. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Elina Boycheva
- Clinical Research Unit of the University Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Science, University of Salamanca, Salamanca, Spain
| | | | - Francisco Ramos-Campos
- Department of Personality, Assessment and Psychological Treatment, University of Salamanca, Salamanca, Spain
| | | | | | - Félix Bermejo-Pareja
- Clinical Research Unit of the University Hospital 12 de Octubre (i+12), Madrid, Spain.,Faculty of Medicine, Complutense University, Madrid, Spain
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11
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Park H, Chey J, Lee J. Vocabulary Knowledge is Not a Predictor of General Cognitive Functioning in Elderly People with Very Low Educational Attainment. Dement Neurocogn Disord 2017; 16:20-25. [PMID: 30906366 PMCID: PMC6427989 DOI: 10.12779/dnd.2017.16.1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Vocabulary knowledge is used as a representative index of general intelligence, and is regarded as a marker for cognitive reserve in elderly people. However, vocabulary knowledge mainly depends on formal education, hence, it may not fully represent cognitive functioning in elderly people with poor educational backgrounds. Herein, we investigated whether vocabulary knowledge is a measure of general cognitive ability among normal elderly people with few years of formal education. METHODS The association between vocabulary knowledge and general cognitive functioning was compared between 35 elderly females with very low educational attainment and 68 elderly females with higher education. RESULTS The vocabulary knowledge was a significant predictor of general cognitive functioning in elderly individuals with more than primary education, even after controlling the effects of age and years of education. However, it was not a significant predictor of general cognitive functioning in elderly individuals with very low educational attainment. CONCLUSIONS Vocabulary assessment was effective in estimating general cognitive functioning in elderly individuals who received ≥6 years of education. Our findings suggested that vocabulary knowledge may not be an effective proxy of premorbid intelligence or cognitive reserve in people who have not completed elementary schooling.
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Affiliation(s)
- Heyeon Park
- Department of Psychology, Seoul National University, Seoul, Korea
- Office of Humanitarian & Public Healthcare Support, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeanyung Chey
- Department of Psychology, Seoul National University, Seoul, Korea
| | - Jiyoun Lee
- Department of Psychology, Seoul National University, Seoul, Korea
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12
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Abstract
Eighty-seven normal older persons were administered the Wisconsin Card Sorting Test (WCST) on two occasions an average of 1.1 years apart. Means for age and education were 68.79 years ( SD = 6.21) and 14.80 years ( SD = 2.42), respectively. Stability coefficients ranged from .12 on the Learning to Learn scale to .66 for the Total Number of Errors scale. The majority of individuals improved on retest with five WCST scores demonstrating significant average retest gains of 5 to 7 standard score points. The standard error of prediction, standard error of difference, and abnormal test-retest discrepancy scores were calculated to assist clinicians in detecting possible meaningful changes in WCST scores on retest.
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13
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Giebel CM, Challis D, Montaldi D. Understanding the cognitive underpinnings of functional impairments in early dementia: a review. Aging Ment Health 2015; 19:859-75. [PMID: 25632849 DOI: 10.1080/13607863.2014.1003282] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Early dementia is marked by cognitive and functional impairments, and although studies indicate an association between these, detailed analyses exploring this relationship are rare. It is crucial to understand how specific cognitive deficits underlie functional deficits to develop successful cognitive interventions. This paper reviews the evidence of impairment in everyday functioning and in working, long-term and prospective memory in early dementia. Findings are evaluated with respect to the relationship between cognitive and functional impairments. METHODS From the literature searches, 17 studies on everyday functioning and 40 studies on memory were obtained. Studies were only included if patients had an official diagnosis and were in the early stages of dementia. RESULTS Complex instrumental activities of daily living were subject to greater impairment than basic activities of daily living. In particular, early dementia patients struggle with finance tasks; a deficit linked to impaired working memory. Regarding cognition, long-term memory is the earliest form of memory to decline as is well recognised. Evidence also indicates deficits in working and prospective memory, with inconsistent evidence about impairments of the former. A major limitation of the literature is a lack of studies assessing individual everyday activities and the associated error patterns that might occur. CONCLUSION This review critically assesses the status of translational research for everyday activities in early dementia, an area with critical implications for cognitive-based rehabilitation. Further research is required into the detailed assessment of individual everyday activity and specific memory deficits, in order to effectively map cognitive functions onto functional performance.
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Affiliation(s)
- Clarissa M Giebel
- a School of Psychological Sciences , The University of Manchester , Manchester , UK
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14
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Meeks S, Van Haitsma K, Mast BT, Arnold S, Streim JE, Sephton S, Smith PJ, Kleban M, Rovine M. Psychological and social resources relate to biomarkers of allostasis in newly admitted nursing home residents. Aging Ment Health 2015; 20:88-99. [PMID: 26237175 PMCID: PMC4628586 DOI: 10.1080/13607863.2015.1072796] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This paper presents preliminary baseline data from a prospective study of nursing home adaptation that attempts to capture the complexity of residents' adaptive resources by examining psychological, social, and biological variables from a longitudinal conceptual framework. Our emphasis was on validating an index of allostasis. METHOD In a sample of 26 long-term care patients, we measured 6 hormone and protein biomarkers to capture the concept of allostasis as an index of physiological resilience, related to other baseline resources, including frailty, hope and optimism, social support, and mental health history, collected via interview with the resident and collaterals. We also examined the performance of self-report measures reflecting psychosocial and well-being constructs, given the prevalence of cognitive impairment in nursing homes. RESULTS Our results supported both the psychometric stability of our self-report measures, and the preliminary validity of our index of allostasis. Each biomarker was associated with at least one other resilience resource, suggesting that our choice of biomarkers was appropriate. As a group, the biomarkers showed good correspondence with the majority of other resource variables, and our standardized summation score was also associated with physical, social, and psychological resilience resources, including those reflecting physical and mental health vulnerability as well as positive resources of social support, optimism, and hope. CONCLUSION Although these results are based on a small sample, the effect sizes were large enough to confer some confidence in the value of pursuing further research relating biomarkers of allostasis to psychological and physical resources and well-being.
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Affiliation(s)
- Suzanne Meeks
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Kimberly Van Haitsma
- College of Nursing, Pennsylvania State University, 201 Health and Human Development East, University Park, PA, USA
| | - Benjamin T. Mast
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Steven Arnold
- Geriatric Psychiatry Section, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Joel E. Streim
- Geriatric Psychiatry Section, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Sephton
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Patrick J. Smith
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Morton Kleban
- Polisher Research Institute, Abramson Center for Jewish Life, North Wales, PA, USA
| | - Michael Rovine
- Department of Human Development and Family Studies, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
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15
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Herrera-Pérez E, Custodio N, Lira D, Montesinos R, Bendezu L. Validity of Addenbrooke's Cognitive Examination to Discriminate between Incipient Dementia and Depression in Elderly Patients of a Private Clinic in Lima, Peru. Dement Geriatr Cogn Dis Extra 2013; 3:333-41. [PMID: 24174928 PMCID: PMC3808224 DOI: 10.1159/000354948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Dementia and depression are different clinical conditions, but share common features, and can be indistinguishable in the initial disease stages. We aimed to establish whether the Peruvian version of the Addenbrooke's Cognitive Examination (ACE-Peru) can distinguish between the cognitive profile in patients with incipient dementia and that in patients with depression. METHODS This was a cross-sectional study to assess the performance on the ACE-Peru of 193 elderly subjects (102 with dementia, 21 with depression, and 70 healthy controls). Depending on the diagnosis, there were two groups of cognitive impairment (CI) - the primary neurodegenerative (PN-CI) subtype and the secondary to depression (SD-CI) subtype - as well as a non-CI group. The area under the curve (AUC) of the receiver-operating characteristic curve was determined to compare the diagnostic performance, using the diagnosis of CI as the gold standard. RESULTS In our sample of elderly subjects aged 59-82 years with at least 7 years of education, the ACE-Peru showed a significantly better performance than the MMSE (AUC = 0.997 vs. AUC = 0.887; p < 0.05) for the discrimination between PN-CI and SD-CI. CONCLUSIONS The ACE-Peru is able to distinguish between the cognitive profile in patients with incipient dementia and that in patients with depression.
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Affiliation(s)
- Eder Herrera-Pérez
- Scientific Research Projects Unit, National Institute of Child Health, Lima, Peru
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Suchy Y, Lee JN, Marchand WR. Aberrant cortico–subcortical functional connectivity among women with poor motor control: Toward uncovering the substrate of hyperkinetic perseveration. Neuropsychologia 2013; 51:2130-41. [DOI: 10.1016/j.neuropsychologia.2013.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/12/2013] [Accepted: 07/04/2013] [Indexed: 11/28/2022]
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Kraybill ML, Thorgusen SR, Suchy Y. The Push-Turn-Taptap Task Outperforms Measures of Executive Functioning in Predicting Declines in Functionality: Evidence-Based Approach to Test Validation. Clin Neuropsychol 2012; 27:238-55. [DOI: 10.1080/13854046.2012.735702] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Yana Suchy
- a Department of Psychology , University of Utah , Salt Lake City , UT , USA
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18
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Komarova NL, Thalhauser CJ. Calculating stage duration statistics in multistage diseases. PLoS One 2011; 6:e28298. [PMID: 22163291 PMCID: PMC3233570 DOI: 10.1371/journal.pone.0028298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 11/04/2011] [Indexed: 11/18/2022] Open
Abstract
Many human diseases are characterized by multiple stages of progression. While the typical sequence of disease progression can be identified, there may be large individual variations among patients. Identifying mean stage durations and their variations is critical for statistical hypothesis testing needed to determine if treatment is having a significant effect on the progression, or if a new therapy is showing a delay of progression through a multistage disease. In this paper we focus on two methods for extracting stage duration statistics from longitudinal datasets: an extension of the linear regression technique, and a counting algorithm. Both are non-iterative, non-parametric and computationally cheap methods, which makes them invaluable tools for studying the epidemiology of diseases, with a goal of identifying different patterns of progression by using bioinformatics methodologies. Here we show that the regression method performs well for calculating the mean stage durations under a wide variety of assumptions, however, its generalization to variance calculations fails under realistic assumptions about the data collection procedure. On the other hand, the counting method yields reliable estimations for both means and variances of stage durations. Applications to Alzheimer disease progression are discussed.
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Affiliation(s)
- Natalia L Komarova
- Department of Mathematics, University of California Irvine, Irvine, California, United States of America.
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Jean L, Simard M, Wiederkehr S, Bergeron MÈ, Turgeon Y, Hudon C, Tremblay I, van Reekum R. Efficacy of a cognitive training programme for mild cognitive impairment: Results of a randomised controlled study. Neuropsychol Rehabil 2010; 20:377-405. [DOI: 10.1080/09602010903343012] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Is ApoE epsilon4 associated with cognitive functioning in African Americans diagnosed with Alzheimer Disease? An exploratory study. South Med J 2009; 102:890-3. [PMID: 19668025 DOI: 10.1097/smj.0b013e3181b21b82] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The effect of the apolipoprotein epsilon4 allele (ApoE epsilon4) on cognitive performance in patients with probable Alzheimer disease (AD) has been studied in primarily Caucasian samples. The aim of this exploratory study was to examine whether the presence of ApoE epsilon4 is associated with cognitive performance in African American AD patients. METHODS A cross-sectional, retrospective design was used to address the study objective. Data were extracted from the records of 65 African American patients who participated in the National Institutes of Health-National Institute on Aging (NIH-NIA) Emory University Alzheimer Disease Center Registry. Inclusion criteria were a clinical diagnosis of probable AD, cognitive testing using the Mattis Dementia Rating Scale and the Consortium to Establish a Registry for Alzheimer Disease (CERAD) neuropsychological battery, and ApoE genotyping. RESULTS Seventy percent of the patients were ApoE epsilon4 positive. Multiple regression analyses indicated that ApoE epsilon4 was significantly associated with poorer design copying (CERAD Constructional Praxis subtest), but other significant relationships were not observed between positive epsilon4 status and cognitive performance. CONCLUSIONS These preliminary findings suggest that the ApoE epsilon4 allele is not strongly associated with a particular pattern of cognitive functioning in African Americans once they are diagnosed with AD. However, these findings require replication in a large prospectively recruited and population-based sample of African American AD patients before firm conclusions can be reached.
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Molly L. Hartman, Anne G. Fisher, Leslie Duran. Assessment of Functional Ability of People with Alzheimer's Disease. Scand J Occup Ther 2009. [DOI: 10.1080/110381299443690] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Eckroth-Bucher M, Siberski J. Preserving cognition through an integrated cognitive stimulation and training program. Am J Alzheimers Dis Other Demen 2009; 24:234-45. [PMID: 19346501 PMCID: PMC10845992 DOI: 10.1177/1533317509332624] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND Cognitive decline leads to disability and increased health care expenditures. METHODS Effectiveness of an intervention to stimulate multiple cognitive domains was determined using a format combining traditional and computer-based activities (Integrated Cognitive Stimulation and Training Program), 45 minutes a day, 2 days a week, for 6 weeks. Nonimpaired, mildly, and moderately-impaired participants > age 65 (n = 32) were randomly allocated into a control or experimental group. Using a repeated measures design participants were tested again postintervention and at 8 weeks follow-up. RESULTS Statistically significant improvement on Dementia Rating Scale scores occurred for mildly and moderately impaired treatment participants (n = 15). Statistical significance was demonstrated on subscales of the WMS-III: Logical Memory I and Logical Memory II. CONCLUSION Blending computer-based with traditional cognitive stimulation activities shows promise in preserving cognitive function in elders. Future studies to explore efficacy in larger, more diverse samples are needed.
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Busch RM, Chapin JS. Review of normative data for common screening measures used to evaluate cognitive functioning in elderly individuals. Clin Neuropsychol 2008; 22:620-50. [PMID: 17853152 DOI: 10.1080/13854040701448793] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
When conducting neuropsychological evaluations of the elderly, it is important to compare patients' test scores to appropriate normative data to maximize diagnostic and descriptive accuracy. Many sets of normative data are now available for screening measures that assess cognitive functioning in the elderly. This article systematically reviewed available norms for 6 widely used screening measures of cognitive functioning in elderly patients. Details regarding the sample characteristics and data collection methods are provided for each set of norms, thereby providing a useful reference for clinicians.
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Affiliation(s)
- Robyn M Busch
- Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Thivierge S, Simard M, Jean L, Grandmaison É. Errorless learning and spaced retrieval techniques to relearn instrumental activities of daily living in mild Alzheimer's disease: A case report study. Neuropsychiatr Dis Treat 2008; 4:987-99. [PMID: 19183790 PMCID: PMC2626924 DOI: 10.2147/ndt.s3684] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Previous studies on cognitive training in Alzheimer's disease (AD) were principally aimed at making patients learn items not related to functional needs. However, AD patients also experience difficulties with instrumental activities of daily living (IADL). The goal of the present multiple baseline case report study was to assess the preliminary efficacy and tolerability of an individualized cognitive training program using the errorless learning (EL) and spaced-retrieval (SR) techniques to relearn forgotten IADLs in mild AD. Following an exhaustive neuropsychological assessment, two participants received two training sessions per week during four weeks. Participant A was trained to use his voice mail and Participant B, to manage the messages from his answering machine. The results showed that the program was well tolerated and improved performance on the trained tasks. These ameliorations were maintained over a 5-week period. The effects of the training did not have any impact on global cognitive functions since the results on these measures remained relatively stable. This case report demonstrated preliminary efficacy of a new cognitive training program using EL and SR techniques tailored to the needs of AD patients. This is an important finding since the loss of these capacities alters autonomy in AD patients.
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Affiliation(s)
- Stéphanie Thivierge
- School of Psychology, Laval University, Quebec City, Quebec, Canada
- Centre de Recherche Université Laval Robert-Giffard, Quebec City, Quebec, Canada
| | - Martine Simard
- School of Psychology, Laval University, Quebec City, Quebec, Canada
- Centre de Recherche Université Laval Robert-Giffard, Quebec City, Quebec, Canada
| | - Léonie Jean
- School of Psychology, Laval University, Quebec City, Quebec, Canada
- Centre de Recherche Université Laval Robert-Giffard, Quebec City, Quebec, Canada
| | - Éric Grandmaison
- Neurosciences and Rehabilitation Units, Moncton Hospital, Moncton, NB, Canada
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Distinct cognitive profiles and rates of decline on the Mattis Dementia Rating Scale in autopsy-confirmed frontotemporal dementia and Alzheimer's disease. J Int Neuropsychol Soc 2008; 14:373-83. [PMID: 18419836 PMCID: PMC2864090 DOI: 10.1017/s135561770808051x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 12/27/2007] [Accepted: 12/28/2007] [Indexed: 11/06/2022]
Abstract
Neuropsychological studies have shown that patients with Frontotemporal dementia (FTD) perform worse than patients with Alzheimer's disease (AD) on tests of conceptualization and verbal fluency, but better on tests of memory and visuospatial functions. However, it is not known if these distinct cognitive profiles are robust enough to be detected using a relatively brief dementia screening instrument such as the Mattis Dementia Rating Scale (MDRS). To address this issue, the MDRS subscale profiles of patients with autopsy-confirmed FTD (n = 17) or AD (n = 34) were compared. Results showed distinct cognitive profiles in which FTD patients performed worse than AD patients on the Initiation/Perseveration and Conceptualization subscales while performing better on the Memory and Construction subscales. The distinct subscale profiles correctly classified 85% of AD patients and 76% of FTD patients. Profiles were maintained in a subset of mildly-to-moderately demented patients (MDRS > or = 105) and correctly classified 89% of these patients. In addition, FTD patients (mean = 30.0 points/year) declined faster than AD patients (mean = 14.8 points/year) on MDRS total and specific subscale scores. These results suggest that the MDRS may be a useful adjunct to other clinical measures for distinguishing FTD from AD and tracking the progression of the disorder.
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Woodard JL, Dorsett ESW, Cooper JG, Hermann BP, Sager MA. Development of a Brief Cognitive Screen for Mild Cognitive Impairment and Neurocognitive Disorder. AGING NEUROPSYCHOLOGY AND COGNITION 2007; 12:299-315. [PMID: 28486831 DOI: 10.1080/138255890968268] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to develop and evaluate a brief cognitive screen for possible Mild Cognitive Impairment (MCI) and other neurocognitive impairment in a sample of general medical patients. Two hundred community-dwelling general medical patients aged 65 or older participated in this study. Age and education corrected scores from the Rey Auditory Verbal Learning Test and Mattis Dementia Rating Scale were used to classify participants into three groups: MCI, neurocognitive disorder, cognitively intact. Groups were then compared on an independent set of measures: the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery, Mini-Mental State Examination, and Clock Drawing Test. The MCI group constituted 9% of the sample, while 10.5% of the sample was classified into the neurocognitive disorder group. The CERAD Verbal Category Fluency and CERAD Word List Memory Test Delayed Recall measures were individually and collectively the most effective in differentiating cognitively intact elders from persons in both the MCI and neurocognitive disorder groups. We conclude that these two brief measures appear to be effective for detecting possible MCI or neurocognitive disorder, thereby facilitating identification of candidates who would benefit from more detailed neuropsychological assessment.
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Affiliation(s)
- John L Woodard
- a Department of Psychology, Rosalind Franklin University of Medicine and Science (formerly Finch University of Health Sciences/The Chicago Medical School)
| | - Elinor S W Dorsett
- a Department of Psychology, Rosalind Franklin University of Medicine and Science (formerly Finch University of Health Sciences/The Chicago Medical School)
| | - James G Cooper
- b Department of Neurology , University of Wisconsin-Madison
| | | | - Mark A Sager
- b Department of Neurology , University of Wisconsin-Madison
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Baird A. Fine Tuning Recommendations for Older Adults with Memory Complaints: Using the Independent Living Scales with the Dementia Rating Scale. Clin Neuropsychol 2006; 20:649-61. [PMID: 16980252 DOI: 10.1080/13854040590967072] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to describe how functional test performance changed as global cognitive functioning dropped, as well as to examine the relationship of demographic variables and depression with functional test results. We found that level of performance on the Independent Living Scales (ILS) correlated highly with Dementia Rating Scale (DRS) scores in 83 older adults presenting for clinical neuropsychological assessment, while correlations with demographic factors and depression were nonsignificant or modest. Based on DRS scores, we divided our sample into four groups: normal cognitive status, borderline cognitive impairment, likely mild dementia, and likely moderate dementia. ILS profiles of the borderline impairment and mild dementia groups were similar and reflected particularly poor performance on subscales tapping financial management and everyday memory. Individuals with likely moderate dementia were markedly impaired on all subscales.
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Affiliation(s)
- Anne Baird
- University of Windsor, Psychology Department, Ontario, Canada.
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Miller JM, Pliskin NH. The clinical utility of the Mattis Dementia Rating Scale in assessing cognitive decline in Alzheimer's disease. Int J Neurosci 2006; 116:613-27. [PMID: 16644521 DOI: 10.1080/00207450600592164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The progression of cognitive decline in Alzheimer's disease (AD) was studied by examining patterns of test performance on successive administrations of the Mattis Dementia Rating Scale (DRS) in a sample of 63 participants who were diagnosed with probable AD. Assessments were performed at intervals ranging approximately from 3 to 38 months apart. Results indicated that the pattern of progression and sequence of neuropsychological decline in AD is influenced by sex and age of disease onset. Results offered support for the clinical staging of AD and further substantiated the clinical utility of the Mattis Dementia Rating Scale in staging degree of dementia.
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Affiliation(s)
- Julie M Miller
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois 60610, USA.
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Rilling LM, Lucas JA, Ivnik RJ, Smith GE, Willis FB, Ferman TJ, Petersen RC, Graff-Radford NR. Mayo's Older African American Normative Studies: norms for the Mattis Dementia Rating Scale. Clin Neuropsychol 2005; 19:229-42. [PMID: 16019706 DOI: 10.1080/13854040590945328] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Normative data are presented for older African Americans on the Mattis Dementia Rating Scale (DRS). These data were collected as part of Mayo's Older African Americans Normative Studies (MOAANS) in an effort to develop age-appropriate norms for African Americans elders on commonly used measures in neuropsychological assessment. In this study, the DRS was administered to 307 MOAANS participants ranging in age from 56 to 94 years. Age-corrected subtest and total scores were derived based on percentile ranks from actual frequency distributions across seven age ranges. Also presented is a regression-based computational formula that may be applied to the age-corrected DRS total score to further correct for years of education. These norms should help improve interpretation of DRS performance in African Americans and allow for greater diagnostic accuracy in patients with early cognitive decline.
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Affiliation(s)
- Laurie M Rilling
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Mast BT, Yochim B, MacNeill SE, Lichtenberg PA. Risk Factors for Geriatric Depression: The Importance of Executive Functioning Within the Vascular Depression Hypothesis. J Gerontol A Biol Sci Med Sci 2004; 59:1290-4. [PMID: 15699528 DOI: 10.1093/gerona/59.12.1290] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Results from recent studies addressing the vascular depression hypothesis have been mixed, with cerebrovascular risk factors (CVRFs) predicting depression in some geriatric patients but not in others. The current study seeks to examine executive dysfunction as a potential moderator of the relationship between CVRFs and depressive symptoms. METHODS Data concerning CVRFs, executive functioning, and depressive symptoms from 77 geriatric rehabilitation patients were incorporated to test the hypothesis that patients with executive dysfunction and greater CVRFs would demonstrate the highest levels of depression over time. CVRFs (diabetes, hypertension, atrial fibrillation) were measured via diagnosis by treating physician. Depression was assessed using the 15-item Geriatric Depression Scale (GDS) at baseline and at 6-month and 18-month follow-ups. Executive functioning was measured at baseline using the Initiation/Perseveration (IP) Subtest of the Mattis Dementia Rating Scale. RESULTS Multivariate analysis of variance demonstrated a significant statistical interaction between the number of CVRFs and scores on the IP Subtest on depressive symptoms. Patients with two or more CVRFs and lower IP scores demonstrated significantly greater depressive symptoms at baseline and at 18-month follow-up than patients with fewer CVRFs and higher IP scores. The univariate effect at 6 months was not significant. CONCLUSION The current data suggest that scores on an index of executive functioning may moderate the relationship between CVRFs and depressive symptoms. Interpretation of these findings is provided in the context of the vascular depression hypothesis and related frontostriatal dysfunction. Patients with greater CVRF burden and poor executive functioning may be at particularly high risk for depression.
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Affiliation(s)
- Benjamin T Mast
- Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA.
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Rampello L, Cerasa S, Alvano A, Buttà V, Raffaele R, Vecchio I, Cavallaro T, Cimino E, Incognito T, Nicoletti F. Dementia with Lewy bodies: a review. Arch Gerontol Geriatr 2004; 39:1-14. [PMID: 15158576 DOI: 10.1016/j.archger.2003.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2003] [Revised: 11/26/2003] [Accepted: 11/28/2003] [Indexed: 02/04/2023]
Abstract
The dementia with Lewy bodies (DLB) is the second major type of senile, degenerative dementia, after the Alzheimer disease (AD). It is characterized by the presence of cytoplasmic inclusions of alpha-synuclein in the cerebral cortex and in the nuclei of the brain stem. DLB patients frequently have complex visual hallucinations, depressive symptoms, Parkinsonian manifestations and cognitive deficits, showing important associations with the Parkinson disease and the AD. The DLB should be differentiated from atypical Parkinsonisms, but the differential diagnosis often remains difficult and unsafe. Clinical and neuropathological findings, as well as neuroimaging are valuable tools in establishing specific diagnosis of DLB. Acetylcholinesterase inhibitors, dopamine-agonists, benzodiazepines of short or medium half-life, and antidepressants may be useful in the treatment of DLB, depending on the dominant symptoms of the given patients.
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Affiliation(s)
- L Rampello
- Department of Neurosciences, University of Catania, Azienda Policlinico-Neurologia, Via S. Sofia, 78, Catania I-95125, Italy.
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Murray LL, Dickerson S, Lichtenberger B, Cox C. Effects of toy stimulation on the cognitive, communicative, and emotional functioning of adults in the middle stages of Alzheimer's disease. JOURNAL OF COMMUNICATION DISORDERS 2003; 36:101-127. [PMID: 12609577 DOI: 10.1016/s0021-9924(03)00002-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
UNLABELLED Although several clinical reports describe the benefits of toy stimulation for dementia patients, there is little empirical support for this sensory stimulation approach. The purpose of this investigation was to examine the effects of toy stimulation on the language, cognition, and emotional state of patients in the middle stages of Alzheimer's disease (AD) during a formal testing situation. Eighteen patients completed a standardized test battery and picture description task twice, once with and once without a toy stimulus present. Three AD patients completed all tasks four times (twice with and twice without the toy) to examine performance consistency. Although some patients improved their performances in the presence of a toy, there were no significant group differences between the toy and no toy conditions for any experimental measure. Of the three patients who completed experimental tasks twice in the presence of a toy, two displayed some consistent improvements whereas the remaining patient's response pattern was variable. Caregiver feedback regarding toy stimulation was positive. Methodological limitations of the current study and suggestions for future research are discussed. LEARNING OUTCOMES As a result of reading this article, the participant will be able to: (1) summarize the previous literature regarding sensory stimulation treatment approaches for patients with Alzheimer's disease or other dementing illnesses; and (2) describe the effects of toy stimulation on the linguistic and cognitive abilities, and emotional status of patients in the middle stages of Alzheimer's disease.
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Affiliation(s)
- Laura L Murray
- Department of Speech and Hearing Sciences, Indiana University, 200 S. Jordan Avenue, Bloomington, IN 47405, USA.
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Cognitive Profile of the Chinese Version of the Dementia Rating Scale for Chinese Elderly with Dementia. Hong Kong J Occup Ther 2003. [DOI: 10.1016/s1569-1861(09)70018-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ellingrod VL, Schultz SK, Ekstam-Smith K, Kutscher E, Turvey C, Arndt S. Comparison of risperidone with olanzapine in elderly patients with dementia and psychosis. Pharmacotherapy 2002; 22:1-5. [PMID: 11794418 DOI: 10.1592/phco.22.1.1.33496] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVES To compare the effects of risperidone and olanzapine on cognition in elderly patients with dementia and psychosis, and to compare the side effects of these drugs. DESIGN Single-blind, multicenter, observational study. SETTING Four rural nursing care facilities. PATIENTS Nineteen elderly patients with dementia and psychosis. INTERVENTION Eleven patients were treated with risperidone, eight with olanzapine. MEASUREMENTS AND MAIN RESULTS Rating assessments were completed at baseline, 1 month, and 2 months. Simple paired and unpaired t tests determined between- and within-group differences. Social functioning, including activities of daily living, improved over baseline in both groups (p=0.03). Cognition declined significantly (p<0.05) in the risperidone group; comparatively more side effects occurred and blood pressure decreased (p<0.05) in the olanzapine group. When compared with each group cross-sectionally at baseline and end point, however, the two groups did not differ significantly. CONCLUSION Improvements in social functioning in all 19 patients suggest that both risperidone and olanzapine may help improve functioning in elderly patients with dementia and psychosis. Cognitive and side effect profiles of these drugs may differ substantially. Further study is needed to determine patient subpopulations who may be able to tolerate one drug over another.
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Allen DN, Sprenkel DG, Heyman RA, Schramke CJ, Heffron NE. Evaluation of Demyelinating and Degenerative Disorders. Neuropsychology 1998. [DOI: 10.1007/978-1-4899-1950-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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MacNeill SE, Lichtenberg PA. Home alone: the role of cognition in return to independent living. Arch Phys Med Rehabil 1997; 78:755-8. [PMID: 9228880 DOI: 10.1016/s0003-9993(97)90085-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To identify unique predictors of the ability to return to living alone in geriatric patients undergoing medical rehabilitation. DESIGN Of 900 consecutive geriatric patients entering medical rehabilitation, 372 were identified as living alone before admission. Data were collected on functional status, cognition, demographics, and discharge disposition. SETTING A freestanding medical rehabilitation facility. All patients were admitted to a geriatric rehabilitation unit. PATIENTS Patients aged 60 to 99, identified as having lived alone before admission, were included. As standard procedure, patients underwent functional and cognitive assessment, and medical records were reviewed. MAIN OUTCOME MEASURE Logistic regression analysis was used to evaluate predictors of discharge disposition, including demographic variables, medical burden, the Functional Independence Measure (FIM), and the Dementia Rating Scale (DRS). RESULTS Both the FIM and DRS provided significant and unique variance in prediction of discharge disposition. Patients discharged home alone performed similarly to those discharged with supervision on FIM motor items but higher on FIM social cognition items, emphasizing the strong role of cognition in discharge disposition. Patients discharged home alone scored above suggested cutoff scores on the DRS, indicating generally intact cognitive functioning, whereas those discharged with supervision scored below suggested cutoffs. CONCLUSION Results emphasize the importance of cognition in the ability to return to completely independent living after medical rehabilitation in geriatric patients.
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Affiliation(s)
- S E MacNeill
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit, USA
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Paolo AM, Troster AI, Ryan JJ. California Verbal Learning Test: normative data for the elderly. J Clin Exp Neuropsychol 1997; 19:220-34. [PMID: 9240482 DOI: 10.1080/01688639708403853] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Overlapping age tables were developed, separately for males and females, to provide additional normative information for the California Verbal Learning Test (CVLT) and extend the normative data to persons older than 80 years of age. Participants were 92 males and 120 females with means for age and education of 70.58 years (SD = 6.98) and 14.92 years (SD = 2.56), respectively. Normative information was also provided for additional measures of retention rate and proportion of perseverations and intrusions. The clinical utility of these norms strongly depends on how closely a person matches the demographic characteristics of the normative group.
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Affiliation(s)
- A M Paolo
- University of Kansas Medical Center, Leavenworth, USA
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Pollak CP, Stokes PE. Circadian rest-activity rhythms in demented and nondemented older community residents and their caregivers. J Am Geriatr Soc 1997; 45:446-52. [PMID: 9100713 DOI: 10.1111/j.1532-5415.1997.tb05169.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Disruptive nocturnal behaviors (DNBs) of older people often threaten the caregiving arrangements on which their community tenure depends. Dementing disorders are especially prone to result in disrupted sleep and agitated behaviors ("sundowning"). The objective here was to develop an objective correlate of DNBs, by which their severity and effects on caregivers can be measured. DESIGN Quantitative comparison of subjective sleep and motor activity patterns in older people and their caregivers. It was hypothesized that older people with reported DNBs would be more motorically active at night than their caregivers. SETTING Subjects' homes. PARTICIPANTS Twenty-five demented and 18 nondemented older day-care participants and their paired caregivers. MEASUREMENTS Older subjects and caregivers simultaneously kept daily sleep logs and recorded wrist motor activity every .5 minute for 9 days. A novel method was devised to identify and exclude from analysis periods when the activity monitor was not being worn. Such periods were common. Activity data were analyzed by computing hourly means and by fitting cosine models by least squares. RESULTS Demented older people were not significantly more active at night than their caregivers, though group differences varied by time of night. They were significantly less active in the daytime than were their caregivers. Nondemented older people were significantly more active at night than their caregivers and were as active by day as their caregivers. The caregivers of demented and nondemented older people had similar rest-activity patterns. The mean amplitudes of cosine models were smaller in the older adults. Acrophases (peaks) fell between 2 and 3 pm and did not differ significantly among the groups. CONCLUSIONS As a result of increased nighttime motor activity and decreased daytime activity, rest-activity rhythms were flatter in older adults than in caregivers. This was not explained fully by age and does not necessarily imply that the output of a circadian pacemaker was low. Decreased daytime activity may have resulted from deficient physical stimulation or frailty. Frailty may also explain why nighttime activity was not more elevated in the demented older people. Increased nighttime activity is probably explained by depression, sleep-schedule disturbances, restless legs, or other sleep disorders. Judging by their shared variations of activity, caregivers interacted mainly with the demented older people at bedtime and at rising time in the morning.
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Affiliation(s)
- C P Pollak
- Department of Neurology, Ohio State University, Columbus 43210, USA
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Morgan CD, Baade LE. Neuropsychological testing and assessment scales for dementia of the Alzheimer's type. Psychiatr Clin North Am 1997; 20:25-43. [PMID: 9139294 DOI: 10.1016/s0193-953x(05)70391-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Neuropsychological assessment plays an important role in the process of diagnosing DAT. Whereas the brief screens are sensitive to the cognitive deficits associated with DAT, full battery measures should be used to rule out early dementia or to differentiate among the various dementing illnesses. Following diagnosis, there are numerous assessment measures that facilitate management and placement decisions. These measures include instruments that help stage the illness to determine severity, instruments that evaluate the patient's capacity to perform activities of daily living, and measures that evaluate for the behavior symptoms common in later-stage dementia.
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Affiliation(s)
- C D Morgan
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, USA
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Goldstein FC, Strasser DC, Woodard JL, Roberts VJ. Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. J Am Geriatr Soc 1997; 45:35-42. [PMID: 8994485 DOI: 10.1111/j.1532-5415.1997.tb00975.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To compare outcomes (physical functions and discharge destinations) of cognitively impaired and intact older hip fracture patients, and to identify cognitive skills related to functional gains. DESIGN Prospective longitudinal study of hip fracture patients treated on an acute inpatient rehabilitation service, with evaluation of functional performance and living status determined at admission and discharge. SETTING A specialized inpatient geriatric rehabilitation program at Wesley Woods Geriatric Hospital, which is affiliated with Emory University School of Medicine. SUBJECTS Fifty-eight hip fracture patients, 35 with and 23 without cognitive impairment. MEASUREMENTS Cognitive functioning measured by the Mattis Dementia Rating Scale (MDRS); functional outcome assessed by the Functional Independence Measure (FIM); comparison of pre-fracture with discharge living environments. MAIN RESULTS Both cognitively impaired and intact hip fracture patients exhibited similar overall FIM motor improvements as well as functional gains in specific FIM areas measuring self-care, sphincter control, and locomotion (e.g., walking). Cognitively intact patients, however, displayed significantly greater gains in mobility (e.g., transfers) at discharge. Cognitively impaired patients who lived in the community were as likely as intact patients to return to the community. Patients who entered the program at a modified dependence level (FIM 3-5) and achieved motor independence at discharge (FIM 6-7) had higher MDRS initiation/ perseveration and memory scores. CONCLUSIONS Hip fracture patients with cognitive impairments can achieve positive outcomes as defined by functional improvement and discharge destination. Intensive post-fracture rehabilitation in the early phase of recovery may promote functional independence and a return to the community for older patients at risk for nursing home placement. Future research should examine the long-term maintenance of these improvements and explore how rehabilitation interventions can be altered to enhance outcome.
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Affiliation(s)
- F C Goldstein
- Department of Neurology (Neurobehavioral Program), Emory University School of Medicine, Atlanta, Georgia, USA
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Paolo AM, Axelrod BN, Tröster AI, Blackwell KT, Koller WC. Utility of a Wisconsin Card Sorting Test short form in persons with Alzheimer's and Parkinson's disease. J Clin Exp Neuropsychol 1996; 18:892-7. [PMID: 9157112 DOI: 10.1080/01688639608408310] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The utility of administering only the first deck of 64 cards from the Wisconsin Card Sorting Test (WCST-64) in persons with Alzheimer's (AD) and Parkinson's disease (PD) was evaluated. There were 35 elderly subjects matched for gender, age, and education in each of four groups: controls, PD without dementia (PDN), PD with dementia (PDD), and AD. Additionally, the control and PDN subjects were matched for level of cognitive functioning as were the PDD and AD groups. Results revealed that demented persons performed significantly worse than nondemented subjects. The WCST-64 was also sensitive to the subtle executive deficits demonstrated by persons with PD without dementia. The findings support the use of the WCST-64 in elderly persons with AD and PD.
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Affiliation(s)
- A M Paolo
- University of Kansas Medical Center, USA
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Vangel SJ, Lichtenberg PA. Mattis dementia rating scale: Clinical utility and relationship with demographic variables. Clin Neuropsychol 1995. [DOI: 10.1080/13854049508400481] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Alexopoulos GS, Meyers BS, Young RC, Chester J, Feder M, Einhorn A. Anxiety in Geriatric Depression: Effects of Age and Cognitive Impairment. Am J Geriatr Psychiatry 1995; 3:108-118. [PMID: 28531014 DOI: 10.1097/00019442-199500320-00003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/1994] [Revised: 07/22/1994] [Accepted: 08/23/1994] [Indexed: 11/25/2022]
Abstract
The authors investigated the occurrence of anxiety symptomatology in a clinical sample of geriatric depressed patients and examined the effect of age and cognitive impairment on the experience of anxiety symptoms. Subjects were psychiatric patients consecutively admitted to a longitudinal study of geriatric depression. Severity of depression, antidepressant treatment, cognitive impairment, medical illness, social support, and physical environment were systematically assessed at entry and approximately every 6 months afterwards. Symptoms of anxiety and phobic anxiety were similar in older (n = 52) and younger (n = 15) subjects, although older subjects had significantly lower scores of subjectively experienced depression, interpersonal sensitivity, anger, hostility, and psychoticism. Older depressed patients with cognitive impairment corresponding to mild or moderate dementia had less anxiety than geriatric depressed patients without dementia. Findings of this study suggest the absence of an age effect on the expression of anxiety during depressive states. Although there is no age effect on anxiety, mild-to-moderate dementia appears to be associated with lower anxiety.
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Affiliation(s)
- George S Alexopoulos
- Cornell University Medical College, The New York Hospital-Cornell Medical Center, White Plains, NY 10605
| | - Barnett S Meyers
- Cornell University Medical College, The New York Hospital-Cornell Medical Center, White Plains, NY 10605
| | - Robert C Young
- Cornell University Medical College, The New York Hospital-Cornell Medical Center, White Plains, NY 10605
| | - Janis Chester
- Cornell University Medical College, The New York Hospital-Cornell Medical Center, White Plains, NY 10605
| | - Maria Feder
- Cornell University Medical College, The New York Hospital-Cornell Medical Center, White Plains, NY 10605
| | - Adam Einhorn
- Cornell University Medical College, The New York Hospital-Cornell Medical Center, White Plains, NY 10605
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Kessler HR, Roth DL, Kaplan RF, Goode KT. Confirmatory factor analysis of the mattis dementia rating scale. Clin Neuropsychol 1994. [DOI: 10.1080/13854049408402047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE To investigate the relationship of depression to functional and cognitive impairment in patients with Alzheimer's disease (AD). DESIGN Clinic-based study comparing AD patients with and without depression. SETTING Geriatric outpatient clinic at the University of Washington Medical Center, Seattle, WA. PARTICIPANTS Ninety-one AD patients, 46 with major depression and 45 without. MEASUREMENTS The relationship of the Mattis Dementia Rating Scale (mDRS), DSM-III-R diagnosis of depression, and Hamilton Depression Rating Scale (HDRS) to daily functioning as measured by the Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), and Communication subscales of the Record of Independent Living (RIL) was examined. MAIN RESULTS Both depression and mDRS related significantly to functional impairment, but the amount of variance contributed differed by level of cognitive impairment and functional area investigated. In mildly cognitively impaired subjects, diagnosis and severity of depression (combined) was significantly related to IADL and Communication subscales, after controlling for age and mDRS. No predictor was significantly related to ADL functioning. In contrast, for moderately cognitively impaired subjects, depression diagnosis was significantly related to ADL and Communication performance, but not to IADL functioning. mDRS also significantly predicted ADL, IADL, and Communication subscales. Severity of depression was not significant. CONCLUSIONS These findings, that the presence (diagnosis) and severity (HDRS score) of depression significantly predicted functional status, but that the degree of association varied by level of cognitive severity, has important diagnostic and treatment implications. In particular, the importance of examining whether functional impairment in depressed AD patients can be modified by depression treatment is discussed.
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Affiliation(s)
- A G Fitz
- University of Washington School of Medicine, Seattle 98195
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Beck CK, Heacock P, Rapp CG, Shue V. COGNITIVE IMPAIRMENT IN THE ELDERLY. Nurs Clin North Am 1993. [DOI: 10.1016/s0029-6465(22)02865-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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