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Edgar CJ, Bush EN, Adams HR, Ballinger R, Byrom B, Campbell M, Eremenco S, McDougall F, Papadopoulos E, Slagle AF, Coons SJ. Recommendations on the Selection, Development, and Modification of Performance Outcome Assessments: A Good Practices Report of an ISPOR Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:959-967. [PMID: 37385712 DOI: 10.1016/j.jval.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/05/2023] [Indexed: 07/01/2023]
Abstract
In evaluating the clinical benefit of new therapeutic interventions, it is critical that the treatment outcomes assessed reflect aspects of health that are clinically important and meaningful to patients. Performance outcome (PerfO) assessments are measurements based on standardized tasks actively undertaken by a patient that reflect physical, cognitive, sensory, and other functional skills that bring meaning to people's lives. PerfO assessments can have substantial value as drug development tools when the concepts of interest being measured best suit task performance and in cases where patients may be limited in their capacity for self-report. In their development, selection, and modification, including the evaluation and documentation of validity, reliability, usability, and interpretability, the good practice recommendations established for other clinical outcome assessment types should continue to be followed, with concept elicitation as a critical foundation. In addition, the importance of standardization, and the need to ensure feasibility and safety, as well as their utility in patient groups, such as pediatric populations, or those with cognitive and psychiatric challenges, may enhance the need for structured pilot evaluations, additional cognitive interviewing, and evaluation of quantitative data, such as that which would support concept confirmation or provide ecological evidence and other forms of construct evidence within a unitary approach to validity. The opportunity for PerfO assessments to inform key areas of clinical benefit is substantial and establishing good practices in their selection or development, validation, and implementation, as well as how they reflect meaningful aspects of health is critical to ensuring high standards and in furthering patient-focused drug development.
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Affiliation(s)
| | - Elizabeth Nicki Bush
- Endpoints and Measurement Strategy, The Janssen Pharmaceutical Companies of Johnson & Johnson, Raritan, NJ, USA
| | | | | | | | - Michelle Campbell
- Office of Neuroscience, Food and Drug Administration, Silver Spring, MD, USA
| | - Sonya Eremenco
- PRO Consortium, Critical Path Institute, Tucson, AZ, USA
| | | | - Elektra Papadopoulos
- Patient Experience Data & Strategy in Immunology and Oncology, AbbVie, North Chicago, IL, USA
| | - Ashley F Slagle
- Scientific and Regulatory Consulting, Aspen Consulting, LLC, Steamboat Springs, CO, USA
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Noda T, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Yamashita M, Uchida S, Ueno K, Maekawa E, Terada T, Reed JL, Yamaoka-Tojo M, Matsunaga A, Ako J. SARC-F predicts poor motor function, quality of life, and prognosis in older patients with cardiovascular disease and cognitive impairment. Exp Gerontol 2023; 171:112021. [PMID: 36356692 DOI: 10.1016/j.exger.2022.112021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We investigated whether SARC-F scores were associated with motor function, quality of life (QOL) related to physical function, and prognosis in older patients with cardiovascular disease (CVD) and cognitive impairment. METHODS This was a retrospective cross-sectional cohort study. The study population consisted of 408 patients with CVD (≥60 years old) who completed the SARC-F questionnaire and Mini-Cog, a cognitive function test, at discharge. Sarcopenia was defined as a total SARC-F score ≥ 4 points. Patients who were cognitively-preserved (Mini-Cog score ≥ 3 points) were excluded. Patients completed the handgrip strength, leg strength, usual gait speed, 6-minute walking distance, short physical performance battery score, and 36-item Short-Form Health Survey Physical Functioning (SF-36PF) tests before discharge. Associations of SARC-F with physical function, QOL, and prognoses (i.e., composite of all-cause death and emergency CVD rehospitalization and the number of CVD rehospitalizations) were investigated. RESULTS Sarcopenia (SARC-F score ≥ 4 points) was associated with poorer motor function test outcomes and SF-36PF scores (all P < 0.001). The correlations remained significant after adjusting for comorbidities (e.g., anemia, prior heart failure, and renal dysfunction). Sarcopenia was also associated with a poorer prognosis (hazard ratio: 1.574; 95 % confidence interval [CI], 1.011-2.445) and an increased risk of CVD rehospitalization (incidence rate ratio: 1.911; 95 % CI, 1.312-2.782) after adjusting for comorbidities. CONCLUSIONS AND IMPLICATIONS In older patients with CVD and cognitive impairment, the SARC-F questionnaire may be a simple and inexpensive tool for identifying patients with decreased motor function and a poor prognosis.
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Affiliation(s)
- Takumi Noda
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Division of Research, ARCE Inc., Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Kensuke Ueno
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Canada
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Kim S, Blieszner R, Roberto KA. Effects of dyadic discrepancy in awareness of mild cognitive impairment on changes in care partner's burden over time. Aging Ment Health 2022; 26:1027-1034. [PMID: 34082621 DOI: 10.1080/13607863.2021.1922602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives:This study explored interpersonal aspects of coping with mild cognitive impairment (MCI), focusing on how shared illness representations between persons with MCI (PwMCI) and their care partners (CPs) are associated with CP perceived burden.Method:Longitudinal data from a purposive sample of 69 MCI care dyads were analyzed using descriptive statistics, t-tests, intraclass correlations, and regression analyses.Results: CP perceived their PwMCI's deficits in MCI-related functions as more negative than PwMCI rated themselves, but the extent of the discrepancy varied across cognitive and behavioral abilities. The discrepancy in dyadic appraisal of PwMCI functioning was associated significantly with CP burden.Conclusion: The findings highlight the value of shared PwMCI and CP perspectives on cognitive functioning for MCI management and psychological adjustment.
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Affiliation(s)
- Sujee Kim
- Center for Gerontology, Virginia Tech, Blacksburg, VA, USA
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Maurus J, Terzer T, Benner A, Goisser S, Eidam A, Roth A, Janssen M, Jaramillo S, Lorenz HM, Micol W, Hauer K, Müller-Tidow C, Bauer JM, Jordan K, Neuendorff NR. Validation of a proxy-reported SARC-F questionnaire for current and retrospective screening of sarcopenia-related functional impairments. J Cachexia Sarcopenia Muscle 2022; 13:264-275. [PMID: 34898035 PMCID: PMC8818621 DOI: 10.1002/jcsm.12871] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The strength, assistance walking, rise from a chair, climb stairs, and falls (SARC-F) questionnaire is a well-established instrument for screening of sarcopenia and sarcopenia-related functional impairments. As it is based on self-reporting, its use precludes patients who are unable to answer the questionnaire as a consequence of severe acute diseases or cognitive impairment. Therefore, we aimed to validate a proxy-reported version of the SARC-F for both ad-hoc as well as retrospective screening for severe sarcopenia-related functional impairments. METHODS Patients aged ≥60 years completed the SARC-F and performed the short physical performance battery (SPPB) at baseline (T1). Proxies in Cohort A gave a simultaneous assessment of the patients' functional status with the proxy-reported SARC-F at T1 and again, retrospectively, after 3 months (T2). Proxies in Cohort B only completed the SARC-F retrospectively at T2. The questionnaires' performances were assessed through sensitivity/specificity analyses and receiver operating characteristic (ROC) curves. For non-inferiority analyses, results of both the patient-reported and proxy-reported SARC-F were correlated with the SPPB total score as well as the results of the chair-rise test subcategory; the respective correlation coefficients were tested against each other. RESULTS One hundred and four patients and 135 proxies participated. Using a SPPB score < 9 points as the reference standard, the proxy-reported SARC-F identified patients at high risk for sarcopenia-related functional impairment with a sensitivity of 0.81 (ad-hoc), 0.88 (retrospective Cohort A), and 0.87 (retrospective Cohort B) as well as a specificity of 0.89 (ad-hoc), 0.78 (retrospective Cohort A), and 0.64 (retrospective Cohort B). Areas under the ROC curves were ≥ 0.9 for the ad-hoc proxy-reported SARC-F and the retrospective proxy-reported SARC-F in both cohorts. The proxy-reported SARC-F showed a non-inferior correlation with the SPPB compared with the patient-reported SARC-F for ad-hoc (P = <0.001) as well as retrospective screening for severe sarcopenia-related functional impairment in both Cohorts A (P = 0.007) and B (P = 0.026). CONCLUSIONS Proxy-reported SARC-F is a valid instrument for both ad-hoc as well as retrospective screening for sarcopenia-related functional impairment and could become the standard tool for evaluating this risk in older adults with severe acute disease, for example, in patients with quickly evolving haematological conditions.
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Affiliation(s)
- Johannes Maurus
- Department of Medicine V - Haematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany.,Clinic for Urology, University Hospital Augsburg, Augsburg, Germany
| | - Tobias Terzer
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sabine Goisser
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Annette Eidam
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Anja Roth
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Maike Janssen
- Department of Medicine V - Haematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sonia Jaramillo
- Department of Medicine V - Haematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hannes Martin Lorenz
- Department of Medicine V - Haematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - William Micol
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Hauer
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Medicine V - Haematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen M Bauer
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany.,Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Karin Jordan
- Department of Medicine V - Haematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nina Rosa Neuendorff
- Department of Medicine V - Haematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany.,Clinic for Haematology and Stem-Cell Transplantation, University Hospital Essen, Essen, Germany
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Cacciamani F, Houot M, Gagliardi G, Dubois B, Sikkes S, Sánchez-Benavides G, Denicolò E, Molinuevo JL, Vannini P, Epelbaum S. Awareness of Cognitive Decline in Patients With Alzheimer's Disease: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 13:697234. [PMID: 34413767 PMCID: PMC8370471 DOI: 10.3389/fnagi.2021.697234] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Identifying a poor degree of awareness of cognitive decline (ACD) could represent an early indicator of Alzheimer's disease (AD). Objectives: (1) to understand whether there is evidence of poor ACD in the pre-dementia stages of AD; (2) to summarize the main findings obtained investigating ACD in AD; (3) to propose a conceptual framework. Data Sources: We searched Scopus, Pubmed, and the reference lists for studies published up to August 2020. Original research articles must report a measure of ACD and included individuals with AD dementia, or prodromal AD (or MCI), or being at risk for AD. Data Synthesis: All studies covering preclinical, prodromal, and AD dementia were systematically reviewed. We intended to perform a meta-analysis of empirical studies on preclinical AD or prodromal AD (or MCI), to compare ACD between clinical groups. Due to the paucity of literature on preclinical AD, meta-analysis was only possible for prodromal AD (or MCI) studies. Results: We systematically reviewed 283 articles, and conducted a meta-analysis of 18 articles on prodromal AD (or MCI), showing that ACD was not significantly different between patients with amnestic and non-amnestic MCI (SMD = 0.09, p = 0.574); ACD was significantly poorer in amnestic MCI (SMD = -0.56, p = 0.001) and mild AD (SMD = -1.39, p < 0.001) than in controls; ACD was also significantly poorer in mild AD than in amnestic MCI (SMD = -0.75, p < 0.001), as well as poorer than in non-amnestic MCI (SMD = -1.00, p < 0.001). We also discuss key findings on ACD in AD, such as its neural and cognitive correlates. Conclusions and Implications: We propose that patients may be complaining of their initial subtle cognitive changes, but ACD would soon start to decrease. The individual would show mild anosognosia in the MCI stage, and severe anosognosia in dementia. The evaluation of ACD (comparing self-report to cognitive scores or to informant-report) could be useful to guide the clinician toward a timely diagnosis, and in trials targeting early-stage AD.
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Affiliation(s)
- Federica Cacciamani
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Inserm, U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Sorbonne Université, Paris, France
- Inria, ARAMIS-Project Team, Paris, France
| | - Marion Houot
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
- Institute of Memory and Alzheimer's Disease (IM2A), Centre of Excellence of Neurodegenerative Disease (CoEN), ICM, CIC Neurosciences, AP-HP, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Geoffroy Gagliardi
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Bruno Dubois
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Inserm, U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Sorbonne Université, Paris, France
- Institute of Memory and Alzheimer's Disease (IM2A), Centre of Excellence of Neurodegenerative Disease (CoEN), ICM, CIC Neurosciences, AP-HP, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Sietske Sikkes
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gonzalo Sánchez-Benavides
- BarcelonaBeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Elena Denicolò
- Department of Biomedical Science and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - José Luis Molinuevo
- BarcelonaBeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Patrizia Vannini
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Stéphane Epelbaum
- Institut du Cerveau, ICM, Hôpital de la Pitié-Salpêtrière, Paris, France
- Inserm, U 1127, Paris, France
- CNRS, UMR 7225, Paris, France
- Sorbonne Université, Paris, France
- Inria, ARAMIS-Project Team, Paris, France
- Institute of Memory and Alzheimer's Disease (IM2A), Centre of Excellence of Neurodegenerative Disease (CoEN), ICM, CIC Neurosciences, AP-HP, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Sorbonne University, Paris, France
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Bastin C, Giacomelli F, Miévis F, Lemaire C, Guillaume B, Salmon E. Anosognosia in Mild Cognitive Impairment: Lack of Awareness of Memory Difficulties Characterizes Prodromal Alzheimer's Disease. Front Psychiatry 2021; 12:631518. [PMID: 33868048 PMCID: PMC8044313 DOI: 10.3389/fpsyt.2021.631518] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/08/2021] [Indexed: 12/29/2022] Open
Abstract
While anosognosia is often present in Alzheimer's disease, the degree of awareness of cognitive difficulties in the earlier stages, such as Mild Cognitive Impairment (MCI), is less clear. Using a questionnaire and Feeling-of-Knowing tasks, the aims of this study were (1) to test the hypothesis that anosognosia is present specifically in prodromal AD stage in patients that, owing to a more severe AD neuropathology, will rapidly progress to overt dementia and (2) to assess the neural bases of self-awareness for memory functioning. A group of 44 patients with amnestic MCI and a group of 29 healthy older participants (CTRL) performed two Feeling-of-Knowing tasks (episodic and semantic FOK) and responded to the Functional Memory Scale (MARS), also completed by one of their relatives. They underwent FDG-PET and structural MRI. The participants were followed clinically for 4 years. At the end of follow-up, 23 patients with MCI developed Alzheimer's disease (converters) and 21 patients still presented symptoms of MCI without progression (non-converters). The analyses focused on the data from inclusion stratified according to clinical status 4 years later (converters, non-converters, CTRL). On the episodic FOK task, converters patients overestimated their ability to later recognize unrecalled words and they showed prediction accuracy (Hamann coefficient) at the level of chance. No difficulty was observed in any group with the semantic FOK task. On the MARS, converters patients had a higher anosognosia score than non-converters patients and CTRL, which did not differ from each other. Correlations between self-awareness scores and neuroimaging data using small volume correction analyses in a priori regions of interest in converters indicated that inaccurate episodic FOK judgments was related to changes in brain areas that might support interpretation of retrieved content for judging the likelihood of recognition. For the MARS, the association between anosognosia and decreased gray matter density of the left inferior prefrontal cortex in converters might indicate poor inhibition over outdated personal knowledge. In amnestic MCI, anosognosia could be an early sign of neurodegeneration in brain areas that would support control mechanisms over memory representations.
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Affiliation(s)
- Christine Bastin
- GIGA-Cyclotron Research Center-in vivo Imaging, University of Liège, Liège, Belgium.,F.R.S.-Fonds National de la Recherche Scientifique, Bruxelles, Belgium
| | - Fabrice Giacomelli
- GIGA-Cyclotron Research Center-in vivo Imaging, University of Liège, Liège, Belgium
| | - Frédéric Miévis
- GIGA-Cyclotron Research Center-in vivo Imaging, University of Liège, Liège, Belgium
| | - Christian Lemaire
- GIGA-Cyclotron Research Center-in vivo Imaging, University of Liège, Liège, Belgium
| | | | - Eric Salmon
- GIGA-Cyclotron Research Center-in vivo Imaging, University of Liège, Liège, Belgium.,Memory Clinic, CHU Liège, Liège, Belgium
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Akhtar A, Dhaliwal J, Saroj P, Uniyal A, Bishnoi M, Sah SP. Chromium picolinate attenuates cognitive deficit in ICV-STZ rat paradigm of sporadic Alzheimer's-like dementia via targeting neuroinflammatory and IRS-1/PI3K/AKT/GSK-3β pathway. Inflammopharmacology 2020; 28:385-400. [PMID: 31898080 DOI: 10.1007/s10787-019-00681-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 02/05/2023]
Abstract
Alzheimer's disease (AD) is prevalent in old age people and is one of the most common brain diseases. Brain insulin resistance, neuroinflammation, oxidative stress, and mitochondrial and cholinergic dysfunction are key features of the disease. In our study, streptozotocin (STZ) in a dose of 3 mg/kg was injected in male Wistar rats bilaterally through the intracerebroventricular (ICV) route on stereotaxic apparatus. Chromium picolinate (CrPic) was tested at doses of 1 mg/kg, 2 mg/kg, and 4 mg/kg, while rivastigmine (2 mg/kg) was used as reference standard drug. Cognitive dysfunction induced by STZ was assessed by behavioral tests like Morris water maze and novel object recognition test. Treatment with CrPic revealed attenuation of cognitive deficit. This was confirmed by behavioral tests, biochemical estimations of antioxidant enzymes, oxidative stress, nitrosative stress, and cholinergic and mitochondrial activity. CrPic did not change AchE activity significantly. STZ-induced neuroinflammation evident by increased TNF-α, IL-6, and CRP levels was also significantly decreased by CrPic. Dysfunctional insulin signaling after ICV-STZ was demonstrated by reduced IRS-1, PI3K, AKT, BDNF gene expression, and increased GSK-3β, NF-κB gene expression with the help of qRT-PCR. CrPic treatment produced an improvement in insulin signaling revealed by increased gene expression of IRS-1, PI3-K, AKT, BDNF, and decreased gene expression of GSK-3β and NF-κB. It was concluded that CrPic reversed AD pathology revealed by improved memory, reduced oxidative stress, neuroinflammation, mitochondrial dysfunction, and upregulated insulin signaling.
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Affiliation(s)
- Ansab Akhtar
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India
| | - Jatinder Dhaliwal
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India
| | - Priyanka Saroj
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India
| | - Ankit Uniyal
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India
| | - Mahendra Bishnoi
- National Agri-Food Biotechnology Institute (NABI), Sector-81, SAS Nagar, Mohali, Punjab, 140306, India
| | - Sangeeta Pilkhwal Sah
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India.
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8
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Shaked D, Sunderaraman P, Piscitello J, Cines S, Hale C, Devanand D, Karlawish J, Cosentino S. Modification of everyday activities and its association with self-awareness in cognitively diverse older adults. PLoS One 2019; 14:e0222769. [PMID: 31697690 PMCID: PMC6837494 DOI: 10.1371/journal.pone.0222769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/06/2019] [Indexed: 01/05/2023] Open
Abstract
Cognitive impairment (CI) in older adults is frequently accompanied by difficulty performing complex everyday activities (e.g., managing finances). However, it is unclear if and how older adults with CI modify their activities (i.e., Do individuals continue, monitor, seek help with, change their approach to, or stop different activities?). In the current study, we examined if older adults with CI are concerned about their ability to carry out complex activities, if and how they modify activities based on their concern, and the factors associated with activity modification. We hypothesized that older adults with CI will more frequently be concerned about, and modify, everyday activities than cognitively healthy (HE) older adults, and that higher awareness of memory loss in the CI group would relate to more frequent modification. The sample included 81 older adults (51 HEs; mean age 70.02 (7.34) and 30 CI; mean age 75.97 (8.12)). Compared to HEs, the CI group reported having more concern about, F(3,77) = 5.50, p = 0.02, and modifying a greater number of activities, F(3,77) = 5.02, p = 0.03. Medication management (30%) and completing taxes (33.3%) were among the most frequently modified activities for the CI and HE groups, respectively. In the CI group, higher memory awareness was associated with more concern (r = .53, p = .005) and activity modification (r = 0.55, p = .003). Findings provide novel information about how cognitively diverse older adults navigate complex activities in daily life. We propose a preliminary theoretical model by which self-awareness may influence navigation of everyday activities in the context of CI.
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Affiliation(s)
- Danielle Shaked
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States of America
| | - Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
| | - Jennifer Piscitello
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
| | - Sarah Cines
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
| | - Christiane Hale
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
| | - Davangere Devanand
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
- Division of Geriatric Psychiatry, Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States of America
| | - Jason Karlawish
- Healthy Brain Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
- * E-mail:
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The incidence of mild cognitive impairment: A systematic review and data synthesis. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2019; 11:248-256. [PMID: 30911599 PMCID: PMC6416157 DOI: 10.1016/j.dadm.2019.01.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction Incidence estimates of mild cognitive impairment (MCI) range widely. We obtained contemporary age-specific MCI incidence rates and examined sources of heterogeneity. Methods We conducted a systematic review of population-based studies from the Americas, Europe, and Australia using restrictive inclusion criteria to limit heterogeneity. Incidence was examined using 5-year age categories for MCI and amnestic/nonamnestic subtypes. Data were synthesized using quantitative and qualitative descriptive analyses and quantitative meta-analyses. Results Meta-analysis estimates (95% CI) of MCI incidence per 1000 person-years were 22.5 (5.1-51.4) for ages 75-79y, 40.9 (7.7-97.5) for ages 80-84y, and 60.1 (6.7-159.0) for ages 85+y. Despite restrictive inclusion criteria, considerable heterogeneity (measured by I2) remained. Meta-analysis findings and simple descriptive statistics were consistent and supported by qualitative review. Discussion Heterogeneity in MCI incidence estimates persisted across age-specific estimates from population samples, likely reflecting differences in populations and methods. Incidence rate ranges are important to consider with summary point estimates.
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10
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Beaver J, Schmitter-Edgecombe M. Multiple Types of Memory and Everyday Functional Assessment in Older Adults. Arch Clin Neuropsychol 2018; 32:413-426. [PMID: 28334170 DOI: 10.1093/arclin/acx016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/11/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Current proxy measures for assessing everyday functioning (e.g., questionnaires, performance-based measures, and direct observation) show discrepancies in their rating of functional status. The present study investigated the relationship between multiple proxy measures of functional status and content memory (i.e., memory for information), temporal order memory, and prospective memory in an older adult sample. Method A total of 197 community-dwelling older adults who did (n = 45) or did not meet (n = 152) criteria for mild cognitive impairment (MCI), completed six different assessments of functional status (two questionnaires, two performance-based tasks, and two direct observation tasks) as well as experimental measures of content memory, prospective memory, and temporal order memory. Results After controlling for demographics and content memory, the temporal order and prospective memory measures explained a significant amount of variance in all proxy functional status measures. When all variables were entered into the regression analyses, content memory and prospective memory were found to be significant predictors of all measures of functional status, whereas temporal order memory was a significant predictor for the questionnaire and direct observation measures, but not performance-based measures. Conclusion The results suggest that direct observation and questionnaire measures may be able to capture components of everyday functioning that require context and temporal sequencing abilities, such as multi-tasking, that are not as well captured in many current laboratory performance-based measures of functional status. Future research should aim to inform the development and use of maximally effective and valid proxy measures of functional ability.
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Affiliation(s)
- Jenna Beaver
- Department of Psychology, Washington State University, Pullman, WA , USA
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11
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Dolci GAM, Damanti S, Scortichini V, Galli A, Rossi PD, Abbate C, Arosio B, Mari D, Arighi A, Fumagalli GG, Scarpini E, Inglese S, Marcucci M. Alzheimer's Disease Diagnosis: Discrepancy between Clinical, Neuroimaging, and Cerebrospinal Fluid Biomarkers Criteria in an Italian Cohort of Geriatric Outpatients: A Retrospective Cross-sectional Study. Front Med (Lausanne) 2017; 4:203. [PMID: 29214153 PMCID: PMC5702632 DOI: 10.3389/fmed.2017.00203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/06/2017] [Indexed: 01/05/2023] Open
Abstract
Background The role of cerebrospinal fluid (CSF) biomarkers, and neuroimaging in the diagnostic process of Alzheimer's disease (AD) is not clear, in particular in the older patients. Objective The aim of this study was to compare the clinical diagnosis of AD with CSF biomarkers and with cerebrovascular damage at neuroimaging in a cohort of geriatric patients. Methods Retrospective analysis of medical records of ≥65-year-old patients with cognitive impairment referred to an Italian geriatric outpatient clinic, for whom the CSF concentration of amyloid-β (Aβ), total Tau (Tau), and phosphorylated Tau (p-Tau) was available. Clinical diagnosis (no dementia, possible and probable AD) was based on the following two sets of criteria: (1) the Diagnostic Statistical Manual of Mental Disorders (DSM-IV) plus the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and (2) the National Institute on Aging-Alzheimer's Association (NIA-AA). The Fazekas visual scale was applied when a magnetic resonance imaging scan was available. Results We included 94 patients, mean age 77.7 years, mean Mini Mental State Examination score 23.9. The concordance (kappa coefficient) between the two sets of clinical criteria was 70%. The mean CSF concentration (pg/ml) (±SD) of biomarkers was as follows: Aβ 687 (±318), Tau 492 (±515), and p-Tau 63 (±56). There was a trend for lower Aβ and higher Tau levels from the no dementia to the probable AD group. The percentage of abnormal liquor according to the local cutoffs was still 15 and 21% in patients without AD based on the DSM-IV plus NINCDS-ADRDA or the NIA-AA criteria, respectively. The exclusion of patient in whom normotensive hydrocephalus was suspected did not change these findings. A total of 80% of patients had the neuroimaging report describing chronic cerebrovascular damage, while the Fazekas scale was positive in 45% of patients overall, in 1/2 of no dementia or possible AD patients, and in about 1/3 of probable AD patients, with no difference across ages. Conclusion We confirmed the expected discrepancy between different approaches to the diagnosis of AD in a geriatric cohort of patients with cognitive impairment. Further research is needed to understand how to interpret this discrepancy and provide clinicians with practical guidelines.
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Affiliation(s)
- Giulia A M Dolci
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sarah Damanti
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Nutritional Sciences, Università degli Studi di Milano, Milan, Italy
| | - Valeria Scortichini
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Geriatric Unit, Medical Department Maggiore Hospital, Bologna, Italy
| | - Alessandro Galli
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Geriatric Unit, ASST Lariana, Ospedale Sant'Anna, Como, Italy
| | - Paolo D Rossi
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Abbate
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Arosio
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Daniela Mari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Arighi
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, Centro Dino Ferrari, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio G Fumagalli
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, Centro Dino Ferrari, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Elio Scarpini
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, Centro Dino Ferrari, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Inglese
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maura Marcucci
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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12
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Edgar CJ. Use of Qualitative Data to Support Content Validity of Performance-Based Cognitive Outcome Assessments. Ther Innov Regul Sci 2017; 51:671. [DOI: 10.1177/2168479017719934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Parrao T, Brockman S, Bucks RS, Bruce DG, Davis WA, Hatch KK, Leavy TL, Axten CA, Starkstein SE. The Structured Interview for Insight and Judgment in Dementia: Development and validation of a new instrument to assess awareness in patients with dementia. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2016; 7:24-32. [PMID: 28203628 PMCID: PMC5295621 DOI: 10.1016/j.dadm.2016.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Poor insight about their cognitive and functional deficits is highly prevalent in patients with Alzheimer's disease (AD); however, there is a lack of reliable, valid instrumentation to measure this construct. The aim of this study was to develop and validate a semistructured interview to assess insight and judgment in patients with AD and to provide information regarding the assessment of competency and risk in this population. METHODS We validated the Structured Clinical Interview for Insight and Judgment in Dementia (SIJID) in a consecutive series of 124 patients with probable AD. The following psychometric properties were evaluated: internal consistency, test-retest reliability, interrater reliability, and convergent and predictive validity. RESULTS The SIJID demonstrated high test-retest, interrater reliability and also showed strong discriminant and convergent validity. It showed good predictive validity based on 1-year follow-up information of the patient's clinical outcomes, with a significant association between higher SIJID total scores at baseline, and more severe neuropsychiatric symptoms and more severe caregiver distress at follow-up. Moreover, higher scores of dangerous behaviors at baseline were significantly correlated with a higher frequency of hospitalization and placement in residential care 1 year later. CONCLUSION The SIJID is a reliable and valid instrument to assess insight and judgment in patients with AD and is a valuable tool for assessing presence and severity of dangerous behaviors, determining risk, and providing critical information for the assessment of competency.
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Affiliation(s)
- Teresa Parrao
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Simone Brockman
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Romola S. Bucks
- School of Psychology, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - David G. Bruce
- School of Medicine and Pharmacology, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Wendy A. Davis
- School of Medicine and Pharmacology, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Katherine K. Hatch
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Tammy L. Leavy
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Christine A.P. Axten
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
| | - Sergio E. Starkstein
- School of Psychiatry and Clinical Neurosciences, University of Western Australia and Fremantle Hospital, Western Australia, Fremantle, Australia
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Zheng Q, Tian Q, Hao C, Gu J, Tao J, Liang Z, Chen X, Fang J, Ruan J, Ai Q, Hao Y. Comparison of attitudes toward disability and people with disability among caregivers, the public, and people with disability: findings from a cross-sectional survey. BMC Public Health 2016; 16:1024. [PMID: 27686163 PMCID: PMC5043610 DOI: 10.1186/s12889-016-3670-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/15/2016] [Indexed: 12/13/2022] Open
Abstract
Background A negative attitude toward disability is one of the potential barriers for people with disability (PWD) to achieve social equality. Although numerous studies have investigated attitudes toward disability, few have evaluated personal attitudes toward disability among PWD, and made comparisons with attitudes of healthy respondents. This study was to investigate and compare the attitudes of PWD, caregivers, and the public toward disability and PWD in China, to identify discrepancies in attitude among the three groupsand to examine potential influencing factors of attitude within each group. Methods A cross-sectional study was conducted among 2912 PWD, 507 caregivers, and 354 members of the public in Guangzhou, China. Data were collected on participants’ socio-demographic information and personal attitudes toward disability using the Attitude to Disability Scale (ADS). ANOVA and ANCOVA were applied to compare the level of attitude among the three groups. Simple and multiple linear regression analyses were used to investigate the relationship between each background factor and attitude within each group. Results Over 90 % of caregivers were PWD’s family members. After controlling the socio-demographic characteristics, caregivers had the lowest total scores of ADS (caregivers: 47.7; PWD: 52.3; the public: 50.5). Caregivers who had taken care of PWD for longer durations of time had a more negative attitude toward disability. In contrast, PWD who had been disabled for longer times had a more positive attitude toward disability. Conclusions The current national social security system of China does not adequately support PWD’s family-member caregivers who may need assistance coping with their life with PWDs. More research is needed, and the development of a new health-care model for PWD is warranted.
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Affiliation(s)
- Qiaolan Zheng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Qi Tian
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Chun Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
| | - Jing Gu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jianting Tao
- Guangzhou Service Center of Assistive Devices, Guangzhou, Guangdong, People's Republic of China
| | - Zuoyi Liang
- Guangzhou Disabled Person's Federation, Guangzhou, Guangdong, People's Republic of China
| | - Xinlin Chen
- Department of Preventive Medicine and Health Statistics, College of Fundamental Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Jiqian Fang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jianhua Ruan
- Guangzhou Service Center of Assistive Devices, Guangzhou, Guangdong, People's Republic of China
| | - Qiuxiang Ai
- Guangzhou Service Center of Assistive Devices, Guangzhou, Guangdong, People's Republic of China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
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Amjad H, Roth DL, Samus QM, Yasar S, Wolff JL. Potentially Unsafe Activities and Living Conditions of Older Adults with Dementia. J Am Geriatr Soc 2016; 64:1223-32. [PMID: 27253366 PMCID: PMC4914464 DOI: 10.1111/jgs.14164] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the prevalence of dementia in the absence of a reported dementia diagnosis and whether potentially unsafe activities and living conditions vary as a function of dementia diagnosis status in a nationally representative sample of older adults. DESIGN Observational cohort study. SETTING Community. PARTICIPANTS Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study (N = 7,609). MEASUREMENTS Participants were classified into four groups based on self-report of dementia diagnosis, proxy screening interview, and cognitive testing: probable dementia with reported dementia diagnosis (n = 457), probable dementia without reported dementia diagnosis (n = 581), possible dementia (n = 996), or no dementia (n = 5,575). Potentially unsafe activities (driving, preparing hot meals, managing finances or medications, attending doctor visits alone) and living conditions (falls, living alone, and unmet needs) were examined according to dementia status subgroups in stratified analyses and multivariate models, adjusting for sociodemographic factors, medical comorbidities, and physical capacity. RESULTS The prevalence of driving (22.9%), preparing hot meals (31.0%), managing finances (21.9%), managing medications (36.6%), and attending doctor visits alone (20.6%) was lowest in persons with probable dementia; however, but in persons with probable dementia, the covariate-adjusted rates of driving, preparing hot meals, managing finances, managing medications, and attending doctor visits alone were significantly higher in those without reported dementia diagnosis than in those with reported diagnosis (all odds ratios ≥2.00, all P < .01). CONCLUSION Older adults with probable dementia who are not aware of a dementia diagnosis are more likely to report engaging in potentially unsafe behaviors. Understanding the prevalence of potentially unsafe activities and living conditions can help clinicians focus safety screening and counseling in older adults with diagnosed or suspected dementia.
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Affiliation(s)
- Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David L. Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Quincy M. Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sevil Yasar
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Jennifer L. Wolff
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
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Narme P, Roussel M, Mouras H, Krystkowiak P, Godefroy O. Does impaired socioemotional functioning account for behavioral dysexecutive disorders? Evidence from a transnosological study. AGING NEUROPSYCHOLOGY AND COGNITION 2016; 24:80-93. [PMID: 27054957 DOI: 10.1080/13825585.2016.1171291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Behavioral dysexecutive disorders are highly prevalent in patients with neurological diseases but cannot be explained by cognitive dysexecutive impairments. In fact, the underlying mechanisms are poorly understood. Given that socioemotional functioning underlies appropriate behavior, socioemotional impairments may contribute to the appearance of behavioral disorders. To investigate this issue, we performed a transnosological study. Seventy-five patients suffering from various neurological diseases (Alzheimer's disease (AD), Parkinson's disease (PD), frontotemporal lobar degeneration, and stroke) were included in the study. The patients were comprehensively assessed in terms of cognitive and behavioral dysexecutive disorders and socioemotional processes (facial emotion recognition and theory of mind). As was seen for cognitive and behavioral dysexecutive impairments, the prevalence of socioemotional impairments varied according to the diagnosis. Stepwise logistic regressions showed that (i) only cognitive executive indices predicted hypoactivity with apathy/abulia, (ii) theory of mind impairments predicted hyperactivity-distractibility-impulsivity and stereotyped/perseverative behaviors, and (iii) impaired facial emotion recognition predicted social behavior disorders. Several dysexecutive behavioral disorders are associated with an underlying impairment in socioemotional processes but not with cognitive indices of executive functioning (except for apathy). These results strongly suggest that some dysexecutive behavioral disorders are the outward signs of an underlying impairment in socioemotional processes.
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Affiliation(s)
- Pauline Narme
- a Laboratoire de Neurosciences Fonctionnelles et Pathologies (EA 4559), Département de médecine , Université de Picardie Jules Verne , Amiens , France.,b Equipe Neuropsychologie du Vieillissement (EA 4468), Institut de Psychologie , Université Paris Descartes , Boulogne-Billancourt , France
| | - Martine Roussel
- a Laboratoire de Neurosciences Fonctionnelles et Pathologies (EA 4559), Département de médecine , Université de Picardie Jules Verne , Amiens , France.,c Service de Neurologie , Centre Hospitalier Universitaire d'Amiens-Nord , Amiens , France
| | - Harold Mouras
- a Laboratoire de Neurosciences Fonctionnelles et Pathologies (EA 4559), Département de médecine , Université de Picardie Jules Verne , Amiens , France.,d Centre de recherche en psychologie: Cognition, psychisme et organisations, Département de Psychologie , Université de Picardie Jules Verne , Amiens , France
| | - Pierre Krystkowiak
- a Laboratoire de Neurosciences Fonctionnelles et Pathologies (EA 4559), Département de médecine , Université de Picardie Jules Verne , Amiens , France.,c Service de Neurologie , Centre Hospitalier Universitaire d'Amiens-Nord , Amiens , France
| | - Olivier Godefroy
- a Laboratoire de Neurosciences Fonctionnelles et Pathologies (EA 4559), Département de médecine , Université de Picardie Jules Verne , Amiens , France.,c Service de Neurologie , Centre Hospitalier Universitaire d'Amiens-Nord , Amiens , France
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Self-awareness in Mild Cognitive Impairment: Quantitative evidence from systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 61:90-107. [DOI: 10.1016/j.neubiorev.2015.10.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 10/11/2015] [Accepted: 10/12/2015] [Indexed: 12/20/2022]
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Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer's disease and Parkinson's disease. Int Psychogeriatr 2015; 27:357-66. [PMID: 25382659 DOI: 10.1017/s1041610214002245] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Impaired awareness of memory deficits has been recognized as a common phenomenon in Alzheimer's disease (AD) and research is now increasingly focusing on awareness in groups at risk for future dementia. This study aimed to determine whether levels of awareness differ among healthy elderly people and patients with subjective cognitive decline (SCD), amnestic and non-amnestic subtypes of mild cognitive impairment (aMCI, naMCI), Alzheimer's disease (AD) and Parkinson's disease (PD), to explore correlates of awareness and to establish frequencies of memory over- and underestimation within each diagnostic group. METHODS 756 consecutive outpatients of a memory clinic and 211 healthy controls underwent thorough neuropsychological testing. Impairment of awareness was measured as the difference between subjective memory appraisals (16-item questionnaire on current memory-related problems in everyday life) and objective memory performance (15-item delayed recall task). Subgroups of over- and underestimators were classified using percentile ranks of controls. RESULTS At group level, awareness significantly decreased along the naMCI→aMCI→AD continuum, with naMCI patients showing a tendency towards overestimation of memory dysfunction. PD patients showed accurate self-appraisals as long as memory function was largely unaffected. However, there was a considerable between-group overlap in awareness scores. Furthermore, different correlates of awareness were observed depending on the diagnostic group. In general, unawareness seems to be associated with decreased cognitive performance in various domains (especially memory), higher age and lower levels of depression and self-reported functional impairment. CONCLUSION Impaired awareness is an important symptom in aMCI. Yet, given the considerable variability in awareness scores, longitudinal studies are required to evaluate their predictive power.
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Clare L, Whitaker CJ, Roberts JL, Nelis SM, Martyr A, Marková IS, Roth I, Woods RT, Morris RG. Memory awareness profiles differentiate mild cognitive impairment from early-stage dementia: evidence from assessments of performance monitoring and evaluative judgement. Dement Geriatr Cogn Disord 2013; 35:266-79. [PMID: 23548548 DOI: 10.1159/000346735] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Measures of memory awareness based on evaluative judgement and performance monitoring are often regarded as equivalent, but the Levels of Awareness Framework suggests they reflect different awareness phenomena. Examination of memory awareness among groups with differing degrees of impairment provides a test of this proposition. METHOD Ninety-nine people with dementia (PwD), 30 people with mild cognitive impairment (PwMCI), and their relatives completed isomorphic performance monitoring and evaluative judgement measures of memory awareness and were followed up at 12 and (PwD only) 20 months. In addition to the resulting awareness indices, comparative accuracy scores were calculated using the relatives' data to establish whether any inaccuracy was specific to self-ratings. RESULTS When making evaluative judgements about their memory in general, both PwD and PwMCI tended to overestimate their own functioning relative to informant ratings made by relatives. When monitoring performance on memory tests, PwD again overestimated performance relative to test scores, but PwMCI were much more accurate. Comparative accuracy scores indicated that, unlike PwD, PwMCI do not show a specific inaccuracy in self-related appraisals. CONCLUSIONS The results support the proposition that awareness indices at the levels of evaluative judgement and performance monitoring should be regarded as reflecting distinct awareness phenomena.
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Affiliation(s)
- Linda Clare
- School of Psychology, Bangor University, Bangor LL57 2AS, UK.
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Maki Y, Yamaguchi T, Yamaguchi H. Evaluation of Anosognosia in Alzheimer's Disease Using the Symptoms of Early Dementia-11 Questionnaire (SED-11Q). Dement Geriatr Cogn Dis Extra 2013; 3:351-9. [PMID: 24403907 PMCID: PMC3884202 DOI: 10.1159/000355367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIMS The objective is to propose a brief method to evaluate anosognosia in Alzheimer's disease (AD) using the Symptoms of Early Dementia-11 Questionnaire (SED-11Q), a short informant-based screening questionnaire for identifying dementia. METHODS The participants were 107 elderly individuals: 13 with a Clinical Dementia Rating (CDR) of 0.5, 73 with mild AD of CDR 1, and 21 with moderate AD of CDR 2. The patients and caregivers answered the SED-11Q independently, and the degree of discrepancy indicated the severity of anosognosia. RESULTS THE SCORES WERE AS FOLLOWS: caregiver scores were 2.46 ± 1.85 (mean ± SD) in CDR 0.5, 6.36 ± 3.02 in CDR 1, and 9.00 ± 1.14 in CDR 2; patient scores were 2.00 ± 1.78, 2.55 ± 2.33, and 1.33 ± 2.46, respectively. Discrepancy was 0.46 ± 1.61, 3.81 ± 3.95, and 7.67 ± 2.87, respectively, and the caregiver assessments were significantly higher than the patient assessments in CDR 1 and CDR 2 (p < 0.001 in both groups). The SED-11Q for anosognosia was validated with the standardized Anosognosia Questionnaire for Dementia (AD-Q). The caregiver scores were moderately correlated with behavioral and psychological symptoms of dementia scores (r = 0.524), and the patient scores were moderately correlated with depression scores (r = 0.561). CONCLUSION The SED-11Q serves a dual purpose: caregiver assessment is useful for the screening of dementia, and any discrepancy between the patient and the caregiver assessment is considered as an indication of the severity of anosognosia; this can be informative for caregivers and essential for successful care.
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Affiliation(s)
- Yohko Maki
- Gunma University Graduate School of Health Sciences, Maebashi, Japan ; Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Tomoharu Yamaguchi
- Gunma University Graduate School of Health Sciences, Maebashi, Japan ; Department of Rehabilitation, Gunma University of Health and Welfare, Maebashi, Japan
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Lee SB, Park JR, Yoo JH, Park JH, Lee JJ, Yoon JC, Jhoo JH, Lee DY, Woo JI, Han JW, Huh Y, Kim TH, Kim KW. Validation of the dementia care assessment packet-instrumental activities of daily living. Psychiatry Investig 2013; 10:238-45. [PMID: 24302946 PMCID: PMC3843015 DOI: 10.4306/pi.2013.10.3.238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 03/20/2013] [Accepted: 04/02/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the psychometric properties of the IADL measure included in the Dementia Care Assessment Packet (DCAP-IADL) in dementia patients. METHODS The study involved 112 dementia patients and 546 controls. The DCAP-IADL was scored in two ways: observed score (OS) and predicted score (PS). The reliability of the DCAP-IADL was evaluated by testing its internal consistency, inter-rater reliability and test-retest reliability. Discriminant validity was evaluated by comparing the mean OS and PS between dementia patients and controls by ANCOVA. Pearson or Spearman correlation analysis was performed with other instruments to assess concurrent validity. Receiver operating characteristics curve analysis was performed to examine diagnostic accuracy. RESULTS Chronbach's α coefficients of the DCAP-IADL were above 0.7. The values in dementia patients were much higher (OS=0.917, PS=0.927), indicating excellent degrees of internal consistency. Inter-rater reliabilities and test-retest reliabilities were statistically significant (p<0.05). PS exhibited higher reliabilities than OS. The mean OS and PS of dementia patients were significantly higher than those of the non-demented group after controlling for age, sex and education level. The DCAP-IADL was significantly correlated with other IADL instruments and MMSE-KC (p<0.001). Areas under the curves of the DCAP-IADL were above 0.9. CONCLUSION The DCAP-IADL is a reliable and valid instrument for evaluating instrumental ability of daily living for the elderly, and may also be useful for screening dementia. Moreover, administering PS may enable the DCAP-IADL to overcome the differences in gender, culture and life style that hinders accurate evaluation of the elderly in previous IADL instruments.
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Affiliation(s)
- Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jeong Ran Park
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jeong-Hwa Yoo
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Republic of Korea
| | - Jung Jae Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong Chul Yoon
- Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin, Republic of Korea
| | - Jin Hyeong Jhoo
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Inn Woo
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yoonseok Huh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tae Hui Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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Santos RL, Sousa MFBD, Ganem AC, Silva TV, Dourado MCN. Cultural aspects in dementia: differences in the awareness of Brazilian caregivers. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2013; 35:191-7. [DOI: 10.1590/s2237-60892013000300006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 11/14/2012] [Indexed: 11/22/2022]
Abstract
Objective: To explore differences in disease awareness in participants of a psychoeducational group designed for Latin American caregivers of people with dementia. Method: We assessed participants of a group developed at an outpatient unit for Alzheimer's disease. Interpretative phenomenological analysis was used to analyze differences in the caregivers' reports. Results and Discussion: The participants, mostly spouses and daughters, presented moderate caregiver burden and different levels of awareness (aware, partially aware, or unaware). Disease awareness and the development of coping strategies were influenced by familism, religiosity, and duty. Becoming a caregiver was considered positive in some cases, due to religious convictions and beliefs related to the importance of caregiving. Caregiver unawareness may reflect an attempt to maintain integrity of the patient's identity. Conclusions: Our data allow some comparisons across cultures, which may be valuable in assessing the influence of different psychosocial environments on the knowledge about dementia.
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Are subjective cognitive complaints relevant in preclinical Alzheimer's disease? A review and guidelines for healthcare professionals. ACTA ACUST UNITED AC 2012. [DOI: 10.1017/s0959259812000172] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
SummaryIdentifying what makes people vulnerable to developing Alzheimer's disease (AD) is at the forefront of many research programmes, while early diagnosis is the goal in clinical practice. What individuals themselves tell their general practitioners (GPs) is clearly important because these subjective complaints may be a clue that something is wrong. More specifically, subjective cognitive complaints (SCC) may be the first sign of AD in individuals whose cognitive performance on standard neuropsychological tasks is normal for their age. The challenge for researchers in this field is twofold: (a) determining when SCC do or do not predict current cognitive functioning and future dementia; and (b) estimating how relevant they are for patients and their proxies. The current article addresses these issues, while guidelines are also provided in an attempt to help clinicians interpret and make treatment decisions about their patients’ SCC.
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Molinuevo J, Hernández B. Perfil del cuidador informal asociado al manejo clínico del paciente con enfermedad de Alzheimer no respondedor al tratamiento sintomático de la enfermedad. Neurologia 2011; 26:518-27. [DOI: 10.1016/j.nrl.2011.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/26/2011] [Accepted: 05/30/2011] [Indexed: 10/18/2022] Open
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Abbate C, Trimarchi PD, Nicolini P, Bergamaschini L, Vergani C, Mari D. Comparison of informant reports and neuropsychological assessment in mild cognitive impairment. Am J Alzheimers Dis Other Demen 2011; 26:528-34. [PMID: 22155894 PMCID: PMC10845647 DOI: 10.1177/1533317511429323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this retrospective study was to investigate the accuracy of informant reports on cognitive status in mild cognitive impairment (MCI) by comparing the subjective evaluation made by patients' relatives with the objective results of neuropsychological assessment. We enrolled 119 MCI outpatients and their relatives. Cognitive impairment was assessed by a battery of standardized neuropsychological tests. Informant reports on cognitive functioning were obtained by means of a structured interview. Subjective and objective evaluations of cognitive status were rated according to the same scoring system in order to enable comparison. All but one relative reported cognitive dysfunctions at the interview, but the kind of cognitive profile emerging from their reports was quite different from the one highlighted by neuropsychological assessment. A subjective evaluation of cognitive status based on informant reports could therefore be useful to identify patients with MCI but is unable to define MCI subtypes.
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Affiliation(s)
- Carlo Abbate
- Fondazione I.R.C.C.S, Ca' Granda, Ospedale Maggiore Policlinico, U.O.C. Geriatria, Milano, Italy.
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Molinuevo J, Hernández B. Profile of the informal carer associated with the clinical management of the Alzheimer's disease patient refractory to symptomatic treatment of the disease. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/j.nrleng.2011.05.001] [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] Open
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Roberto KA, Blieszner R, McCann BR, McPherson MC. Family triad perceptions of mild cognitive impairment. J Gerontol B Psychol Sci Soc Sci 2011; 66:756-68. [PMID: 21994274 DOI: 10.1093/geronb/gbr107] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We examined subjective perceptions of memory loss among older adults with mild cognitive impairment (MCI) and two other relatives in order to improve understanding of family coping. We also investigated contextual conditions associated with perceptions of family dynamics and relationships. METHOD We conducted interviews with 56 family triads (the elder with MCI, the primary care partner, and a secondary care partner). Guided by Pearlin and colleagues' caregiving stress process framework, questions addressed perceptions of memory changes and interpretation of the effects of MCI on family interaction patterns. RESULTS Analyses of family triads revealed four degrees of the extent to which family members similarly acknowledged elders' MCI. The acknowledgment groups differed on history of family dynamics, experience with dementia, and perceived extent of memory change in the elder. Families characterized by full acknowledgment coped better with perceived changes in the elder's functioning than those in which members' perceptions of MCI were incongruent. DISCUSSION Pursuing family-level data on responses to MCI uncovered more nuanced reactions, often differing across triad members, than individual-based research has found. Family perceptions about changes in elders' memory have important implications for within-family interactions and support that can help families cope successfully with MCI.
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Affiliation(s)
- Karen A Roberto
- Center for Gerontology (0426), Virginia Tech, Blacksburg, VA 24061, USA.
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Hernandez SSS, Vital TM, Gobbi S, Costa JLR, Stella F. Atividade física e sintomas neuropsiquiátricos em pacientes com demência de Alzheimer. MOTRIZ: REVISTA DE EDUCACAO FISICA 2011. [DOI: 10.1590/s1980-65742011000300016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Na demência de Alzheimer (DA) é comum a presença de sintomas neuropsiquiátricos resultantes de mudanças anatômicas e bioquímicas no cérebro. O objetivo deste estudo foi realizar uma revisão sistemática dos estudos que investigaram a relação entre atividade física e sintomas neuropsiquiátricos na DA. Efetuou-se uma pesquisa nas bases de dados: Academic Search Premier, Biological Abstracts, Medline, PsycINFO, Pubmed, Scielo, Science Direct, Sport Discus e Web of Science, utilizando-se as seguintes palavras - chave e operadores boleanos: (Neuropsychiatric disturbances OR Neuropsychiatric symptoms OR Neuropsychological disturbances OR Aberrant behavior OR Aberrant behaviour OR Behavior disturbances OR Behaviour disturbances OR Behavior management OR Behaviour management OR Disruptive behavior OR Disruptive behaviour) AND (Alzheimer) AND (Exercise OR Motor intervention OR training OR Physical activity OR fitness), além de referências cruzadas dos artigos selecionados. Foram encontrados oito estudos que preencheram os critérios de inclusão. Concluiu-se que bons resultados têm sido evidenciados para os distúrbios de agitação e sono de pacientes com DA. Entretanto então há um consenso de qual o melhor tipo de atividade para estes pacientes.
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Affiliation(s)
| | | | | | | | - Florindo Stella
- Univ Estadual Paulista, Brasil; Universidade Estadual de Campinas, Brasil
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Wiechetek Ostos M, Schenk F, Baenziger T, von Gunten A. An exploratory study on facial emotion recognition capacity in beginning Alzheimer's disease. Eur Neurol 2011; 65:361-7. [PMID: 21625142 DOI: 10.1159/000327979] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 03/18/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE It was the aim of this study to investigate facial emotion recognition (FER) in the elderly with cognitive impairment. METHOD Twelve patients with Alzheimer's disease (AD) and 12 healthy control subjects were asked to name dynamic or static pictures of basic facial emotions using the Multimodal Emotion Recognition Test and to assess the degree of their difficulty in the recognition task, while their electrodermal conductance was registered as an unconscious processing measure. RESULTS AD patients had lower objective recognition performances for disgust and fear, but only disgust was accompanied by decreased subjective FER in AD patients. The electrodermal response was similar in all groups. No significant effect of dynamic versus static emotion presentation on FER was found. CONCLUSION Selective impairment in recognizing facial expressions of disgust and fear may indicate a nonlinear decline in FER capacity with increasing cognitive impairment and result from progressive though specific damage to neural structures engaged in emotional processing and facial emotion identification. Although our results suggest unchanged unconscious FER processing with increasing cognitive impairment, further investigations on unconscious FER and self-awareness of FER capacity in neurodegenerative disorders are required.
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Affiliation(s)
- Marzanna Wiechetek Ostos
- Consultation de la Mémoire, Département de Psychiatrie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Sousa MFBD, Santos RL, Brasil D, Dourado M. Consciência da doença na demência do tipo Alzheimer: uma revisão sistemática de estudos longitudinais. JORNAL BRASILEIRO DE PSIQUIATRIA 2011. [DOI: 10.1590/s0047-20852011000100010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVOS: Avaliar as definições, métodos de avaliação e hipóteses etiológicas utilizadas em estudos longitudinais sobre consciência da doença na demência do tipo Alzheimer. MÉTODO: Pesquisa, nas bases de dados Medline, ISI, Lilacs e SciELO, de estudos longitudinais sobre consciência da doença na demência do tipo Alzheimer entre 1999 e 2009. As palavras-chave utilizadas foram: "Alzheimer", "dementia", "anosognosia", "awareness of deficit", "awareness of disease", "insight" e "longitudinal study". Os artigos examinados foram classificados conforme as hipóteses etiológicas encontradas. RESULTADOS: Os nove artigos selecionados foram divididos em duas áreas: hipóteses etiológicas biológicas e hipóteses etiológicas psicossociais. Os termos "falta de consciência dos déficits", "consciência do déficit", "insight" e "negação do déficit de memória" são utilizados nos estudos como sinônimos do termo "anosognosia", mesmo sendo, conceitualmente, diferentes. O método de avaliação mais utilizado foi o uso de questionários de discrepância entre os relatos dos pacientes e cuidadores. CONCLUSÕES: Os estudos longitudinais apresentam hipóteses etiológicas heterogêneas, além da inexistência de um padrão conceitual e metodológico de avaliação. Essas dificuldades impossibilitam a obtenção de resultados homogêneos, o que gera a necessidade de aprofundamento dos estudos na área.
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Dahlrup B, Nordell E, Andrén S, Elmståhl S. Family caregivers' assessment of symptoms in persons with dementia using the GBS-scale: differences in rating after psychosocial intervention--an 18-month follow-up study. Clin Interv Aging 2010; 6:9-18. [PMID: 21472087 PMCID: PMC3066248 DOI: 10.2147/cia.s14237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to examine if psychosocial intervention for family caregivers made any differences in describing symptoms of dementia in the persons they cared for. The study population comprised family caregivers of persons aged 70 years and older receiving social services and diagnosed with dementia disorders. A group of 129 family caregivers underwent psychosocial intervention including education, information, and provision of a support group, while 133 family caregivers did not and these formed the control group. Family caregivers were followed-up every 6 months for a total of 18 months. They rated intellectual, emotional, and activity of daily living (ADL) functions in persons with dementia using the Gottfries-Bråne-Steen scale (GBS-scale). Family caregivers who underwent psychosocial intervention rated the intellectual and emotional symptoms of dementia significantly higher 6 months later compared to controls and the effect was sustained during the 18-month follow-up irrespective of relationship and education. Most notably, decrease in function of recent memory, ability to increase tempo, long-windedness, distractibility, and blunting were better identified. Our findings suggest that the family caregivers who underwent psychosocial intervention achieved better understanding of different symptoms and the behaviors of dementia. These findings may explain earlier findings of positive effects after psychosocial intervention on family caregivers’ sense of burden, satisfaction, and ability to delay nursing home placement.
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Affiliation(s)
- Beth Dahlrup
- Department of Health Sciences, Division of Geriatric Medicine, Lund University, Sweden.
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Pereira FS, Oliveira AM, Diniz BS, Forlenza OV, Yassuda MS. Cross-cultural Adaptation, Reliability and Validity of the DAFS-R in a Sample of Brazilian Older Adults. Arch Clin Neuropsychol 2010; 25:335-43. [DOI: 10.1093/arclin/acq029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ohman A, Nygård L, Kottorp A. Occupational performance and awareness of disability in mild cognitive impairment or dementia. Scand J Occup Ther 2010; 18:133-42. [PMID: 20334589 DOI: 10.3109/11038121003645993] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Limited awareness of disabilities is common in mild cognitive impairment and dementia. In order to get a broader base in planning interventions, it is important to consider a person's awareness of his/her disability encountered in performance. The aim of this study was to examine the relationship between occupational performance and awareness of disability in older adults with mild cognitive impairment or dementia. Thirty-five older adults were evaluated with the AMPS (Assessment of Motor and Process Skills) and with the AAD (Assessment of Awareness of Disability). Many-faceted Rasch models generated individual measures of ADL performance and awareness of disability. Non-parametric correlation statistics were used to analyse the relationships. The findings showed that there was an overall positive relationship between occupational performance and awareness of disability. However, individual variations in the sample implied that limitations in performance were not equivalent to a limited awareness of disability. In conclusion, awareness of disability should be individually evaluated when planning interventions together with clients and their families.
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Affiliation(s)
- Annika Ohman
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
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Abstract
This paper reviews the characteristics of sleep disorders found in people at a greater risk of dementia: the elderly adult, patients with mild cognitive impairment (MCI) and those with neurodegenerative diseases. The frequency of sleep architecture modifications and circadian rhythm sleep disturbances increases with age. Although around 40% of older adults complain of poor sleep, true sleep disorders are far less prevalent in healthy older adults and are frequently associated with comorbidities. The sleep disorders observed in Alzheimer's disease (AD) patients are often similar to (but more intense than) those found in non-demented elderly people. Poor sleep results in an increased risk of significant morbidities and even mortality in demented patients and constitutes a major source of stress for caregivers. The prevalence of primary sleep disorders such as rapid eye movement (REM) sleep behavior disorders (RBDs), restless legs syndrome (RLS), periodic limb movements (PLMs) and sleep-disordered breathing increases with age. There are no published data on RLS and PLMs in demented persons but RBDs and sleep apnea syndrome have been studied more extensively. In fact, RBDs are suggestive of Lewy body dementia (LBD) and are predictive for neurodegeneration in Parkinson's disease. Obstructive sleep apnea (OSA) shares common risk factors with AD and may even be an integral part of the pathological process in AD. In MCI patients, the hypotheses in which (i) sleep disorders may represent early predictive factors for progression to dementia and (ii) MCI is symptomatic of a non-diagnosed sleep disorder remain to be elucidated. Guidelines for drug and non-drug treatments of sleep disorders in the elderly and in demented patients are also considered in this review. In healthy but frail elderly people and in early-stage AD patients, sleep should be more thoroughly characterized (notably by using standardized interviews and polysomnographic recording).
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Affiliation(s)
- S Bombois
- Center for Memory Resources and Research, EA2691, Lille University Hospital, University of Lille Nord de France, Lille cedex, France.
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Abstract
Extensive research supports the use of informant ratings in diagnosing dementia. In comparison, far fewer studies have examined the use of informant ratings in identifying mild cognitive impairment (MCI), a state that occurs as healthy older adults make the gradual transition to dementia. A review of available studies that have examined discrepancies between MCI patient and informant reports has for the most part demonstrated that informant ratings reveal greater loss of everyday functional ability and cognitive competency. Additionally, current findings support a significantly greater association of informant ratings with objective measures of patient cognitive performance and characteristics of underlying dementing processes. Structured measures used to examine the diagnostic efficacy of informant ratings in identifying cases of MCI are reviewed. Two recently developed instruments seem especially promising, but further validation efforts will be required before they can be considered to meet standards for clinical use.
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Riepe MW, Mittendorf T, Förstl H, Frölich L, Haupt M, Leidl R, Vauth C, von der Schulenburg MG. Quality of life as an outcome in Alzheimer's disease and other dementias--obstacles and goals. BMC Neurol 2009; 9:47. [PMID: 19706186 PMCID: PMC2746172 DOI: 10.1186/1471-2377-9-47] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 08/25/2009] [Indexed: 11/10/2022] Open
Abstract
Background The number of individuals at risk for dementia will probably increase in ageing societies as will the array of preventive and therapeutic options, both however within limited economic resources. For economic and medical purposes valid instruments are required to assess disease processes and the efficacy of therapeutic interventions for different forms and stages of illness. In principal, the impact of illness and success of an intervention can be assessed with biomedical variables, e.g. severity of symptoms or frequency of complications of a disease. However, this does not allow clear judgement on clinical relevance or comparison across different diseases. Discussion Outcome model variables such as quality of life (QoL) or health care resource utilization require the patient to appraise their own well-being or third parties to set preferences. In Alzheimer's disease and other dementias the evaluation process performed by the patient is subject to the disease process itself because over progress of the disease neuroanatomical structures are affected that mediate evaluation processes. Summary Published research and methodological considerations thus lead to the conclusion that current QoL-instruments, which have been useful in other contexts, are ill-suited and insufficiently validated to play a major role in dementia research, decision making and resource allocation. New models integrating biomedical and outcome variables need to be developed in order to meet the upcoming medical and economic challenges.
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Affiliation(s)
- Matthias W Riepe
- Department of Psychiatry and Psychotherapy II, Mental Health & Old Age Psychiatry, Ulm University, Ulm, Germany.
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Abstract
BACKGROUND Normal aging and dementia are characterized by increased prevalence of sleep disorders and alterations of both sleep continuity and architecture. However, little is still known about the nature of sleep in mild cognitive impairment (MCI), which is presumably situated on the continuum from healthy aging to dementia. This unsystematic review summarizes the current literature on the prevalence and severity of sleep disturbances in MCI. METHODS Eighteen studies addressing sleep/night-time disturbances among other neuropsychiatric symptoms in individuals with MCI were identified through a search of databases and an examination of reference lists of selected papers. Fifteen of those studies reported data on prevalence or severity of sleep/night-time disturbances. RESULTS Results indicated that 14-59% of patients with MCI had sleep disturbances. These disturbances were often identified as one of the four most prevalent neuropsychiatric symptoms of MCI and were considered as clinically significant in some studies. In addition, there was some evidence that the prevalence of sleep disturbances in MCI is intermediate between that of normal aging and dementia. Longitudinal data suggest that sleep problems are associated with both incident MCI and dementia. CONCLUSIONS These findings support the hypothesis that sleep disturbances are one of the core non-cognitive symptoms of MCI. It remains to be known whether sleep problems could help to identify those individuals with MCI who will eventually develop dementia. Studies characterizing sleep more systematically are needed to verify this proposition and to clarify the associations between sleep disturbances and other neuropsychiatric symptoms of MCI.
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Pringle Specht JK, Taylor R, Bossen AL. Partnering for Care: The Evidence and the Expert. J Gerontol Nurs 2009; 35:16-22. [DOI: 10.3928/00989134-20090301-09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bossen AL, Pringle Specht JK, McKenzie SE. Needs of People with Early-Stage Alzheimer’s Disease: Reviewing the Evidence. J Gerontol Nurs 2009; 35:8-15. [DOI: 10.3928/00989134-20090301-01] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kurz A, Cramer B, Egert S, Frölich L, Gertz HJ, Knorr C, Thöne-Otto A, Wagenpfeil S, Werheid K. Neuropsychologisch fundierte kognitive Verhaltenstherapie für Patienten mit Alzheimer-Krankheit im Frühstadium. ACTA ACUST UNITED AC 2008. [DOI: 10.1024/1011-6877.21.3.157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Die KORDIAL-Studie (Kognitiv-verhaltenstherapeutische ressourcenorientierte Therapie früher Demenzen im Alltag) ist eine multizentrische, randomisierte, kontrollierte, einfach-blinde Parallelgruppen-Studie zur Evaluation der Wirksamkeit einer neuropsychologisch fundierten verhaltenstherapeutischen Intervention für Patienten im klinischen Frühstadium der Alzheimer-Krankheit unter Alltagsbedingungen. Die experimentelle Intervention wurde speziell auf die Bedürfnisse und Fähigkeiten von Patienten mit beginnender Demenz abgestimmt. Sie zielt sowohl auf die Aufrechterhaltung der Funktionsfähigkeit im Alltag, vor allem durch Vermittlung von Strategien zur Kompensation kognitiver Defizite, als auch auf die emotionale Bewältigung der Krankheit und auf die Prävention sekundärer psychopathologischer Symptome ab. Um möglichst dauerhafte Veränderungen im Alltag zu erzielen, werden die Bezugspersonen der Patienten systematisch in die Intervention einbezogen. Im Falle des positiven Ausgangs der Studie könnte eine auf neuropsychologischen Erkenntnissen basierende Verhaltenstherapie zu einem etablierten Bestandteil der Behandlung von Patienten mit beginnender Demenz werden.
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Affiliation(s)
- Alexander Kurz
- Klinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München
| | - Barbara Cramer
- Klinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München
| | - Silvia Egert
- Münchner Studienzentrum, Klinikum rechts der Isar, Technische Universität München
| | - Lutz Frölich
- Abteilung Gerontopsychiatrie, Zentralinstitut für Seelische Gesundheit, Mannheim
| | | | - Carolin Knorr
- Abteilung Gerontopsychiatrie, Zentralinstitut für Seelische Gesundheit, Mannheim
| | | | - Stefan Wagenpfeil
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München
| | - Katja Werheid
- Institut für Psychologie, Humboldt-Universität zu Berlin
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Sørensen LV, Waldorff FB, Waldemar G. Early counselling and support for patients with mild Alzheimer's disease and their caregivers: a qualitative study on outcome. Aging Ment Health 2008; 12:444-50. [PMID: 18791891 DOI: 10.1080/13607860802224342] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this qualitative study was to identify and analyse the participants' experienced outcome of an intensive structured psychosocial intervention programme with tailored counselling, education and support groups for home-living patients with mild Alzheimer's disease and their spousal caregivers. METHOD Data were collected by semi-structured in-depth interviews conducted separately with each person in 10 couples before the intervention and 1-3 months after completed intervention. For the analysis, a template organizing style of interpretation was used. RESULTS The analysis revealed that patients found support groups relevant: they found it stimulating to be with peers, it supported their self-esteem, and it supported them in finding new ways of managing everyday life and social relations. During and after the intervention, caregivers were better able to cope with the challenges their partner's disease involved, and they were able to face everyday life and social relations with more serenity and competence. After the intervention, both patients and caregivers sought suitable support groups they could join as a permanent activity and caregivers sought permanent counselling. CONCLUSION Early tailored counselling and support may improve patients' and caregivers' opportunities to adapt to the challenges of Alzheimer's disease and to maintain well-being.
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Affiliation(s)
- Lisbeth V Sørensen
- Department of Neurology, Memory Disorder Research Group, Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Arlt S, Hornung J, Eichenlaub M, Jahn H, Bullinger M, Petersen C. The patient with dementia, the caregiver and the doctor: cognition, depression and quality of life from three perspectives. Int J Geriatr Psychiatry 2008; 23:604-10. [PMID: 18008392 DOI: 10.1002/gps.1946] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND For comprehensive information about the situation of patients with dementia or mild cognitive impairment (MCI), clinicians have to rely on information from different sources, e.g. caregivers or the patients themselves, which may differ from each other. In addition to the assessment of cognitive impairment, the importance of evaluating not only depressive symptoms but also health related quality of life (HRQOL) in clinical research and practice in dementia has increased. OBJECTIVE To examine about how the ratings of patients, caregivers and clinicians regarding the patients' cognitive impairment, depression and HRQOL relate to each other by comparing these three perspectives by using self- and proxy-rating measures. METHOD One hundred outpatients with mild to moderate dementia or MCI and their family caregivers participated in this study. Depression and cognitive impairment were examined with self- and proxy-ratings as well as the Mini-Mental Status Examination (MMSE); HRQOL was assessed with the SF-12 Health Survey and the EUROHIS quality of life index. RESULTS We found high correspondence between caregivers' assessment of cognitive function and MMSE scores, while patients' self-rating did not correlate with MMSE. HRQOL was underestimated by caregivers compared to self-rating. Concerning depression, the patients' assessment was in good accordance with the clinician's evaluation. CONCLUSION The study suggests that patients with mild to moderate dementia and MCI are important informants of their HRQOL and depressive symptoms, but they underestimate their cognitive deficits. Assessing different perspectives of the patients' HRQOL is relevant in order to obtain a comprehensive understanding of the patients' well-being.
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Affiliation(s)
- Sönke Arlt
- Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany.
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