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Manca R, De Marco M, Colston A, Raymont V, Amin J, Davies R, Kumar P, Russell G, Blackburn DJ, Venneri A. The Impact of Social Isolation Due to COVID-19 on Symptom Progression in People With Dementia: Findings of the SOLITUDE Study. Front Psychiatry 2022; 13:877595. [PMID: 35619615 PMCID: PMC9127264 DOI: 10.3389/fpsyt.2022.877595] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND People with dementia (PWD) are vulnerable to abrupt changes to daily routines. The lockdown enforced on the 23rd of March 2020 in the UK to contain the expansion of the COVID-19 pandemic limited opportunities for PWD to access healthcare services and socialise. The SOLITUDE study explored the potential long-term effects of lockdown on PWD's symptoms and carers' burden. METHODS Forty-five carers and 36 PWD completed a telephone-based assessment at recruitment (T0) and after 3 (T1) and 6 months (T2). PWD completed measures validated for telephonic evaluations of cognition and depression. Carers completed questionnaires on their burden and on PWD's health and answered a customised interview on symptom changes observed in the initial months of lockdown. Longitudinal changes were investigated for all outcome variables with repeated-measures models. Additional post hoc multiple regression analyses were carried out to investigate whether several objective factors (i.e., demographics and time under social restrictions) and carer-reported symptom changes observed following lockdown before T0 were associated with all outcomes at T0. RESULTS No significant changes were observed in any outcomes over the 6 months of observations. However, post hoc analyses showed that the length of social isolation before T0 was negatively correlated with episodic and semantic memory performance at T0. Carers reporting worsening of neuropsychiatric symptoms and faster disease progression in PWD also reported higher burden. Moreover, carer-reported worsening of cognitive symptoms was associated with poorer semantic memory at T0. CONCLUSION PWD's symptoms and carers' burden remained stable over 6 months of observation. However, the amount of time spent under social restrictions before T0 appears to have had a significant detrimental impact on cognitive performance of patients. In fact, carer-reported cognitive decline during social isolation was consistent with the finding of poorer semantic memory, a domain sensitive to progression in Alzheimer's disease. Therefore, the initial stricter period of social isolation had greater detrimental impact on patients and their carers, followed then by a plateau. Future interventions may be designed to maintain an optimal level of social and cognitive engagement for PWD in challenging times, to prevent abrupt worsening of symptoms and associated detrimental consequences on patients' carers.
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Affiliation(s)
- Riccardo Manca
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Matteo De Marco
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Amanda Colston
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Vanessa Raymont
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Jay Amin
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Memory Assessment and Research Centre, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Rhys Davies
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Pramod Kumar
- Berkshire Healthcare NHS Foundation Trust, Bracknell, United Kingdom
| | - Gregor Russell
- Bradford District Care NHS Foundation Trust, Bradford, United Kingdom
| | - Daniel J Blackburn
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Annalena Venneri
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
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Wasef S, Laksono I, Kapoor P, Tang-Wei D, Gold D, Saripella A, Riazi S, Islam S, Englesakis M, Wong J, Chung F. Screening for subjective cognitive decline in the elderly via subjective cognitive complaints and informant-reported questionnaires: a systematic review. BMC Anesthesiol 2021; 21:277. [PMID: 34753428 PMCID: PMC8579566 DOI: 10.1186/s12871-021-01493-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Subjective cognitive decline may represent at-risk persons progressing to mild cognitive impairment (MCI), which can be exacerbated by effects of anesthesia and surgery. The objective of this systematic review is to identify the most common questions in subjective cognitive complaint and informant-reported questionnaires used in assessing cognitive impairment of elderly patients that are correlated with standardized tests for cognitive impairment screening. METHODS We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database, Emcare Nursing, Web of Science, Scopus, CINAHL, ClinicalTrials.Gov, and ICTRP between September 20, 2005 to August 31, 2020. We included studies that evaluated subjective cognitive complaints and informant-reported questions in elderly patients. RESULTS AND CONCLUSION A total of 28,407 patients were included from 22 studies that assessed 21 subjective complaint questionnaires and nine informant-reported questionnaires. The most common subjective cognitive complaints were those assessing anterograde memory, closely followed by perceptual-motor function and executive function. The most common informant-reported questions were those assessing executive function, temporal orientation, and anterograde memory. Questions assessing learning and memory were most associated with results from standardized tests assessing cognitive impairment. Assessing learning and memory plays a key role in evaluating subjective cognitive decline in elderly patients. Delivering subjective cognitive complaints questions to elderly patient preoperatively may aid in screening for those exhibiting cognitive signs, and in turn are at risk of postoperative complications. Thus, the results from this review contribute to knowledge for healthcare professionals regarding the use of subjective cognitive complaints and informant-reported complaints in preoperative settings.
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Affiliation(s)
- Sara Wasef
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Isabelle Laksono
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Paras Kapoor
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Tang-Wei
- Department of Neurology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Gold
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sheila Riazi
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sazzadul Islam
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
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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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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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