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Fang Z, Zhang Q. Association between cognitive impairment and cardiovascular mortality in mature and older adults: A meta-analysis. Exp Gerontol 2024; 192:112440. [PMID: 38679351 DOI: 10.1016/j.exger.2024.112440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Cognitive impairment contributes significantly to negative health outcomes. This meta-analysis aimed to investigate the association between cognitive impairment and cardiovascular mortality in mature and older adults. METHODS PubMed, Web of Science, and Embase databases were searched until February 10, 2024, to identify the association between cognitive impairment and cardiovascular mortality in mature and older adults (aged 50 years and older) from the general population. The adjusted risk estimates from the included studies were extracted and pooled using a random effects model. RESULTS Ten studies were included in the meta-analysis, involving 16,765 participants. The pooled hazard ratio (HR) of cardiovascular mortality was 1.75 (95 % confidence interval [CI] 1.44-2.14; I2 = 48.2 %) for individuals with cognitive impairment compared to those without, even after adjusting for common confounding factors. Subgroup analysis revealed that the prognostic value of cognitive impairment may be influenced by the assessment tools used for measuring cognition. Additionally, cognitive impairment significantly predicted cardiovascular mortality in women (HR 2.40; 95 % CI 1.54-3.74; I2 = 45.4 %) but not in men (HR 1.49; 95 % CI 0.99-2.24; I2 = 44.8 %). CONCLUSIONS Cognitive impairment is a significant predictor of cardiovascular mortality in mature and older adults from the general population. However, future studies are needed to evaluate the specific impact of cognitive impairment on different genders.
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Affiliation(s)
- Ze Fang
- Department of Geriatrics, Zhongjiang County People's Hospital, Zhongjiang County, Deyang City, Sichuan Province 618100, China.
| | - Qiongfang Zhang
- Department of Infection Management, Zhongjiang County People's Hospital, Zhongjiang County, Deyang City, Sichuan Province 618100, China
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Bergman H, Borson S, Jessen F, Krolak-Salmon P, Pirani A, Rasmussen J, Rodrigo J, Taddeo D. Dementia and comorbidities in primary care: a scoping review. BMC PRIMARY CARE 2023; 24:277. [PMID: 38097969 PMCID: PMC10720181 DOI: 10.1186/s12875-023-02229-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND People with dementia (PwD) are known to have more chronic conditions compared to those without dementia, which can impact the clinical presentation of dementia, complicate clinical management and reduce overall quality of life. While primary care providers (PCPs) are integral to dementia care, it is currently unclear how PCPs adapt dementia care practices to account for comorbidities. This scoping review maps recent literature that describes the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities, identifies critical knowledge gaps and proposes potential avenues for future research. METHODS We searched for peer-reviewed literature published between 2017-2022 in MEDLINE, Cochrane Library, and Scopus using key terms related to dementia, primary care, and comorbidity. The literature was screened for relevance by title-abstract screening and subsequent full-text screening. The prioritized papers were categorized as either 'Risk Assessment and Prevention', 'Screening, Detection, and Diagnosis' or 'Management' and were further labelled as either 'Tools and Technologies', 'Recommendations for Clinical Practice' or 'Programs and Initiatives'. RESULTS We identified 1,058 unique records in our search and respectively excluded 800 and 230 publications during title-abstract and full-text screening. Twenty-eight articles were included in our review, where ~ 50% describe the development and testing of tools and technologies that use pre-existing conditions to assess dementia risk. Only one publication provides official dementia screening guidelines for PCPs in people with pre-existing conditions. About 30% of the articles discuss managing the care of PwD, where most were anchored around models of multidisciplinary care and mitigating potentially inappropriate prescribing. CONCLUSION To our knowledge, this is the first scoping review that examines the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities. Given our findings, we recommend that future studies: 1) further validate tools for risk assessment, timely detection and diagnosis that incorporate other health conditions; 2) provide additional guidance into how comorbidities could impact dementia care (including prescribing medication) in primary care settings; 3) incorporate comorbidities into primary care quality indicators for dementia; and 4) explore how to best incorporate dementia and comorbidities into models/frameworks of holistic, person-centred care.
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Affiliation(s)
- Howard Bergman
- Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC, H3S 1Z1, Canada.
| | - Soo Borson
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Frank Jessen
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | | | | | | | - Jesus Rodrigo
- Spanish Alzheimer's Confederation (Confederación Española de Alzheimer), Pamplona, Spain
| | - Daiana Taddeo
- Italian College of General Practitioners and Primary Care (SIMG - Società Italiana Di Medicina Genrale E Cure Primarie), Florence, Italy
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Giannakou K, Golenia A, Liabeuf S, Malyszko J, Mattace-Raso F, Farinha A, Spasovski G, Hafez G, Wiecek A, Capolongo G, Capasso G, Massy ZA, Pépin M. Methodological challenges and biases in the field of cognitive function among patients with chronic kidney disease. Front Med (Lausanne) 2023; 10:1215583. [PMID: 37621458 PMCID: PMC10446481 DOI: 10.3389/fmed.2023.1215583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic kidney disease (CKD) affects approximately 850 million people globally and is associated with an increased risk of cognitive impairment. The prevalence of cognitive impairment among CKD patients ranges from 30 to 60%, and the link between CKD and cognitive impairment is partially understood. Methodological challenges and biases in studying cognitive function in CKD patients need to be addressed to improve diagnosis, treatment, and management of cognitive impairment in this population. Here, we review the methodological challenges and study design issues, including observational studies' limitations, internal validity, and different types of bias that can impact the validity of research findings. Understanding the unique challenges and biases associated with studying cognitive function in CKD patients can help to identify potential sources of error and improve the quality of future research, leading to more accurate diagnoses and better treatment plans for CKD patients.
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Affiliation(s)
- Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | | | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Francesco Mattace-Raso
- Department of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ana Farinha
- Department of Nephrology, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Goce Spasovski
- University Department of Nephrology, Clinical Centre “Mother Theresa”University Sts Cyril and Methodius, Skopje, North Macedonia
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Türkiye
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Giovanna Capolongo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Biogem Research Institute, Ariano Irpino, Italy
| | - Ziad A. Massy
- Service de Néphrologie, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris & Université Paris-Saclay (Versailles-Saint-Quentin-en-Yvelines), Boulogne Billancourt, France
- Inserm U-1018 Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Équipe 5, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
| | - Marion Pépin
- Inserm U-1018 Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Équipe 5, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
- Departement of Geriatric Medicine, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
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Völter C, Fricke H, Götze L, Labrenz F, Tokic M, Wirth R, Nasreddine ZS, Dawes P. Evaluation of the non-auditory neurocognitive test MoCA-HI for hearing-impaired. Front Neurol 2022; 13:1022292. [PMID: 36582608 PMCID: PMC9792785 DOI: 10.3389/fneur.2022.1022292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
Background Since hearing loss and cognitive decline often co-occur among older adults, a cognitive screening test suitable for hearing-impaired people is of high clinical relevance. We report the first evaluation of a German language version of the Montreal Cognitive Assessment-Hearing Impaired version (MoCA-HI). Objective The aim of the present study was to compare cognitively healthy participants with and without hearing loss, to examine the impact of age, sex, educational level and degree of hearing impairment on the German MoCA-HI performance, and to develop normative data. Material and methods The German MoCA-HI was tested in 94 participants with normal or mild hearing impairment (group 1: 4PTA ≤ 40 dB on the better hearing ear) and 81 participants with moderate to profound hearing loss (group 2: 4PTA > 40 dB on the better hearing ear). Additionally, all participants performed the standard MoCA (version 8.2). Results No significant group difference between group 1 and 2 was found in the MoCA-HI total score (p = 0.05). In contrast, group 1 performed significantly better than group 2 on the standard MoCA (p < 0.001). There was no difference between the MoCA and the MoCA-HI performance in group 1 (p = 0.12), whereas individuals of group 2 performed significantly better on the MoCA-HI than on the standard MoCA (p < 0.001). Test-retest reliability of the MoCA-HI was high (p < 0.001). Higher age (p < 0.001), male sex (p = 0.009) and lower education (p < 0.001) were associated with a lower overall MoCA-HI score. Based on the demographic data normative data were developed by a regression-based approach. Conclusion The MoCA-HI is a cognitive screening test which is suitable for people with hearing impairment.
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Affiliation(s)
- Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany,*Correspondence: Christiane Völter
| | - Hannah Fricke
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Lisa Götze
- Department of Otorhinolaryngology, Head and Neck Surgery, Catholic Hospital Bochum, Bochum, Germany
| | - Franziska Labrenz
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Marianne Tokic
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | | | - Piers Dawes
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
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Giaquinto F, Battista P, Angelelli P. Touchscreen Cognitive Tools for Mild Cognitive Impairment and Dementia Used in Primary Care Across Diverse Cultural and Literacy Populations: A Systematic Review. J Alzheimers Dis 2022; 90:1359-1380. [PMID: 36245376 DOI: 10.3233/jad-220547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Touchscreen cognitive tools opened new promising opportunities for the early detection of cognitive impairment; however, most research studies are conducted in English-speaking populations and high-income countries, with a gap in knowledge about their use in populations with cultural, linguistic, and educational diversity. OBJECTIVE To review the touchscreen tools used in primary care settings for the cognitive assessment of mild cognitive impairment (MCI) and dementia, with a focus on populations of different cultures, languages, and literacy. METHODS This systematic review was conducted following the PRISMA guidelines. Studies were identified by searching across MEDLINE, EMBASE, EBSCO, OVID, SCOPUS, SCIELO, LILACS, and by cross-referencing. All studies that provide a first-level cognitive assessment for MCI and dementia with any touchscreen tools suitable to be used in the context of primary care were included. RESULTS Forty-two studies reporting on 30 tools and batteries were identified. Substantial differences among the tools emerged, in terms of theoretical framework, clinical validity, and features related to the application in clinical practice. A small proportion of the tools are available in multiple languages. Only 7 out of the 30 tools have a multiple languages validation. Only two tools are validated in low-educated samples, e.g., IDEA and mSTS-MCI. CONCLUSION General practitioners can benefit from touchscreen cognitive tools. However, easy requirements of the device, low dependence on the examiner, fast administration, and adaptation to different cultures and languages are some of the main features that we need to take into consideration when implementing touchscreen cognitive tools in the culture and language of underrepresented populations.
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Affiliation(s)
- Francesco Giaquinto
- Department of History, Laboratory of Applied Psychology and Intervention, Society and Human Studies, University of Salento, Lecce, Italy
| | - Petronilla Battista
- Clinical and Scientific Institutes Maugeri Pavia, Scientific Institute of Bari, IRCCS, Italy
| | - Paola Angelelli
- Department of History, Laboratory of Applied Psychology and Intervention, Society and Human Studies, University of Salento, Lecce, Italy
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Identifying Primary Care Models of Dementia Care that Improve Quality of Life for People Living with Dementia and their Care Partners: An Environmental Scan. Can J Aging 2022; 41:550-564. [PMID: 36482723 DOI: 10.1017/s0714980821000635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Dementia is a growing concern in Canada, affecting peoples' health and raising the cost of care. Between June and October 2019, we conducted an environmental scan to identify primary care models, strategies, and resources for dementia care from 11 pre-selected countries and assess their impact on quality-of-life measures. Search strategies included a rapid scoping review, grey literature search, and discussions with stakeholders. Eighteen primary care-based models of dementia care were identified. Common factors include team-based care, centralized care/case coordination, individual treatment plans, a stepped-care approach, and support for care partners. Five provinces had released a dementia strategy. Evidence of positive outcomes supported primary care-based models for dementia care, although only one model demonstrated evidence of impact on quality of life. Although these findings are encouraging, further research is needed to identify primary care-based models of dementia care that demonstrably improve quality of life for people living with dementia and their care partners.
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Carson RG, Holton E. Deficits in rate of force production during multifinger tasks are associated with cognitive status. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5732. [PMID: 35586946 PMCID: PMC9321751 DOI: 10.1002/gps.5732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/27/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The multifinger force deficit (MFFD) is the decline in force generated by an individual finger as the number of fingers contributing to the action is increased. It has been proposed that as a measure of neural sufficiency rather than muscle status, it provides a means of detecting individuals at risk of cognitive decline. Age-related deficits in central neural drive exert a disproportionate impact on the rate at which force can be generated. We examined whether a MFFD derived from the maximum rate at which force is generated, is more sensitive to individual differences in cognitive status, than one calculated using the maximum level of force. METHODS Monotonic associations between each of two variants of the MFFD, and cognition (measured with the Montreal Cognitive Assessment), were estimated cross sectionally using generalized partial rank correlations, in which age, level of education and degree of handedness were included as covariates. The participants (n=26) were community dwelling adults aged 66-87. RESULTS The MFFD derived using the maximum rate of force development was negatively associated with cognitive status. The association for the MFFD based on the maximum level of force, was not statistically reliable. The associations with cognitive status obtained for both variants of the MFFD were of greater magnitude than those reported previously for standard grip strength dynamometry. CONCLUSION The sensitivity with which the MFFD detects risk of cognitive decline may be enhanced by using the maximum rate of force developed by each finger, rather than the maximum force generated by each finger.
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Affiliation(s)
- Richard G. Carson
- Trinity College Institute of Neuroscience and School of PsychologyTrinity College DublinDublin 2Ireland,School of PsychologyQueen's University BelfastBelfastNorthern IrelandUK
| | - Eimíle Holton
- Trinity College Institute of Neuroscience and School of PsychologyTrinity College DublinDublin 2Ireland
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Lin S, Chen M. Gender-specific impact of cognitive impairment on all-cause mortality in older persons: A meta-analysis. Exp Gerontol 2022; 165:111860. [DOI: 10.1016/j.exger.2022.111860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/23/2022] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
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Cucos CA, Cracana I, Dobre M, Popescu BO, Tudose C, Spiru L, Manda G, Niculescu G, Milanesi E. Sulfiredoxin-1 blood mRNA expression levels negatively correlate with hippocampal atrophy and cognitive decline. F1000Res 2022; 11:114. [PMID: 35242306 PMCID: PMC8857523 DOI: 10.12688/f1000research.76191.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Cognitive decline, correlating with hippocampal atrophy, characterizes several neurodegenerative disorders having a background of low-level chronic inflammation and oxidative stress. Methods: In this cross-sectional study, we examined how cognitive decline and hippocampal subfields volume are associated with the expression of redox and inflammatory genes in peripheral blood. We analyzed 34 individuals with different cognitive scores according to Mini-Mental State Examination, corrected by age and education (adjMMSE). We identified a group presenting cognitive decline (CD) with adjMMSE<27 (n=14) and a normal cognition (NC) group with adjMMSE≥27 (n=20). A multiparametric approach, comprising structural magnetic resonance imaging measurement of different hippocampal segments and blood mRNA expression of redox and inflammatory genes was applied. Results: Our findings indicate that hippocampal segment volumes correlate positively with adjMMSE and negatively with the blood transcript levels of 19 genes, mostly redox genes correlating especially with the left subiculum and presubiculum. A strong negative correlation between hippocampal subfields atrophy and Sulfiredoxin-1 (
SRXN1) redox gene was emphasized. Conclusions: Concluding, these results suggest that
SRXN1 might be a valuable candidate blood biomarker for non-invasively monitoring the evolution of hippocampal atrophy in CD patients.
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Affiliation(s)
| | - Ioana Cracana
- Medinst Diagnostic Romano-German SRL, Bucharest, Romania
| | - Maria Dobre
- Victor Babes National Institute of Pathology, Bucharest, 050096, Romania
| | - Bogdan Ovidiu Popescu
- Victor Babes National Institute of Pathology, Bucharest, 050096, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Hospital Colentina, Bucharest, Romania
| | - Catalina Tudose
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Prof. Dr. Al. Obregia” Psychiatry Clinical Hospital & the Memory Center of the Romanian Alzheimer Society, Section II, Bucharest, Romania
| | - Luiza Spiru
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- “Ana Aslan” International Foundation, Bucharest, Romania
| | - Gina Manda
- Victor Babes National Institute of Pathology, Bucharest, 050096, Romania
| | - Gabriela Niculescu
- Faculty of Medical Engineering, University Politehnica of Bucharest, Bucharest, Romania
| | - Elena Milanesi
- Victor Babes National Institute of Pathology, Bucharest, 050096, Romania
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Deng Q, Liu W. Inequalities in cognitive impairment among older adults in China and the associated social determinants: a decomposition approach. Int J Equity Health 2021; 20:82. [PMID: 33741012 PMCID: PMC7980641 DOI: 10.1186/s12939-021-01422-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/08/2021] [Indexed: 12/19/2022] Open
Abstract
Background Despite there is growing evidence focusing on health inequalities in China, socioeconomic inequalities in cognitive impairment among older adults have received little attention. This study aims to measure socioeconomic inequalities in cognitive impairment among Chinese older adults, and determine the contributing social factors to the inequalities. Methods A cross-sectional analysis was performed using data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 10,556 older adults aged 65 and over were included in the study. The prevalence of cognitive impairment was measured by using the Chinese version of the Mini-Mental State Examination. The socioeconomic inequalities in cognitive impairment were illustrated and quantified by the concentration curve and normalized concentration index. Multivariate logistic regression was conducted to identify the associated factors of cognitive impairment. And decomposition analysis was further applied to decompose the contribution of each determinant to the observed inequalities in cognitive impairment. Results The study indicated that the prevalence of cognitive impairment among Chinese older adults was 18.95%. The overall concentration index for cognitive impairment was − 0.046, which suggested a higher concentration of cognitive impairment among socioeconomically disadvantaged older adults. The results showed the prevalence of cognitive impairment was associated with sex, age, marital status, education level, occupation, economic status, emotional support, financial support, living arrangement, and participation in informal activities. Decomposition results further revealed the contributions of the determinants to the inequalities in cognitive impairment. Specifically, age (131.61%), marital status (85.68%), emotional support (84.85%), education level (39.73%), occupation (21.24%), sex (17.25%), financial support (− 4.19%), economic status (1.02%), living arrangement (0.88%), and informal activities (0.30%) have varying degrees of contributions to the inequality in cognitive impairment. Conclusion This study sheds light on the pro-rich inequality in cognitive impairment among older adults in China. It suggests that policymakers should pay more attention to older adults who are female, old-old, widowed, illiterate, economically disadvantaged, with no social support, and less socially involved. Also, more targeted interventions should be undertaken to improve the socioeconomic conditions of these vulnerable individuals and strengthen their ability to cope with the risk of cognitive impairment.
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Affiliation(s)
- Qingwen Deng
- School of Public Health, Fujian Medical University, Room 108 in the Building for School of Public Health, No. 1 Xuefubei Road, Minhou District, Fuzhou, 350122, China
| | - Wenbin Liu
- School of Public Health, Fujian Medical University, Room 108 in the Building for School of Public Health, No. 1 Xuefubei Road, Minhou District, Fuzhou, 350122, China.
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Sannemann L, Müller T, Waterink L, Zwan M, Wimo A, Stomrud E, Pinó S, Arrufat J, Rodríguez‐Gomez O, Benaque A, Bon J, Ferreira D, Johansson G, Dron A, Dumas A, Georges J, Kramberger MG, Visser PJ, Winblad B, Campo L, Boada M, Jessen F. General practitioners' attitude toward early and pre-dementia diagnosis of AD in five European countries-A MOPEAD project survey. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12130. [PMID: 33665337 PMCID: PMC7901232 DOI: 10.1002/dad2.12130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION General practitioners (GPs) play a key role in early identification of dementia, yet diagnosis is often missed or delayed in primary care. As part of the multinational Models of Patient Engagement for Alzheimer's Disease project, we assess GPs' attitude toward early and pre-dementia diagnosis of AD and explore barriers to early diagnosis. METHODS Our survey covered general attitude toward early diagnosis, diagnostic procedures, resources, and opinion on present and future treatment options across five European countries. RESULTS In total 343 GPs completed the survey; 74% of GPs indicated that an early diagnosis is valuable. There were country-specific differences in GPs' perceptions of reimbursement and time available for the patient. If a drug were available to slow down the progression of AD, 59% of the GPs would change their implementation of early diagnosis. DISCUSSION Our findings provide insight into GPs' attitudes by exploring differences in perception and management of early diagnosis.
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Affiliation(s)
- Lena Sannemann
- Department of PsychiatryUniversity of CologneFaculty of Medicine and University Hospital CologneCologneGermany
| | - Theresa Müller
- Department of PsychiatryUniversity of CologneFaculty of Medicine and University Hospital CologneCologneGermany
| | - Lisa Waterink
- Department of NeurologyAlzheimer Center Amsterdam, Amsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Marissa Zwan
- Department of NeurologyAlzheimer Center Amsterdam, Amsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - Anders Wimo
- Department of NeurobiologyDivision of Neurogeriatrics, Care Sciences and Society, Karolinska InstitutetSolnaSweden
| | - Erik Stomrud
- Clinical Memory Research UnitLund UniversityMalmöSweden
- Emmaboda Health CentreRegion Kalmar CountyEmmabodaSweden
| | - Susana Pinó
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències AplicadesUniversitat Internacional de CatalunyaBarcelonaSpain
| | | | - Octavio Rodríguez‐Gomez
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències AplicadesUniversitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | - Alba Benaque
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències AplicadesUniversitat Internacional de CatalunyaBarcelonaSpain
| | - Jaka Bon
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical Center Ljubljana and Medical FacultyUniversity of LjubljanaLjubljanaSlovenia
| | - Daniel Ferreira
- Department of NeurobiologyDivision of Clinical Geriatrics, Centre for Alzheimer Research, Care Sciences, and Society, Karolinska InstitutetHuddingeStockholmSweden
| | - Gunilla Johansson
- Department of NeurobiologyDivision of Neurogeriatrics, Care Sciences and Society, Karolinska InstitutetSolnaSweden
| | - Amanda Dron
- Modus Research and Innovation LimitedDundee Technology ParkDundeeUK
| | | | | | - Milica G Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical Center Ljubljana and Medical FacultyUniversity of LjubljanaLjubljanaSlovenia
| | - Pieter Jelle Visser
- Department of NeurologyAlzheimer Center Amsterdam, Amsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamthe Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Bengt Winblad
- Department of NeurobiologyDivision of Neurogeriatrics, Care Sciences and Society, Karolinska InstitutetSolnaSweden
- Theme AgingKarolinska University HospitalStockholmSweden
| | | | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències AplicadesUniversitat Internacional de CatalunyaBarcelonaSpain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | - Frank Jessen
- Department of PsychiatryUniversity of CologneFaculty of Medicine and University Hospital CologneCologneGermany
- German Center for Neurodegenerative Diseases (DZNE)BonnGermany
- Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD)University of CologneKölnGermany
| | - MOPEAD consortium
- Department of PsychiatryUniversity of CologneFaculty of Medicine and University Hospital CologneCologneGermany
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Dautzenberg G, Lijmer J, Beekman A. Clinical value of the Montreal Cognitive Assessment (MoCA) in patients suspected of cognitive impairment in old age psychiatry. Using the MoCA for triaging to a memory clinic. Cogn Neuropsychiatry 2021; 26:1-17. [PMID: 33272076 DOI: 10.1080/13546805.2020.1850434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: Diagnostic pathways are limited. A validated instrument that can triage patients when they are suspected of mild dementia (MD) is necessary to optimise referrals. Method: The MoCA is validated for identifying MD and mild cognitive impairment (MCI) in a cohort of patients suspected of cognitive impairment (CI) after initial assessment in old age psychiatry. The reference standard was the consensus-based diagnoses for MD and MCI, adhering to the international criteria and using suspected patients, but without CI as comparisons (NoCI). Results: The mean MoCA scores differ significantly between the groups: 24(SE: .59) in NoCI, 21(SE: .31) in MCI and 16,7(SE: .45) in MD (p < .05). The AUC of MD against non-demented (MCI + NoCI) was 0.83(95%CI: 0.78-0.88) resulting in 90% sensitivity, 65% specificity, 50%PPV and 94%NPV at a "best" cutoff of <21 according the Youden index and respectively 0.77(95%CI: 0.69-0.85), 56%, 73%, 90%, 28% for CI (MD + MCI) against NoCI at <21. Conclusion: 90% of individuals with a MoCA of <21 will have CI (MD + MCI), while 94% with a MoCA of ≥21 will not have dementia. The MoCA can reduce referrals substantially (50%) by selecting who don't need further work up in a memory clinic, even if they were suspected of CI after initial assessment.
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Affiliation(s)
- Géraud Dautzenberg
- Department of Old Age Psychiatry, Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | - Jeroen Lijmer
- Department of Psychiatry, OLVG Hospital, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
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13
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Callahan KE, Boustani M, Ferrante L, Forman DE, Gurwitz J, High KP, McFarland F, Robinson T, Studenski S, Yang M, Schmader KE. Embedding and Sustaining a Focus on Function in Specialty Research and Care. J Am Geriatr Soc 2020; 69:225-233. [PMID: 33064303 DOI: 10.1111/jgs.16860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 07/21/2020] [Accepted: 07/25/2020] [Indexed: 12/12/2022]
Abstract
Function and the independent performance of daily activities are of critical importance to older adults. Although function was once a domain of interest primarily limited to geriatricians, transdisciplinary research has demonstrated its value across the spectrum of medical and surgical care. Nonetheless, integrating a functional perspective into medical and surgical therapeutics has yet to be implemented consistently into clinical practice. This article summarizes the presentations and discussions from a workshop, "Embedding/Sustaining a Focus on Function in Specialty Research and Care," held on January 31 to February 1, 2019. The third in a series supported by the National Institute on Aging and the John A. Hartford Foundation, the workshop aimed to identify scientific gaps and recommend research strategies to advance the implementation of function in care of older adults. Transdisciplinary leaders discussed implementation of mobility programs and functional assessments, including comprehensive geriatric assessment; integrating cognitive and sensory functional assessments; the role of culture, environment, and community in incorporating function into research; innovative methods to better identify functional limitations, techniques, and interventions to facilitate functional gains; and the role of the health system in fostering integration of function. Workshop participants emphasized the importance of aligning goals and assessments and adopting a team science approach that includes clinicians and frontline staff in the planning, development, testing, and implementation of tools and initiatives. This article summarizes those discussions.
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Affiliation(s)
- Kathryn E Callahan
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Malaz Boustani
- Center for Aging Research and Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lauren Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Daniel E Forman
- Section of Geriatric Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jerry Gurwitz
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kevin P High
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.,Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Frances McFarland
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Thomas Robinson
- Department of Surgery, University of Colorado School of Medicine and the Denver Veterans Affairs Medical Center, Denver, Colorado, USA
| | - Stephanie Studenski
- Section of Geriatric Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,National Institute on Aging, Bethesda, Maryland, USA
| | - Mia Yang
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Kenneth E Schmader
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine and the Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
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14
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Calil V, Elliott E, Borelli WV, Barbosa BJAP, Bram J, Silva FDO, Cardoso LGM, Mariano LI, Dias N, Hornberger M, Caramelli P. Challenges in the diagnosis of dementia: insights from the United Kingdom-Brazil Dementia Workshop. Dement Neuropsychol 2020; 14:201-208. [PMID: 32973973 PMCID: PMC7500814 DOI: 10.1590/1980-57642020dn14-030001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
In July 2019, a group of multidisciplinary dementia researchers from Brazil and
the United Kingdom (UK) met in the city of Belo Horizonte, Minas Gerais, Brazil,
to discuss and propose solutions to current challenges faced in the diagnosis,
public perception and care of dementia. Here we summarize the outcomes from the
workshop addressing challenges in diagnosis. Brazil faces a major problem in
dementia underdiagnosis, particularly involving the population in an adverse
socioeconomic context. There is poor availability of resources and specialists,
and the knowledge of general practitioners and other healthcare professionals is
far from satisfactory. Low education level is a further obstacle in diagnosing
dementia, as the most commonly used screening tests are not designed to evaluate
this population. Patients and their families must overcome the stigma of a
diagnosis of dementia, which is still prevalent in Brazil and increases the
burden of this condition. Whilst the UK has greater resources, dedicated memory
services and a National Dementia Strategy plan, the National Health Service
(NHS) has limited funding. Therefore, some challenges regarding diagnosis are
common across both countries. The authors suggest possible solutions to confront
these, with the goal of improving assessment and recognition of dementia and
reducing misdiagnosis.
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Affiliation(s)
- Victor Calil
- Instituto D'Or de Ensino e Pesquisa - Rio de Janeiro, RJ, Brazil.,Universidade Federal do Rio de Janeiro - Rio de Janeiro, RJ, Brazil
| | - Emma Elliott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow - Glasgow, United Kingdom
| | - Wyllians Vendramini Borelli
- Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre, RS, Brazil.,Instituto do Cérebro do Rio Grande do Sul - Porto Alegre, RS, Brazil
| | - Breno José Alencar Pires Barbosa
- Instituto de Medicina Integral Prof. Fernando Figueira - Recife, PE, Brazil.,Departmento de Neurologia, Hospital das Clínicas, Universidade de São Paulo - São Paulo, SP, Brazil
| | - Jessyka Bram
- Laboratório de Neurociências, Departamento e Instituto de Psiquiatria, Universidade de São Paulo - São Paulo, SP, Brazil
| | | | | | - Luciano Inácio Mariano
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Natalia Dias
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Michael Hornberger
- Norwich Medical School, University of East Anglia - Norwich, United Kingdom
| | - Paulo Caramelli
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
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15
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Völter C, Götze L, Bruene-Cohrs U, Dazert S, Thomas JP. [Hearing and cognition: neurocognitive test batteries in otorhinolaryngology]. HNO 2019; 68:155-163. [PMID: 31628531 DOI: 10.1007/s00106-019-00762-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hearing and cognition are closely related to each other. Particularly in suboptimal listening situations, cognitive abilities become important to enable speech comprehension. Besides, studies have indicated that hearing impairment is associated with a more rapid mental decline compared to persons with normal hearing. However, hearing loss also has an impact on neurocognitive testing, which is generally based on auditive stimuli. With increasing age, the risk of sensory but also of cognitive impairments increases. So far this comorbidity receives little consideration in otorhinolaryngology. MATERIALS AND METHODS The paper presents an overview and evaluation of widely used German neurocognitive test batteries for older patients, with regard to the different test modalities and their focus. RESULTS A multitude of different neurocognitive screening tests and detailed test batteries are available, particularly in the field of dementia. So far, sensory deficits have not been considered in neurocognitive testing, neither concerning application nor interpretation. Normative data adapted to the hearing impaired are still missing. CONCLUSION With regard to demographic changes and the well-known bias between hearing and cognition, screening of neurocognitive functions should be implemented in basic otorhinolaryngologic diagnostics. More comprehensive test batteries might be useful for research purposes or speech therapy.
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Affiliation(s)
- C Völter
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Bleichstr. 15, 44787, Bochum, Deutschland.
| | - L Götze
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Bleichstr. 15, 44787, Bochum, Deutschland
| | - U Bruene-Cohrs
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum Bochum, Alexandrinentrasse 1, 44791, Bochum, Deutschland
| | - S Dazert
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Bleichstr. 15, 44787, Bochum, Deutschland
| | - J P Thomas
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Bleichstr. 15, 44787, Bochum, Deutschland
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16
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Cummings J, Passmore P, McGuinness B, Mok V, Chen C, Engelborghs S, Woodward M, Manzano S, Garcia-Ribas G, Cappa S, Bertolucci P, Chu LW. Souvenaid in the management of mild cognitive impairment: an expert consensus opinion. ALZHEIMERS RESEARCH & THERAPY 2019; 11:73. [PMID: 31421681 PMCID: PMC6698334 DOI: 10.1186/s13195-019-0528-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/06/2019] [Indexed: 02/06/2023]
Abstract
Background Mild cognitive impairment (MCI) among an aging global population is a growing challenge for healthcare providers and payers. In many cases, MCI is an ominous portent for dementia. Early and accurate diagnosis of MCI provides a window of opportunity to improve the outcomes using a personalized care plan including lifestyle modifications to reduce the impact of modifiable risk factors (for example, blood pressure control and increased physical activity), cognitive training, dietary advice, and nutritional support. Souvenaid is a once-daily drink containing a mixture of precursors and cofactors (long-chain omega-3 fatty acids, uridine, choline, B vitamins, vitamin C, vitamin E, and selenium), which was developed to support the formation and function of neuronal membranes and synapses. Healthcare providers, patients, and carers require expert advice about the use of Souvenaid. Methods An international panel of experts was convened to review the evidence and to make recommendations about the diagnosis and management of MCI, identification of candidates for Souvenaid, and use of Souvenaid in real-world practice. This article provides a summary of the expert opinions and makes recommendations for clinical practice and future research. Summary of opinion Early diagnosis of MCI requires the use of suitable neuropsychological tests combined with a careful clinical history. A multimodal approach is recommended; dietary and nutritional interventions should be considered alongside individualized lifestyle modifications. Although single-agent nutritional supplements have failed to produce cognitive benefits for patients with MCI, a broader nutritional approach warrants consideration. Evidence from randomized controlled trials suggests that Souvenaid should be considered as an option for some patients with early Alzheimer’s disease (AD), including those with MCI due to AD (prodromal AD). Conclusion Early and accurate diagnosis of MCI provides a window of opportunity to improve the outcomes using a multimodal management approach including lifestyle risk factor modification and consideration of the multinutrient Souvenaid. Electronic supplementary material The online version of this article (10.1186/s13195-019-0528-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeffrey Cummings
- Department of Brain Health, School of Integrated Health Sciences, UNLV; Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.
| | - Peter Passmore
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Belfast, UK
| | - Bernadette McGuinness
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Belfast, UK
| | - Vincent Mok
- Therese Pei Fong Chow Research Center for Prevention of Dementia, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Christopher Chen
- Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
| | - Sebastiaan Engelborghs
- Reference Centre for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium.,Department of Neurology, Centre for Neurosciences, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Michael Woodward
- Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | | | | | - Stefano Cappa
- University School for Advanced Studies IUSS, Pavia and IRCCS Istituto Centro, S. Giovanni di Dio, Brescia, Italy
| | - Paulo Bertolucci
- Service of Cognitive and Behavioral Neurology, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Leung-Wing Chu
- Department of Medicine, The University of Hong Kong and Hong Kong Brain Memory Centre, Hong Kong Special Administrative Region, China
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17
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Lv X, Li W, Ma Y, Chen H, Zeng Y, Yu X, Hofman A, Wang H. Cognitive decline and mortality among community-dwelling Chinese older people. BMC Med 2019; 17:63. [PMID: 30871536 PMCID: PMC6419492 DOI: 10.1186/s12916-019-1295-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/25/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Whether cognitive decline is related to a higher risk of death independent of the initial cognitive function is inconclusive. Evidence of the association between cognitive decline and mortality among Chinese older people is limited. We aimed to examine whether cognitive decline, assessed by the rate of decrease in the Mini-Mental State Examination (MMSE) score, was associated with mortality independent of initial cognitive function (baseline MMSE score) among Chinese older people. METHODS We established two successive and non-overlapping cohorts of older adults nested within the Chinese Longitudinal Healthy Longevity Survey (CLHLS), an ongoing, open, community-based cohort survey conducted every 2-3 years. Cognitive function was measured using the Chinese version of the MMSE. A total of 11,732 older adults who completed two consecutive cognitive function examinations were included and followed for 3 years. A Cox proportional hazards model was used to examine the association of cognitive decline with mortality after adjusting for sociodemographic characteristics, health behaviours, comorbidities and initial cognitive function. RESULTS The mean age was 82.5 years old, and 44.9% (5264/11732) of participants were men. After adjusting for baseline MMSE scores and other covariates, the rate of change in MMSE scores over 3 years was monotonically and positively associated with subsequent 3-year mortality. Compared to those with stable cognitive function, participants with rapid cognitive decline (decline faster than average, a reduction of MMSE scores > 1.62 points/year) had a 75% higher risk of death (hazard ratio = 1.75, 95% confidence interval 1.57-1.95). The association between cognitive decline and mortality was stronger among relatively younger Chinese older people (aged 65-79 years versus 80 years and over) and those with normal cognitive function at baseline (MMSE scores ≥ 24 versus < 24 points), respectively, but did not differ by cohort and sex. CONCLUSION Faster cognitive decline was associated with higher mortality independent of initial cognitive function, especially among those aged 65-79 years and those with normal cognitive function at baseline. The association was consistent across two successive cohorts. Our findings indicate the practical significance of monitoring cognitive change in older adults.
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Affiliation(s)
- Xiaozhen Lv
- Dementia Care and Research Center, Clinical Research Division, Peking University Institute of Mental Health (Sixth Hospital), No. 51 Huayuanbei Road, Haidian District, Beijing, 100191, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Wenyuan Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Yuan Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Huashuai Chen
- Center for the Study of Aging and Human Development, Medical School of Duke University, Box 3003, Room 1506 Busse Building, Blue Zone, Duke South, Durham, NC, 27710, USA.,International Trade Department, Business School of Xiangtan University, Xiangtan, Hunan, China
| | - Yi Zeng
- Center for the Study of Aging and Human Development, Medical School of Duke University, Box 3003, Room 1506 Busse Building, Blue Zone, Duke South, Durham, NC, 27710, USA.,Center for Healthy Aging and Development Studies, National School of Development, Raissun Institute for Advanced Studies, Peking University, No. 5 Yiheyuan Road, Haidian District, Beijing, 100875, China
| | - Xin Yu
- Dementia Care and Research Center, Clinical Research Division, Peking University Institute of Mental Health (Sixth Hospital), No. 51 Huayuanbei Road, Haidian District, Beijing, 100191, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Huali Wang
- Dementia Care and Research Center, Clinical Research Division, Peking University Institute of Mental Health (Sixth Hospital), No. 51 Huayuanbei Road, Haidian District, Beijing, 100191, China. .,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
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18
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McPherson B. Self-Reported Benefit and Satisfaction with a Beamforming Body-Worn Hearing Aid for Elderly Adults. Int J Otolaryngol 2018; 2018:2046894. [PMID: 30515217 PMCID: PMC6236654 DOI: 10.1155/2018/2046894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/17/2018] [Accepted: 10/11/2018] [Indexed: 11/18/2022] Open
Abstract
Hearing impairment is a leading cause of disability globally and is particularly prevalent in elderly populations. Hearing aids are commonly recommended to mitigate the adverse effects on communication associated with hearing loss. However, the acceptability of hearing aids to elderly individuals is low and the majority of potential users do not wear hearing aids. Most hearing aids are designed with a discreet form factor in mind, to minimize device visibility. Given the range of comorbidities associated with hearing loss in the elderly, this conventional form factor may not always be optimal. The present study examined the experiences of elderly individuals with a recently developed, unconventional, body-worn hearing instrument, the EasyHear™ Grand (Logital Co. Ltd., Hong Kong). The bilaterally fitted instrument incorporates large controls, a color display, beamforming sound processing, and Bluetooth capabilities. Forty-three elderly participants (mean age=71; range 46-88 years) were surveyed to gauge level of benefit and satisfaction with the device and opinions regarding the hearing aid. They were assessed using three standardized questionnaires (the International Outcome Inventory-Hearing Aids, the Profile of Hearing Aid Benefit, and the Client Oriented Scale of Improvement) and through open-ended, structured interviews. Participants rated their EasyHear device fitting highly for hours of use and improved quality of life and rated the device favorably for improved communication and benefit in background noise. A majority of users felt the device improved listening ability in their expressed area of greatest need, and also for their second highest prioritized area of greatest need. Less than 10% of users felt their listening was only occasionally or hardly ever improved when using the body-worn device. Benefit and satisfaction ratings with the EasyHear Grand were comparable to those in studies involving conventional form factor devices. Interviews highlighted areas where users felt the device could be improved-extra noise reduction, changes to device dimensions, receiver/eartip fit, and cableless technology were among the areas mentioned. Many participants valued smartphone linkage and Bluetooth capability. The EasyHear Grand, with its body-worn design and large, simple controls, was well accepted by the majority of participants. Hearing aids that break from conventional design formats may benefit many elderly individuals with hearing impairment and promote increased user acceptability.
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