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Cardoso S, Barros R, Marôco J, de Mendonça A, Guerreiro M. Different MMSE domains are associated to cognitive decline and education. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:533-539. [PMID: 35234096 DOI: 10.1080/23279095.2022.2041018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Mini-Mental State Examination (MMSE) is a long-established test to screen for dementia, estimate the severity and monitor the progression of cognitive impairment. The MMSE total score is dependent upon demographic factors, particularly education, but little is known about how education influences the 6 distinct MMSE cognitive domains. The present study aims to understand how the performances in the MMSE cognitive domains reflect clinical diagnosis and educational level. The study recruited 1043 participants, comprising 388 healthy controls, 360 patients with Mild Cognitive Impairment (MCI) and 295 patients with dementia. The association of the MMSE cognitive domains scores with clinical diagnosis (healthy, MCI, dementia) and educational level (primary education, middle school, high school and university/college) was analyzed with a multivariate ordinal regression model. The scores in all MMSE domains were generally higher in healthy controls as compared to patients with MCI, and higher in these as compared to patients with dementia. The MMSE domain Constructional ability was associated to the education level, the domains Orientation, Recall and Language were associated to diagnosis, Attention and calculation was associated to both education level and diagnosis, and Registration was not associated to either education or diagnosis. In conclusion, impairment in specific MMSE domains pinpoints cognitive decline, probably indicating brain areas affected by neurodegeneration, and impairment in others reflects lower education levels and the lack of acquisition of relevant schooling abilities.
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Affiliation(s)
- Sandra Cardoso
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ricardo Barros
- Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - João Marôco
- ISPA -Instituto Universitário, Lisbon, Portugal
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Steffener J, Nicholls J, Farghal S, Franklin D. The Beneficial, Formative Role of Lifetime Exposures across Cognitive Domains in Barbados Using Data from the SABE Study. Can J Aging 2024:1-11. [PMID: 38801134 DOI: 10.1017/s0714980824000242] [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: 05/29/2024] Open
Abstract
This study tested the hypothesis that within older Barbadian adults, sex, education, and occupation type lessen age-related cognitive decline. The analyses used a cross-sectional data set from 1325 people collected in the 2006 SABE Study (Health, Well-being, and Aging). Cognition was assessed as scores in each subdomain of the Mini-Mental State Exam. The loss of a single point in each subdomain was predicted by sex, years of education, job type, and their interactions with age. Results demonstrated that age and protective factors affect each cognitive domain differently. High education combined with mentally complex employment helped maintain cognitive performance in later life. Beneficial lifetime exposures are additive, providing combined benefits. Findings provide insight into public policy aiming to minimize the number of adults with cognitive decline and dementia in Barbados and the Caribbean.
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Affiliation(s)
- Jason Steffener
- Interdisciplinary School of Health Science, University of Ottawa, Ottawa, ON, Canada
| | | | - Shireen Farghal
- Interdisciplinary School of Health Science, University of Ottawa, Ottawa, ON, Canada
| | - Dylan Franklin
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
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Andreatta Maduro P, Guimarães MP, de Sousa Rodrigues M, Pereira Rolim Coimbra Pinto AP, da Mota Junior AA, Lima Rocha AS, Matoso JMD, Bavaresco Gambassi B, Schwingel PA. Comparing the Efficacy of Two Cognitive Screening Tools in Identifying Gray and White Matter Brain Damage among Older Adults. J Aging Res 2024; 2024:5527225. [PMID: 38690079 PMCID: PMC11060871 DOI: 10.1155/2024/5527225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/19/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024] Open
Abstract
Background Ageing is associated with structural changes in brain regions and functional decline in cognitive domains. Noninvasive tools for identifying structural damage in the brains of older adults are relevant for early treatment. Aims This study aims to evaluate and compare the accuracy of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA©) in identifying gray and white matter brain damage in older individuals with varying degrees of cognitive impairment. Methods Ninety older adults (62 women) with an average age of 69 ± 7 years were enrolled and categorized as having no cognitive impairment (NCI), mild cognitive impairment (MCI), or moderate cognitive impairment (MoCI). Magnetic resonance imaging (MRI) was utilized to assess the number, volume, and distribution of brain damage. The Fazekas and Scheltens scales were applied to the brain MRIs, and inferential statistics were employed to compare variables among the groups. Results Cognitive impairment was observed in 56.7% of the participants (95% confidence interval (CI): 46.4-66.4%), with thirty-six older adults (40%) classified as MCI and 15 (17%) as MoCI. Cognitive impairment and medial temporal lobe (MTL) atrophy were found to be associated (p=0.001), exhibiting higher mean volume scales of the MTL atrophied area in the MoCI group (p < 0.001). The MMSE accurately revealed MTL atrophy based on the Scheltens (p < 0.05) and Fazekas (p < 0.05) scales. At the same time, the MoCA accurately identified periventricular white matter (PWM) abnormalities according to the Fazekas scale (p < 0.05). Conclusions The MMSE and MoCA screening tools effectively identified gray and white matter brain damage in older adults with varying degrees of cognitive impairment. Lower MMSE scores are associated with MTL atrophy and lesions, and lower MoCA scores are related to PWM lesions. The concurrent use of MMSE and MoCA is recommended for assessing structural changes in distinct brain regions.
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Affiliation(s)
- Paula Andreatta Maduro
- Post-Graduation Program in Health Sciences (PPGCS), University of Pernambuco (UPE), Recife, PE 50100-130, Brazil
- Human Performance Research Laboratory (LAPEDH), UPE, Petrolina, PE 56328-900, Brazil
- University Hospital of the Federal University of Vale do São Francisco (HU-UNIVASF), Brazilian Hospital Services Company (EBSERH), Petrolina, PE 56304-205, Brazil
| | | | - Mateus de Sousa Rodrigues
- Human Performance Research Laboratory (LAPEDH), UPE, Petrolina, PE 56328-900, Brazil
- University Hospital of the Federal University of Vale do São Francisco (HU-UNIVASF), Brazilian Hospital Services Company (EBSERH), Petrolina, PE 56304-205, Brazil
| | - Ana Paula Pereira Rolim Coimbra Pinto
- University Hospital of the Federal University of Vale do São Francisco (HU-UNIVASF), Brazilian Hospital Services Company (EBSERH), Petrolina, PE 56304-205, Brazil
| | - Américo Alves da Mota Junior
- Human Performance Research Laboratory (LAPEDH), UPE, Petrolina, PE 56328-900, Brazil
- University Hospital of the Federal University of Vale do São Francisco (HU-UNIVASF), Brazilian Hospital Services Company (EBSERH), Petrolina, PE 56304-205, Brazil
| | - Alaine Souza Lima Rocha
- Post-Graduation Program in Health Sciences (PPGCS), University of Pernambuco (UPE), Recife, PE 50100-130, Brazil
- Human Performance Research Laboratory (LAPEDH), UPE, Petrolina, PE 56328-900, Brazil
- Department of Physical Therapy, Federal University of Ceará (UFC), Fortaleza, CE 60430-450, Brazil
| | - Juliana Magalhães Duarte Matoso
- Human Performance Research Laboratory (LAPEDH), UPE, Petrolina, PE 56328-900, Brazil
- Department of Clinical Medicine, Pedro Ernesto University Hospital, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ 20551-030, Brazil
| | - Bruno Bavaresco Gambassi
- Human Performance Research Laboratory (LAPEDH), UPE, Petrolina, PE 56328-900, Brazil
- Post-Graduation Program in Management of Health Programs and Services (PPGGPSS), CEUMA University (UNICEUMA), São Luís, MA 65075-120, Brazil
| | - Paulo Adriano Schwingel
- Post-Graduation Program in Health Sciences (PPGCS), University of Pernambuco (UPE), Recife, PE 50100-130, Brazil
- Human Performance Research Laboratory (LAPEDH), UPE, Petrolina, PE 56328-900, Brazil
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Naheed A, Hakim M, Islam MS, Islam MB, Tang EY, Prodhan AA, Amin MR, Stephan BC, Mohammad QD. Prevalence of dementia among older age people and variation across different sociodemographic characteristics: a cross-sectional study in Bangladesh. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 17:100257. [PMID: 37849932 PMCID: PMC10577143 DOI: 10.1016/j.lansea.2023.100257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/06/2023] [Accepted: 07/19/2023] [Indexed: 10/19/2023]
Abstract
Background Dementia is a significant global health issue, particularly for low-income and middle-income countries which majorly contribute to the dementia cases reported globally (67%). We estimated the prevalence of dementia among older people in Bangladesh and compared the estimate across different sociodemographic characteristics and divisions. Methods A cross-sectional study was conducted in 2019 among individuals aged 60 years or older in seven administrative divisions in Bangladesh. Equal numbers of male and female participants were recruited from each division through a multi-stage random sampling technique. Recruitment was proportionally distributed in urban and rural areas in each division. Following consent, the Mini Mental State Examination (MMSE) was performed on all participants. Dementia was defined as an MMSE score of <24 out of 30. Data on age, sex, education, marital status, occupation, socioeconomic status, and type of community (urban or rural) were obtained using a structured questionnaire to compare the prevalence of dementia across different sociodemographic characteristics. Findings Between January and December 2019, 2795 individuals were recruited including ∼400 from each of the seven administrative divisions. The mean age was 67 years (SD: 7), 68% were from rural areas and 51% were female. The prevalence of dementia was 8.0% (95% CI: 7.0-8.9%) with variations across age, sex, education, marital status, occupation, and division. No variations in prevalence were observed across urban/rural locations or socioeconomic status. After adjusting for age, sex, education, occupation and marital status, the odds of dementia was two times higher in females than males (OR: 2.15, 95% CI: 1.43-3.28); nine times higher in people aged ≥90 years than people aged 60-69 years (OR: 9.62, 95% CI: 4.79-19.13), and three times higher in people with no education compared to those who had completed primary school (OR: 3.10, 95% CI: 1.95-5.17). Interpretations The prevalence of dementia is high in Bangladesh and varies across sociodemographic characteristics with a higher prevalence among females, older people, and people with no education. There is an urgent need to identify the key risk factors for dementia in developing countries, such as Bangladesh, to inform the development of context-relevant risk reduction and prevention strategies. Funding None.
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Affiliation(s)
- Aliya Naheed
- Initiative for Non Communicable Diseases, Health Systems and Population Studies Division, icddr,b, Mohakhali, Dhaka, 1000, Bangladesh
| | - Maliha Hakim
- National Institute of Neurosciences & Hospital, Dhaka, 1207, Bangladesh
| | - Md Saimul Islam
- Initiative for Non Communicable Diseases, Health Systems and Population Studies Division, icddr,b, Mohakhali, Dhaka, 1000, Bangladesh
| | - Md Badrul Islam
- Laboratory Science and Services Division, icddr,b, Mohakhali, Dhaka, 1000, Bangladesh
| | | | - Abdul Alim Prodhan
- Non Communicable Disease Control Program, Directorate General of Health Services, Dhaka, 1212, Bangladesh
| | - Mohammad Robed Amin
- Non Communicable Disease Control Program, Directorate General of Health Services, Dhaka, 1212, Bangladesh
- Department of Medicine, Dhaka Medical College and Hospital, Dhaka, 1000, Bangladesh
| | - Blossom C.M. Stephan
- Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Dementia Centre of Excellence, Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
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Gu H, Yao X, Diao C, Liu M, Kong W, Liu H, Zhao Y, Meng Z. Global cognitive function is associated with sex, educational level, occupation type, and speech recognition rate in older Chinese adults: a single-center, prospective, cross-sectional study. BMC Geriatr 2022; 22:947. [PMID: 36482356 PMCID: PMC9733133 DOI: 10.1186/s12877-022-03603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The development of cognitive impairment may be delayed if its risk factors are identified and detected, if its developmental trend can be predicted, and if early intervention can be performed. This study primarily aimed to investigate the association between global cognitive function and hearing loss, educational level, and occupation type and to determine any differences in such associations according to sex among older Chinese adults. METHODS In this cross-sectional study, we prospectively recruited 219 individuals above 55 years old in an otolaryngology outpatient clinic who could write independently and had no severe vision impairment. Audiometric examinations included otoscopy, acoustic immittance, pure-tone audiometry, and speech audiometry for each ear. Cognitive function was evaluated by using the Chinese version of the Mini-Mental State Examination (MMSE). Multivariable linear regression analyses were performed to evaluate the relationship between variables and MMSE scores after adjusting for independent variables that were statistically significant in the univariable analyses. RESULTS We enrolled 219 individuals: 98 men (mean ± standard deviation age, 63.08 ± 6.64 years) and 121 women (62.64 ± 7.17 years). The overall MMSE scores of the normal hearing group and the mild, moderate, and severe-to-profound hearing loss groups were 24.00 (5.00), 24.00 (5.00), 23.00 (5.00), and 23.00 (13.00), respectively. MMSE scores were higher among participants with higher educational levels (p < 0.001) and were significantly correlated with occupation type (p < 0.001). MMSE scores were significantly higher in men than in women (p < 0.001). However, after the analysis of the five subdomains, significant differences were only observed for attention and calculation (p < 0.001) and language (p = 0.011). We further compared the distribution of educational levels between men and women by using the chi-square test; there was no significant difference in educational level between the sexes (p = 0.070). CONCLUSIONS We reported statistically significant relationships between global cognitive function and sex, educational level, and occupation type. Sex-specific strategies may be required to improve healthcare policies.
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Affiliation(s)
- Hailing Gu
- grid.412901.f0000 0004 1770 1022Department of Otolaryngology-Head and Neck Surgery, Hearing Center/Hearing and Speech Science Laboratory, West China Hospital of Sichuan University, 37 Guo Xue Lane, Chengdu, 610041 Sichuan People’s Republic of China
| | - Xinyi Yao
- grid.412901.f0000 0004 1770 1022Department of Otolaryngology-Head and Neck Surgery, Hearing Center/Hearing and Speech Science Laboratory, West China Hospital of Sichuan University, 37 Guo Xue Lane, Chengdu, 610041 Sichuan People’s Republic of China
| | - Cong Diao
- grid.412901.f0000 0004 1770 1022Department of Otolaryngology-Head and Neck Surgery, Hearing Center/Hearing and Speech Science Laboratory, West China Hospital of Sichuan University, 37 Guo Xue Lane, Chengdu, 610041 Sichuan People’s Republic of China
| | - Min Liu
- grid.412901.f0000 0004 1770 1022Department of Otolaryngology-Head and Neck Surgery, Hearing Center/Hearing and Speech Science Laboratory, West China Hospital of Sichuan University, 37 Guo Xue Lane, Chengdu, 610041 Sichuan People’s Republic of China
| | - Weili Kong
- grid.412901.f0000 0004 1770 1022Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Haotian Liu
- grid.412901.f0000 0004 1770 1022Department of Otolaryngology-Head and Neck Surgery, Hearing Center/Hearing and Speech Science Laboratory, West China Hospital of Sichuan University, 37 Guo Xue Lane, Chengdu, 610041 Sichuan People’s Republic of China
| | - Yu Zhao
- grid.412901.f0000 0004 1770 1022Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaoli Meng
- grid.412901.f0000 0004 1770 1022Department of Otolaryngology-Head and Neck Surgery, Hearing Center/Hearing and Speech Science Laboratory, West China Hospital of Sichuan University, 37 Guo Xue Lane, Chengdu, 610041 Sichuan People’s Republic of China
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Pellicer-Espinosa I, Díaz-Orueta U. Cognitive Screening Instruments for Older Adults with Low Educational and Literacy Levels: A Systematic Review. J Appl Gerontol 2021; 41:1222-1231. [PMID: 34856843 PMCID: PMC8966106 DOI: 10.1177/07334648211056230] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This study presents a systematic review on existing cognitive screening tools for mild cognitive impairment and dementia in populations with low education and literacy levels. Cochrane Library, PubMed and LILACS databases were examined for studies including adults aged 50 years old or older with low educational level. 61 articles were included. Despite its frequent use, studies on Mini-Mental State Examination (MMSE) revealed that educational level biased the score obtained, regardless of other factors. Separately, the Informant Questionnaire on Cognitive Decline in the Elderly, the Fototest, or the Eurotest, appear to minimize the effect of education and literacy. MMSE is unreliable for individuals with low literacy. Tasks involving reading, writing, arithmetics, drawing, praxis, visuospatial, and visuoconstructive skills have a greater educational bias than naming, orientation, or memory. An adequate determination of educational level and validation of instruments in populations with heterogeneous levels of literacy requires further research.
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Affiliation(s)
| | - Unai Díaz-Orueta
- Department of Psychology, Maynooth University, Maynooth, Ireland
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Ma M, Yahirun J, Saenz J, Sheehan C. Offspring Educational Attainment and Older Parents' Cognition in Mexico. Demography 2021; 58:75-109. [PMID: 33612872 PMCID: PMC7894606 DOI: 10.1215/00703370-8931725] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Population-level disparities in later-life cognitive health point to the importance of family resources. Although the bulk of prior work establishes the directional flow of resources from parents to offspring, the "linked lives" perspective raises the question of how offspring resources could affect parental health as well. This paper examines whether adult children's education influences older parents' (aged 50+) cognitive health in Mexico, where schooling reforms have contributed to significant gains in the educational achievements of recent birth cohorts. Harnessing a change in compulsory school laws and applying an instrumental variables approach, we found that each year of offspring schooling was associated with higher overall cognition among parents, but was less predictive across different cognitive functioning domains. More offspring schooling improved parents' cognitive abilities in verbal learning, verbal fluency, and orientation, but not in visual scanning, visuo-spatial ability, or visual memory. The beneficial effects of offspring schooling on those cognitive domains are more salient for mothers compared to fathers, suggesting potential gendered effects in the influence of offspring schooling. The results remained robust to controls for parent-child contact and geographic proximity, suggesting other avenues through which offspring education could affect parental health and a pathway for future research. Our findings contribute to growing research which stresses the causal influence of familial educational attainment on population health.
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Affiliation(s)
- Mingming Ma
- Institute for Advanced Research, Shanghai University of Finance and Economics, 111 Wuchuan Road, Shanghai 200433, China
| | - Jenjira Yahirun
- Department of Sociology, Bowling Green State University, 242 Williams Hall, Bowling Green, OH 43404, USA
| | - Joseph Saenz
- Davis School of Gerontology, University of Southern California, 3715 McClintock Ave, Los Angeles, CA 90089, USA
| | - Connor Sheehan
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, P.O. Box 873701, Tempe, AZ 85287, USA
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Sandvik RK, Selbaek G, Bergh S, Aarsland D, Husebo BS. Signs of Imminent Dying and Change in Symptom Intensity During Pharmacological Treatment in Dying Nursing Home Patients: A Prospective Trajectory Study. J Am Med Dir Assoc 2016; 17:821-7. [PMID: 27321869 DOI: 10.1016/j.jamda.2016.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate whether it is possible to determine signs of imminent dying and change in pain and symptom intensity during pharmacological treatment in nursing home patients, from day perceived as dying and to day of death. DESIGN Prospective, longitudinal trajectory trial. SETTING Forty-seven nursing homes within 35 municipalities of Norway. PARTICIPANTS A total of 691 nursing home patients were followed during the first year after admission and 152 were assessed carefully in their last days of life. MEASUREMENTS Time between admission and day of death, and symptom severity by Edmonton symptom assessment system (ESAS), pain (mobilization-observation-behavior-intensity-dementia-2), level of dementia (clinical dementia rating scale), physical function (Karnofsky performance scale), and activities of daily living (physical self-maintenance scale). RESULTS Twenty-five percent died during the first year after admission. Increased fatigue (logistic regression, odds ratio [OR] 1.8, P = .009) and poor appetite (OR 1.2, P = .005) were significantly associated with being able to identify the day a person was imminently dying, which was possible in 61% of the dying (n = 82). On that day, the administration of opioids, midazolam, and anticholinergics increased significantly (P < .001), and was associated with amelioration of symptoms, such as pain (mixed-models linear regression, 60% vs 46%, P < .001), anxiety (44% vs 31%, P < .001), and depression (33% vs 15%, P < .001). However, most symptoms were still prevalent at day of death, and moderate to severe dyspnea and death rattle increased from 44% to 53% (P = .040) and 8% to 19% (P < .001), respectively. Respiratory symptoms were not associated with opioids or anticholinergics. CONCLUSION Pharmacological treatment ameliorated distressing symptoms in dying nursing home patients; however, most symptoms, including pain and dyspnea, were still common at day of death. Results emphasize critical needs for better implementation of guidelines and staff education. TRIAL REGISTRATION ClinicalTrials.govNCT01920100.
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Affiliation(s)
- Reidun K Sandvik
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Institute for Nursing Subjects, Bergen University College, Bergen, Norway.
| | - Geir Selbaek
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sverre Bergh
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience King's College, London, UK; Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Municipality of Bergen, Bergen, Norway
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Abstract
BACKGROUND Identifying dementia in primary care could minimize the impact of a late intervention; however, it shows high rates of misdiagnosis. One of the reasons seems to be the lack of knowledge of adequate cognitive screening instruments. This is a systematic review of the available instruments for the primary care context. METHOD For this systematic review, articles were collected according to the following combined key terms: "cognitive screening" and "dementia" and "primary care" and "review". Studies should be reviews focusing on cognitive screening instruments best used in primary care setting. RESULTS Thirteen reviews were selected. In total, it was considered 34 cognitive screening instruments. Half of the instruments can be applied in an adequate time-limit for primary care context. Memory is the most commonly assessed cognitive function (91%). Almost half of the tests are mentioned to have influence of education or cultural factors (44%). CONCLUSION Tests such as 6CIT, AMT, GPCOG, Mini-Cog, MIS, MoCA, and STMS seem to be good alternatives to the use of the Mini-Mental State Examination when considering factors such as application time, sensitivity, specificity, and number of studies. However, there is a wide range of tests with different characteristics, therefore it is recommended that the professional gets some expertise in a few number of instruments in order to be able to choose which to use, or use in combination, depending on the setting and the profile of the patient.
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Assis LDO, de Paula JJ, Assis MG, de Moraes EN, Malloy-Diniz LF. Psychometric properties of the Brazilian version of Pfeffer's Functional Activities Questionnaire. Front Aging Neurosci 2014; 6:255. [PMID: 25309432 PMCID: PMC4174881 DOI: 10.3389/fnagi.2014.00255] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/08/2014] [Indexed: 11/25/2022] Open
Abstract
Pfeffer's Functional Activities Questionnaire (FAQ) is one of the most commonly employed tools in studies on pathological cognitive aging. Despite the different versions of the questionnaire translated for use in clinical practice, few studies have analyzed the psychometric properties of the Brazilian version of the FAQ (P-FAQ). Thus, the aim of the present study was to analyze the P-FAQ with regard to internal consistency, factorial structure and associations with demographic factors (age, sex, and schooling), depressive symptoms, cognitive measures and other measures of functionality. One hundred sixty-one older adults were divided into four groups (91 with dementia, 46 with mild cognitive impairment, 11 with psychiatric disorders and 13 healthy controls). All participants were evaluated by cognitive, behavioral and functional tests and scales. Their caregivers answered the P-FAQ. The questionnaire showed high internal consistency (α = 0.91). Factor analysis revealed a two-factor structure, which, accounted for 66% of the total variance. The P-FAQ was not correlated with demographic factors, was weakly correlated with depressive symptoms (ϱ = 0.271, p < 0.01, R2 = 7%) and strongly correlated with cognitive measures (Matttis Dementia Rating Scale total score: ϱ = −0.574, p < 0.01, R2 = 33%) as well as complex instrumental activities of daily living (ϱ = −0.845, p < 0.01, R2 = 71%). Cognitive performance and depression status were independent predictors of P-FAQ scores in regression models. The present findings indicate that the P-FAQ has satisfactory reliability, internal consistency, construct validity and ecological validity. Therefore, this questionnaire can be used in clinical practice and research involving the Brazilian population of older adults.
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Affiliation(s)
- Luciana de Oliveira Assis
- Post Graduation Program in Neuroscience, Federal University of Minas Gerais Belo Horizonte, Brazil ; Faculty of Humanities, Social Sciences and Health, FUMEC University Belo Horizonte, Brazil
| | - Jonas J de Paula
- Department of Psychology, Faculty of Medical Sciences of Minas Gerais Belo Horizonte, MG, Brazil ; Faculty of Medicine, National Institute of Science and Technology - Molecular Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Marcella G Assis
- Department of Occupational Therapy, Faculty of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Edgar N de Moraes
- Department of Clinics, Faculty of Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Leandro F Malloy-Diniz
- Faculty of Medicine, National Institute of Science and Technology - Molecular Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil ; Laboratory of Neuropsychological Investigations (LIN), Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Mental Health, Faculty of Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
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Paula JJD, Bertola L, Ávila RTD, Assis LDO, Albuquerque M, Bicalho MA, Moraes END, Nicolato R, Malloy-Diniz LF. Development, validity, and reliability of the General Activities of Daily Living Scale: a multidimensional measure of activities of daily living for older people. ACTA ACUST UNITED AC 2014; 36:143-52. [PMID: 24554276 DOI: 10.1590/1516-4446-2012-1003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 05/23/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To propose and evaluate the psychometric properties of a multidimensional measure of activities of daily living (ADLs) based on the Katz and Lawton indices for Alzheimer's disease (AD) and mild cognitive impairment (MCI). METHODS In this study, 85 patients with MCI and 93 with AD, stratified by age (≤ 74 years, > 74 years), completed the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale, and their caregivers completed scales for ADLs. Construct validity (factor analysis), reliability (internal consistency), and criterion-related validity (receiver operating characteristic analysis and logistic regression) were assessed. RESULTS Three factors of ADL (self-care, domestic activities, and complex activities) were identified and used for item reorganization and for the creation of a new inventory, called the General Activities of Daily Living Scale (GADL). The components showed good internal consistency (> 0.800) and moderate (younger participants) or high (older participants) accuracy for the distinction between MCI and AD. An additive effect was found between the GADL complex ADLs and global ADLs with the MMSE for the correct classification of younger patients. CONCLUSION The GADL showed evidence of validity and reliability for the Brazilian elderly population. It may also play an important role in the differential diagnosis of MCI and AD.
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Affiliation(s)
- Jonas J de Paula
- Laboratory of Research in Clinical Neuroscience (LINC), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Laiss Bertola
- Laboratory of Research in Clinical Neuroscience (LINC), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Rafaela T de Ávila
- Laboratory of Research in Clinical Neuroscience (LINC), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Luciana de O Assis
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maicon Albuquerque
- Laboratory of Research in Clinical Neuroscience (LINC), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Maria A Bicalho
- Department of Medical Practice, School of Medicine, UFMG, Belo Horizonte, MG, Brazil
| | - Edgar N de Moraes
- Department of Medical Practice, School of Medicine, UFMG, Belo Horizonte, MG, Brazil
| | - Rodrigo Nicolato
- National Science and Technology Institute for Molecular Medicine, School of Medicine, UFMG, Belo Horizonte, MG, Brazil
| | - Leandro F Malloy-Diniz
- Laboratory of Research in Clinical Neuroscience (LINC), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Bertola L, Paula JJD, Moraes EN, Haase VG, Malloy-Diniz LF. Applicability of the single-case methodology in a patient with dementia with Lewy bodies. BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 35:439-40. [PMID: 24402220 DOI: 10.1590/1516-4446-2013-1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/08/2013] [Indexed: 11/22/2022]
Affiliation(s)
- Laiss Bertola
- Laboratory of Neuropsychological Investigations (LIN), National Science and Technology Institute for Molecular Medicine, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo HorizonteMG, Brazil
| | - Jonas Jardim de Paula
- Laboratory of Neuropsychological Investigations (LIN), National Science and Technology Institute for Molecular Medicine, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo HorizonteMG, Brazil
| | - Edgar Nunes Moraes
- Department of Medical Practice, School of Medicine, UFMG, Belo HorizonteMG, Brazil
| | - Vitor Geraldi Haase
- Laboratory of Developmental Neuropsychology, Department of Psychology, School of Philosophy and Human Sciences, UFMG, Belo HorizonteMG, Brazil
| | - Leandro Fernandes Malloy-Diniz
- Laboratory of Neuropsychological Investigations (LIN), National Science and Technology Institute for Molecular Medicine, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo HorizonteMG, Brazil
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13
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Shigaeff N, Jacinto AF, Franco FGDM, Chiochetta G, Cendoroglo MS, Cítero VDA. Cognitive assessment in an elderly population with metabolic syndrome in Brazil. Dement Neuropsychol 2013; 7:206-209. [PMID: 29213841 PMCID: PMC5619519 DOI: 10.1590/s1980-57642013dn70200011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Chronic degenerative conditions are very common in the elderly. According to medical literature, there is a correlation between cognitive impairment among elders and arterial hypertension/hyperglycemia which in turn are common diseases among the elderly population worldwide. Nonetheless, data on the association between cognitive impairment and Metabolic Syndrome (MetS) remains controversial. OBJECTIVE To compare the cognitive status of Brazilian elderly outpatients with and without MetS. METHODS A cross-sectional case-control study with 49 subjects (25 MetS and 24 controls) who underwent a global geriatric and neuropsychological assessment was carried out. The scores for cognitive abilities (sustained attention, alternating attention, immediate memory, working memory, memory - immediate recall, memory - delayed recall, memory - recognition, executive function, ideomotor praxis, constructive praxis, naming ability, verbal fluency) were compared with the data for the normal population and differences between case and control groups were analyzed using Student's t-test or the Mann-Whitney test. RESULTS Forty-five patients (91.8%) were female, with a mean age of 73.9±5.9 years, and 3.0±1.0 years of schooling. A significant difference (p<0.01) was found between case and control groups regarding the MetS components. For cognitive abilities, no statistically significant difference was detected between the groups and all subjects presented low cognitive scores. CONCLUSION The results obtained in the present study showed that MetS was not associated with cognitive impairment in this population. Further prospective studies are necessary to investigate the influence of well-controlled MetS on cognitive performance among elders.
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Affiliation(s)
- Nadia Shigaeff
- Universidade Federal de São Paulo, São Paulo SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo SP, Brazil
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14
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Romann AJ, Dornelles S, Maineri NDL, Rieder CRDM, Olchik MR. Cognitive assessment instruments in Parkinson's disease patients undergoing deep brain stimulation. Dement Neuropsychol 2012; 6:2-11. [PMID: 29213766 PMCID: PMC5619101 DOI: 10.1590/s1980-57642012dn06010002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep Brain Stimulation (DBS) is a widely used surgical technique in individuals
with Parkinson's disease (PD) that can lead to significant reductions in motor
symptoms.
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Affiliation(s)
- Aline Juliane Romann
- Mestranda em Medicina, Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil (UFRGS). Fonoaudióloga Clínica
| | - Silvia Dornelles
- Doutora em Ciências da Criança e do Adolescente, UFRGS. Professora Adjunto da UFRGS, Departamento de Psicologia do Desenvolvimento e da Personalidade
| | - Nicole de Liz Maineri
- Mestre em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil (PUCRS). Neuropsicóloga do Laboratório de Estudos Cognitivos, MemoLab (Hospital Moinhos de Vento)
| | - Carlos Roberto de Mello Rieder
- Doutor em Clinical Neuroscience (University of Birmingham). Professor Adjunto de Neurologia da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) e do Programa de Pós Graduação em Medicina, Ciências Médicas, UFRGS
| | - Maira Rozenfeld Olchik
- Doutora em Educação, UFRGS. Professora Adjunto do Curso de Fonoaudiologia da UFRGS, Departamento de Cirurgia e Ortopedia
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15
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Sanchez MADS, Correa PCR, Lourenço RA. Cross-cultural Adaptation of the "Functional Activities Questionnaire - FAQ" for use in Brazil. Dement Neuropsychol 2011; 5:322-327. [PMID: 29213759 PMCID: PMC5619045 DOI: 10.1590/s1980-57642011dn05040010] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 09/17/2011] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE The aim of this paper was to present the results of the first stage of cross-cultural adaptation of the Functional Activities Questionnaire (FAQ). METHODS The tool was subjected to translation and re-translation, and the test-retest reliability of a proposed version for use in Brazil was analyzed. RESULTS Of the 548 questionnaire respondents, a convenience sample of 68 informants was selected for retesting. Internal consistency was measured by Cronbach's alpha (0.95) while test-retest reliability was assessed using intra-class correlation (0.97). The findings have shown that FAQ is brief - averaging seven minutes to apply, easily understood and has good intra-rater test-retest reliability. CONCLUSION Our results suggest this adapted version of the FAQ is a reliable and stable tool which may be useful for assessing function in Brazilian elderly. Notwithstanding, the version should be subjected to further analysis with the aim of reaching functional equivalence.
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Affiliation(s)
- Maria Angélica dos Santos Sanchez
- Doutoranda, Departamento de
Pós-Graduação em Ciências Médicas, Faculdade de
Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de
Janeiro RJ, Brazil e Laboratório de Pesquisa em Envelhecimento Humano,
GeronLab
| | - Pricila Cristina Ribeiro Correa
- Doutoranda em Saúde Coletiva, Instituto de
Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro RJ, Brazil
e Laboratório de Pesquisa em Envelhecimento Humano, GeronLab
| | - Roberto Alves Lourenço
- Doutor em Saúde Coletiva, Instituto de Medicina
Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro RJ, Brazil e
Laboratório de Pesquisa em Envelhecimento Humano, GeronLab
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Engelhardt E, Tocquer C, André C, Moreira DM, Okamoto IH, Cavalcanti JLDS. Vascular dementia: Cognitive, functional and behavioral assessment. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part II. Dement Neuropsychol 2011; 5:264-274. [PMID: 29213753 PMCID: PMC5619039 DOI: 10.1590/s1980-57642011dn05040004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 11/02/2011] [Indexed: 01/10/2023] Open
Abstract
Vascular dementia (VaD) is the most prevalent form of secondary dementia and the second most common of all dementias. The present paper aims to define guidelines on the basic principles for treating patients with suspected VaD (and vascular cognitive impairment - no dementia) using an evidence-based approach. The material was retrieved and selected from searches of databases (Medline, Scielo, Lilacs), preferentially from the last 15 years, to propose a systematic way to assess cognition, function and behavior, and disease severity staging, with instruments adapted for our milieu, and diagnosis disclosure. The present proposal contributes to the definition of standard diagnostic criteria for VaD based on various levels of evidence. It is noteworthy that only around half of the population of patients with vascular cognitive impairment present with dementia, which calls for future proposals defining diagnostic criteria and procedures for this condition.
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Affiliation(s)
- Eliasz Engelhardt
- Full Professor (retired) – UFRJ, Coordinator of the
Cognitive Neurology and Behavior Sector, INDC, CDA/IPUB, UFRJ, Rio de Janeiro RJ,
Brazil
| | - Carla Tocquer
- Neurologist, Masters and PhD in Neuropsychology, Claude
Bernard University, France
| | - Charles André
- Associate Professor of Neurology, Faculty of Medicine,
UFRJ. Medical Director of SINAPSE Rehabilitation and Neurophysiology, Rio de Janeiro
RJ, Brazil
| | - Denise Madeira Moreira
- Adjunct Professor of Radiology, School of Medicine, UFRJ.
Head of Radiology Sector, INDC, UFRJ, Rio de Janeiro RJ, Brazil
| | - Ivan Hideyo Okamoto
- Department of Neurology Neurosurgery, UNIFESP, Institute
of Memory, UNIFESP, São Paulo SP, Brazil
| | - José Luiz de Sá Cavalcanti
- Adjunct Professor of Neurology, INDC, UFRJ. Cognitive
Neurology and Behavior Sector, INDC, UFRJ, Rio de Janeiro RJ, Brazil
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