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Rhodes E, Mechanic-Hamilton D, Phillips JS, Bahena A, Vitali N, Hlava Q, Cook P, Gee J, Grossman M, McMillan C, Massimo L. Discrepancies in Patient and Caregiver Ratings of Personality Change in Alzheimer's Disease and Related Dementias. Arch Clin Neuropsychol 2024; 39:399-408. [PMID: 37867324 PMCID: PMC11110615 DOI: 10.1093/arclin/acad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE Personality change in Alzheimer's disease and related dementias (ADRD) is complicated by the patient and informant factors that confound accurate reporting of personality traits. We assessed the impact of caregiver burden on informant report of Big Five personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness) and investigated the regional cortical volumes associated with larger discrepancies in the patient and informant report of the Big Five personality traits. METHOD Sixty-four ADRD participants with heterogeneous neurodegenerative clinical phenotypes and their informants completed the Big Five Inventory (BFI). Caregiver burden was measured using the Zarit Burden Interview. Discrepancy scores were computed as the difference between patient and informant ratings for the BFI. Regional gray matter volumes from T1-weighted 3T MRI were normalized to intracranial volume and related to global Big Five discrepancy scores using linear regression. RESULTS Higher levels of caregiver burden were associated with higher informant ratings of patient neuroticism (ß = 0.08, p = .012) and with lower informant ratings of patient agreeableness (ß = 0.11, p = .021) and conscientiousness (ß = 0.04, p = .034) independent of disease severity. Patients with greater Big Five discrepancy scores showed smaller cortical volumes in the right medial prefrontal cortex (β = -5.24, p = .045) and right superior temporal gyrus (β = -7.91, p = .028). CONCLUSIONS Informant ratings of personality traits in ADRD can be confounded by the caregiver burden, highlighting the need for more objective measures of personality and behavior in dementia samples. Discrepancies between informant and patient ratings of personality may additionally reflect loss of insight secondary to cortical atrophy in the frontal and temporal structures.
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Affiliation(s)
- Emma Rhodes
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dawn Mechanic-Hamilton
- Alzheimer’s Disease Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffrey S Phillips
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alejandra Bahena
- Digital Neuropathology Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nykko Vitali
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Quinn Hlava
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Philip Cook
- Department of Radiology, Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James Gee
- Department of Radiology, Penn Image Computing and Science Laboratory (PICSL), University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Murray Grossman
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Corey McMillan
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lauren Massimo
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA 19104, USA
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Alexander CM, Martyr A, Gamble LD, Quinn C, Pentecost C, Morris RG, Clare L. Dyadic influences on awareness of condition in people with dementia: findings from the IDEAL cohort. Front Aging Neurosci 2023; 15:1277336. [PMID: 38146375 PMCID: PMC10749333 DOI: 10.3389/fnagi.2023.1277336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction The discrepancy between caregiver-ratings and self-ratings of abilities is commonly used to assess awareness in people with dementia. We investigated the contribution of caregiver and dyadic characteristics to the difference in perspective between caregiver-informants and people with dementia about difficulties experienced, when considering awareness of condition. Methods We conducted exploratory cross-sectional analyses using data from the IDEAL cohort. Participants were 1,038 community-dwelling people with mild-to-moderate dementia, and coresident spouse/partner caregivers. The Representations and Adjustment to Dementia Index (RADIX) checklist reporting difficulties commonly experienced in dementia was completed by 960 caregiver-informants and 989 people with dementia. Difference in scores was calculated for 916 dyads. Demographic information, cognition, informant-rated functional ability and neuropsychiatric symptoms were recorded for the person with dementia. Self-reported data were collected on mood, comorbidity, religion, importance of religion, relationship quality, and caregiver stress. Results For most dyads, caregivers reported more RADIX difficulties than people with dementia. Caregiver RADIX ratings were more closely associated with informant-rated functional ability and neuropsychiatric symptoms than with cognition. More RADIX difficulties and higher stress were reported by female caregivers. Greater RADIX difference was associated with more caregiver stress, and older age but less depression in people with dementia. Conclusion Few dyadic characteristics were important, but caregiver stress was higher where caregivers reported more RADIX difficulties and/or the difference in perspective was greater, whereas partners with dementia reported better mood. In addition to offering information about awareness of condition, the caregiver rating and difference in perspectives could indicate where more support is needed.
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Affiliation(s)
- Catherine M. Alexander
- The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, United Kingdom
- NIHR Applied Research Collaboration South West Peninsula, Exeter, United Kingdom
| | - Anthony Martyr
- The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, United Kingdom
| | - Laura D. Gamble
- Population Health Sciences Institute, Newcastle upon Tyne University, Newcastle, United Kingdom
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
- Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Claire Pentecost
- The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, United Kingdom
| | - Robin G. Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Linda Clare
- The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, United Kingdom
- NIHR Applied Research Collaboration South West Peninsula, Exeter, United Kingdom
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Guieysse T, Lamothe R, Houot M, Razafimahatratra S, Medani T, Lejeune FX, Dreyfus G, Klarsfeld A, Pantazis D, Koechlin E, Andrade K. Detecting Anosognosia from the Prodromal Stage of Alzheimer's Disease. J Alzheimers Dis 2023; 95:1723-1733. [PMID: 37718816 PMCID: PMC10578267 DOI: 10.3233/jad-230552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Though not originally developed for this purpose, the Healthy Aging Brain Care Monitor (HABC-M) seems a valuable instrument for assessing anosognosia in Alzheimer's disease (AD). OBJECTIVES Our study aimed at 1) investigating the validity of the HABC-M (31 items), and its cognitive, psychological, and functional subscales, in discriminating AD patients from controls; 2) exploring whether the HABC-M discrepancy scores between the self-reports of patients/controls in these different domains and the respective ratings provided by their caregivers/informants correlate with an online measure of self-awareness; 3) determining whether the caregiver burden level, also derived from the HABC-M, could add additional support for detecting anosognosia. METHODS The HABC-M was administered to 30 AD patients and 30 healthy controls, and to their caregivers/informants. A measure of online awareness was established from subjects' estimation of their performances in a computerized experiment. RESULTS The HABC-M discrepancy scores distinguished AD patients from controls. The cognitive subscale discriminated the two groups from the prodromal AD stage, with an AUC of 0.88 [95% CI: 0.78;0.97]. Adding the caregiver burden level raised it to 0.94 [0.86;0.99]. Significant correlations between the HABC-M and online discrepancy scores were observed in the patients group, providing convergent validity of these methods. CONCLUSIONS The cognitive HABC-M (six items) can detect anosognosia across the AD spectrum. The caregiver burden (four items) may corroborate the suspicion of anosognosia. The short-hybrid scale, built from these 10 items instead of the usual 31, showed the highest sensitivity for detecting anosognosia from the prodromal AD stage, which may further help with timely diagnosis.
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Affiliation(s)
- Thomas Guieysse
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Roxane Lamothe
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marion Houot
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Solofo Razafimahatratra
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Takfarinas Medani
- Signal & Image Processing Institute, University of Southern California, Los Angeles, CA, USA
| | - François-Xavier Lejeune
- Paris Brain Institute (Institut du Cerveau, ICM), Data Analysis Core, INSERM, CNRS, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - André Klarsfeld
- Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France
| | - Dimitrios Pantazis
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Etienne Koechlin
- Laboratoire de Neurosciences Cognitives et Computationnelles, École Normale Supérieure, Paris, France
| | - Katia Andrade
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France
- FrontLab, Paris Brain Institute, ICM, Pitié Salpêtrière GH, Paris, France
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Huang SS. Depression among caregivers of patients with dementia: Associative factors and management approaches. World J Psychiatry 2022; 12:59-76. [PMID: 35111579 PMCID: PMC8783169 DOI: 10.5498/wjp.v12.i1.59] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
As elderly people increasingly come to represent a higher proportion of the world’s population, various forms of dementia are becoming a significant chronic disease burden. The World Health Organization emphasizes dementia care as a public health priority and calls for more support for family caregivers who commonly play a significant, central role in dementia care. Taking care of someone with dementia is a long-term responsibility that can be stressful and may lead to depression among family caregivers. Depression and related behavioral and cognitive changes among caregivers could in turn affect the status and prognosis of the dementia patient. This review article explores depression in dementia caregivers and summarizes proposed mechanisms, associated factors, management and research findings, and proposes future research directions.
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Affiliation(s)
- Si-Sheng Huang
- Division of Geriatric Psychiatry, Department of Psychiatry, Changhua Christian Hospital, Changhua 500, Taiwan
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Huang WC, Chang MC, Wang WF, Jhang KM. A Comparison of Caregiver Burden for Different Types of Dementia: An 18-Month Retrospective Cohort Study. Front Psychol 2022; 12:798315. [PMID: 35111109 PMCID: PMC8801423 DOI: 10.3389/fpsyg.2021.798315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022] Open
Abstract
Background This study aimed to elucidate the influence of dementia etiologies on the degree of caregiver burden and determine which factors predict a high caregiving burden. Methods This 18-month retrospective cohort study enrolled 630 patients and their caregivers from the Dementia Center of Changhua Christian Hospital. The care team performed face-to-face interviews every 6 months, for 18 months from when a diagnosis of dementia was made. The primary outcome was the change in Zarit Burden Interview (ZBI) scores. Generalized estimating equations were used for the longitudinal data analysis. Results Participants with Lewy body disease (LBD) had a significantly higher caregiving burden compared with those with Alzheimer's disease (AD) (β = 3.83 ± 1.47, Wald = 6.79, p = 0.009) after adjusting for patient and caregiver features. Caregivers of mixed-type dementia and frontotemporal dementia (FTD) experienced a greater burden than caregivers of AD, at 6- and 18-month follow-up. Patients with more severe dementia, neuropsychiatric symptoms, being cared for by more than two caregivers, or utilizing social resources were associated with higher ZBI scores; the depressive mood of caregiver also predicted higher ZBI scores. Conclusion This longitudinal study demonstrated that caregiver burden was influenced by the underlying dementia etiology of patients. The dementia care team should provide personalized education and transfer patients and caregivers to appropriate resources, especially for high-risk populations.
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Affiliation(s)
- Wen-Chien Huang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Che Chang
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
- Department of Recreation and Holistic Wellness, Ming Dao University, Changhua, Taiwan
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
- *Correspondence: Kai-Ming Jhang
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Alexander CM, Martyr A, Savage SA, Morris RG, Clare L. Measuring Awareness in People With Dementia: Results of a Systematic Scoping Review. J Geriatr Psychiatry Neurol 2021; 34:335-348. [PMID: 32400259 PMCID: PMC8326902 DOI: 10.1177/0891988720924717] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Awareness of the diagnosis or related changes in functioning varies in people with dementia (PwD), with implications for the well-being of PwD and their carers. Measuring awareness in a clinical setting could facilitate tailored support and optimize involvement in personal health and care decisions. This scoping review aimed to identify validated methods of assessing awareness in dementia and appraise their clinical utility. METHOD A systematic search was conducted of English-language publications that measured awareness in PwD, in 6 electronic databases. Search terms included dement*, Alzheimer*, Pick disease, and awareness, unawareness, anosognosia, insight, denial, metacognit*, or discrepanc*. RESULTS We screened 30,634 articles, finding 345 articles that met our inclusion criteria. We identified 76 measures, most commonly using a discrepancy questionnaire comparing evaluations of function by PwD and an informant. There were 30 awareness measures developed and validated for use in dementia populations but few designed for general clinical use. CONCLUSIONS Although we found a range of clinical indications for measuring awareness, there were few studies investigating clinical applications and few tools designed for clinical purposes. Further investigation and development of a person-centered tool could facilitate health and care choices in mild-to-moderate dementia.
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Affiliation(s)
- Catherine M. Alexander
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom,Catherine M. Alexander, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, United Kingdom.
| | - Anthony Martyr
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom
| | - Sharon A. Savage
- Psychology Department, University of Exeter, Washington Singer Laboratories, Streatham Campus, Exeter, United Kingdom
| | - Robin G. Morris
- King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Linda Clare
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom
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Frederiksen KS, Cooper C, Frisoni GB, Frölich L, Georges J, Kramberger MG, Nilsson C, Passmore P, Mantoan Ritter L, Religa D, Schmidt R, Stefanova E, Verdelho A, Vandenbulcke M, Winblad B, Waldemar G. A European Academy of Neurology guideline on medical management issues in dementia. Eur J Neurol 2020; 27:1805-1820. [PMID: 32713125 PMCID: PMC7540303 DOI: 10.1111/ene.14412] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Dementia is one of the most common disorders and is associated with increased morbidity, mortality and decreased quality of life. The present guideline addresses important medical management issues including systematic medical follow-up, vascular risk factors in dementia, pain in dementia, use of antipsychotics in dementia and epilepsy in dementia. METHODS A systematic review of the literature was carried out. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework, we developed a guideline. Where recommendations based on GRADE were not possible, a good practice statement was formulated. RESULTS Systematic management of vascular risk factors should be performed in patients with mild to moderate dementia as prevention of cerebrovascular pathology may impact on the progression of dementia (Good Practice statement). Individuals with dementia (without previous stroke) and atrial fibrillation should be treated with anticoagulants (weak recommendation). Discontinuation of opioids should be considered in certain individuals with dementia (e.g. for whom there are no signs or symptoms of pain or no clear indication, or suspicion of side effects; Good Practice statement). Behavioral symptoms in persons with dementia should not be treated with mild analgesics (weak recommendation). In all patients with dementia treated with opioids, assessment of the individual risk-benefit ratio should be performed at regular intervals. Regular, preplanned medical follow-up should be offered to all patients with dementia. The setting will depend on the organization of local health services and should, as a minimum, include general practitioners with easy access to dementia specialists (Good Practice statement). Individuals with dementia and agitation and/or aggression should be treated with atypical antipsychotics only after all non-pharmacological measures have been proven to be without benefit or in the case of severe self-harm or harm to others (weak recommendation). Antipsychotics should be discontinued after cessation of behavioral disturbances and in patients in whom there are side effects (Good Practice statement). For treatment of epilepsy in individuals with dementia, newer anticonvulsants should be considered as first-line therapy (Good Practice statement). CONCLUSION This GRADE-based guideline offers recommendations on several important medical issues in patients with dementia, and thus adds important guidance for clinicians. For some issues, very little or no evidence was identified, highlighting the importance of further studies within these areas.
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Affiliation(s)
- K. S. Frederiksen
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - C. Cooper
- Department of Clinical Educational and Health PsychologyUniversity College LondonLondonUK
| | - G. B. Frisoni
- Memory ClinicUniversity Hospital of GenevaUniversity of GenevaGenevaSwitzerland
| | - L. Frölich
- Department of Geriatric PsychiatryZentralinstitut für Seelische Gesundheit MannheimMedical Faculty MannheimUniversity of HeidelbergMannheimGermany
| | | | - M. G. Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical Center Ljubljana, and Medical facultyUniversity of LjubljanaLjubljanaSlovenia
| | - C. Nilsson
- Department of Neurology and Rehabilitation MedicineSkåne University HospitalLundSweden
- Clinical Memory Research UnitDepartment of Clinical SciencesLund UniversityMalmöSweden
| | | | - L. Mantoan Ritter
- Epilepsy CentreKing's College NHS Foundation TrustKing´s College LondonLondonUK
| | - D. Religa
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetNeo, StockholmSweden
- Karolinska University HospitalTheme AgingHuddingeSweden
| | - R. Schmidt
- University Clinic for NeurologyMedical University of GrazGrazAustria
| | - E. Stefanova
- Medical FacultyNeurology clinic CCSUniversity of BelgradeBelgradeSerbia
| | - A. Verdelho
- Department of Neurosciences and Mental HealthCHLNorte‐Hospital de Santa MariaIMMISAMBFaculty of MedicineUniversity of LisbonLisbonPortugal
| | - M. Vandenbulcke
- Department of NeurosciencesKU LeuvenGeriatric PsychiatryUniversity Hospitals LeuvenLeuvenBelgium
| | - B. Winblad
- Karolinska University HospitalTheme AgingHuddingeSweden
- Division of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetBioClinicumSolnaSweden
| | - G. Waldemar
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
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Pennington C, Duncan G, Ritchie C. Altered awareness of motor symptoms in Parkinson's disease and Dementia with Lewy Bodies: A systematic review. Int J Geriatr Psychiatry 2020; 35:972-981. [PMID: 32525228 DOI: 10.1002/gps.5362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Altered awareness of motor symptoms is reported in people with Parkinson's disease and Dementia with Lewy Bodies, and may adversely affect quality of life and medication concordance. How symptom awareness is influenced by motor and cognitive disease severity, age and medication use is not fully understood. We carried out a systematic review of the literature on motor symptom awareness in Parkinson's disease and Dementia with Lewy Bodies. METHODS Pubmed and Wed of Science were searched for relevant articles published in or prior to March 2019. Data regarding participant demographics, diagnosis, cognitive status, method of assessing awareness and study findings were extracted from relevant publications. RESULTS Sixteen relevant publications were identified. Motor symptom awareness appears to decline over the course of Parkinson's disease. Imaging studies implicate the prefrontal cortex, with different mechanisms involved in hypokinesia and dyskinesia awareness. The hypothesis that people with right hemisphere based disease would have more severely reduced awareness is only weakly supported. Most studies focused on cognitively intact individuals, and on awareness of dyskinesia rather than hypokinesia. CONCLUSIONS Whilst reduced awareness of dyskinesia and to a lesser extent hypokinesia is common, there is a lack of longitudinal data on how awareness changes over time, and how it interacts with global cognitive changes. Motor symptom awareness in Dementia with Lewy Bodies is understudied. Future studies of symptom awareness should include robust assessment of overall cognitive functioning, and use a longitudinal design to elucidate how awareness changes over time. J Am Geriatr Soc 68:-, 2020.
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Affiliation(s)
- Catherine Pennington
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon Duncan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Craig Ritchie
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Brunet HE, Cummings JL, Banks SJ, Miller JB. Awareness of Psychiatric Symptoms in a Mixed Clinical Sample of Older Adults. J Geriatr Psychiatry Neurol 2020; 33:124-134. [PMID: 31401920 DOI: 10.1177/0891988719868311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examined the neuropsychological correlates and impact on caregiver distress of reduced awareness of mood symptoms in patients with suspected neurodegenerative disease. METHOD Records from a clinical sample of older adults were examined (N = 940). RESULTS More than one-third of patient and caregiver ratings of mood symptoms did not agree (comparing patient and caregiver self-report measures); 27.9% of patients were unaware of depression (UoD) and 16.6% of patients were unaware of anxiety (UoA). The UoD group exhibited poorer verbal memory and executive abilities and the UoA group exhibited poorer verbal memory than those with preserved awareness. Unawareness was not associated with caregiver distress. CONCLUSIONS These findings highlight the importance of capturing informant report in clinical practice with older adults suspected of cognitive impairment. Unawareness of mood symptoms was related to memory dysfunction and-to a lesser extent-to executive abilities and may have implications for addressing patient and caregiver needs for disorders affecting these cognitive systems.
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Affiliation(s)
- Hannah E Brunet
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jeffrey L Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.,School of Allied Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Sarah J Banks
- University of California San Diego, San Diego, CA, USA
| | - Justin B Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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Maki Y, Takao M, Hattori H, Suzuki T. Promoting dementia‐friendly communities to improve the well‐being of individuals with and without dementia. Geriatr Gerontol Int 2020; 20:511-519. [DOI: 10.1111/ggi.13896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 12/25/2019] [Accepted: 01/09/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Yohko Maki
- National Center for Geriatrics and Gerontology Aichi Japan
| | - Makiko Takao
- Hosei Graduate School of Regional Policy Design Tokyo Japan
| | | | - Takao Suzuki
- National Center for Geriatrics and Gerontology Aichi Japan
- J. F. Oberlin University, Institute for Gerontology Tokyo Japan
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11
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Connors MH, Seeher K, Teixeira-Pinto A, Woodward M, Ames D, Brodaty H. Dementia and caregiver burden: A three-year longitudinal study. Int J Geriatr Psychiatry 2020; 35:250-258. [PMID: 31821606 DOI: 10.1002/gps.5244] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/07/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Dementia, with its progressive cognitive and functional decline and associated neuropsychiatric symptoms, places a large burden on caregivers. While frequently studied, longitudinal findings about the overall trajectory of burden are mixed. The study sought to characterize caregiver burden over a 3-year period and identify predictors of this burden. METHODS Seven-hundred-and-eighty-one patients with dementia were recruited from nine memory clinics around Australia. Measures of caregiver burden, cognition, function, and neuropsychiatric symptoms were completed with patients and their caregivers at regular intervals over a 3-year period. Patients' level of services and medication use were also recorded. RESULTS Of the 720 patients with measures of caregiver burden at baseline, 47.4% of caregivers had clinically significant levels of burden. This proportion increased over time, with 56.8% affected at 3 years. Overall levels of burden increased for caregivers of patients without services, though did not change for caregivers of patients receiving services or residential care after controlling for other variables. Patient characteristics-including greater neuropsychiatric symptoms, lower functional ability, fewer medications, lack of driving ability-and female sex of caregivers were associated with greater burden. CONCLUSIONS High levels of caregiver burden are present in a large proportion of caregivers of people with dementia and this increases over time for those without services. Clinical characteristics of patients (including neuropsychiatric symptoms, function, overall health, driving status), level of services, and caregiver sex appear to be the best predictors of this burden. These characteristics may help identify caregivers at greater risk of burden to target for intervention.
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Affiliation(s)
- Michael H Connors
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
| | - Katrin Seeher
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
| | | | | | - David Ames
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Victoria, Australia.,National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
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Wilson RS, Barnes LL, Rajan KB, Boyle PA, Sytsma J, Weuve J, Evans DA. Antecedents and consequences of unawareness of memory impairment in dementia. Neuropsychology 2018; 32:931-940. [PMID: 30047756 PMCID: PMC6234063 DOI: 10.1037/neu0000437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To assess the prevalence, antecedents, and consequences of unawareness of memory impairment in dementia. METHOD Persons (n = 1,862) from a geographically defined community without dementia at enrollment subsequently underwent clinical classification (248 with dementia, 611 with mild cognitive impairment, 1,003 with no cognitive impairment), memory testing, and self-appraisal of memory. Memory performance was regressed on self-appraised memory, and the residuals served as an index of memory awareness. After clinical classification, participants completed brief cognitive testing at 3-year intervals for up to 15 years. RESULTS When unawareness was defined as a score at or below thresholds ranging from the 15th to 25th percentiles, it was more common in dementia (67%-83%) and mild cognitive impairment (15%-33%) than in no cognitive impairment (2%-6%; all p < .001). A continuous measure of awareness (M = 0.00, SD = 0.61) was reduced by 0.37-unit in mild cognitive impairment (SE = 0.04, p < .001) and 1.04-unit in dementia (SE = 0.06), p < .001) compared with those without cognitive impairment, and these associations were weaker in Black persons than White persons (estimate for dementia by race = 0.37, SE = 0.12, p = .003; estimate for mild cognitive impairment by race = 0.30, SE = 0.08, p < .001). Higher premorbid neuroticism was associated with better memory awareness in dementia. Higher memory awareness was not related to mortality in mild cognitive impairment or dementia but had a marginal association with slower cognitive decline in mild cognitive impairment. CONCLUSIONS Unawareness of memory impairment is a common manifestation of dementia, particularly in White persons, but is not strongly related to adverse disease outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Robert S. Wilson
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Kumar B. Rajan
- Rush Institute for Healthy Aging, Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - Patricia A. Boyle
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Joel Sytsma
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences, Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Jennifer Weuve
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA
| | - Denis A. Evans
- Rush Institute for Healthy Aging, Department of Internal Medicine, Rush University Medical Center, Chicago, IL
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