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Mashinchi GM, McFarland CP, Hall S, Strongin DL, Williams GA, Cotter KA. Handicraft art leisure activities and cognitive reserve. Clin Neuropsychol 2024; 38:683-714. [PMID: 37674299 DOI: 10.1080/13854046.2023.2253993] [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: 05/16/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
ObjectiveOlder individuals face a higher likelihood of developing dementia. The rate of cognitive decline resulting from dementia is not equivalent for all, as some patients with dementia are able to function independently longer than others, despite having similar disease burden. The cognitive reserve (CR) theory provides one explanation for the differing rate of decline. CR suggests that there are factors-most notably, educational attainment and occupational attainment-that can protect against the cognitive decline. Although the beneficial effects of these notable CR factors are clear, not all are easily modifiable. Participation in leisure activities may represent a more easily modifiable factor. Some research hints at beneficial effects of leisure activities, although specific leisure activities have not been well examined. The present study examined the relations between handicraft art leisure activities (HALAs) and multiple cognitive domains. MethodArchival WAIS-IV and demographic data for 50 California retirement community residents were examined. ResultsHALA participation accounted for statistically significant variance in working memory performance (R2 = .40, β = .24%) over and above the established CR factors of age, depression, educational attainment, and occupational attainment. In addition, HALA participation was related to a better ability to perform abstract visual information tasks (Block Design subtest, r = .28, p = .05) and non-verbal reasoning tasks (Visual Puzzles subtest, r = .38, p = .008). ConclusionsHALA participation among older adults could contribute to the retention of cognitive function, supporting the role of HALA participation as a CR factor.
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Sex differences on anxiety and depression in older adults and their relationship with cognitive impairment. Semergen 2023; 49:101923. [PMID: 36758261 DOI: 10.1016/j.semerg.2023.101923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Subjective memory complaints (SMCs) in elderly adults could express cognitive decline in the future. A consensus has been reached about how these SMC relate to mood variables, but further research is required to determine which socio-demographic, cognitive, functional and occupational factors will act as predictors in elderly adults. OBJETIVE To analyze, through a descriptive observational study, the relationship between anxiety/depression and sex, age and occupation, with cognitive/functional performance in 367 older adults with SMC, but without objective cognitive impairment in a primary healthcare center. METHODS The cognitive variables were measured by applying the Spanish version of Mini-Mental State Examination (MEC-35) and Set-test for verbal fluency. To measure functional level, the Barthel index and Lawton and Brody scales were employed. Physical occupational status and mental occupational status were measured based on three levels, low, medium and high, according to the American Occupational Therapy Association. RESULTS Low educational and occupational physical and mental levels were related to anxiety and depression. In addition, differences by sex were found on anxiety and depression related to different factors. In men, anxiety was related to higher cognitive level, and in women to higher functional performance in IADLs. On the contrary, depression in men was related to lower cognitive level and higher performance in ADLs. CONCLUSIONS It is important to maintain a sex-gender perspective on the study of anxiety and depression in elderly, taking into account social roles and the traints of the work environment, in order to avoid cognitive and functional impairment.
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Bansal K, Clark DJ, Fox EJ, Conroy C, Freeborn P, Rose DK. Spatiotemporal strategies adopted to walk at fast speed in high- and low-functioning individuals post-stroke: a cross-sectional study. Top Stroke Rehabil 2023; 30:1-10. [PMID: 36524626 DOI: 10.1080/10749357.2021.2008593] [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: 02/01/2023]
Abstract
BACKGROUND Walking at fast speed is a gait training strategy post-stroke. It is unknown how faster-than-preferred pace impacts spatiotemporal gait characteristics in survivors with different functional abilities. OBJECTIVE To test the hypothesis that compared to high-functioning individuals, low-functioning individuals will be limited in modifying spatiotemporal gait parameters for walking at faster-than-preferred speed, and these limitations are associated with fear of falling. METHODS Forty-two adults, 17.6 ± 14.6 months post-stroke, traversed an instrumented walkway at preferred and fast speeds. Participants were categorized to a low-functioning group (LFG) (n = 20; <0.45 m/s) and high-functioning group (HFG) (n = 22; ≥0.45 m/s). Cadence, step length, stance time and spatiotemporal asymmetry measures were calculated. The Modified Falls-efficacy Scale examined fear of falling. Multivariate and correlational analysis tested hypotheses. RESULTS Increased speed from preferred to fast pace was significantly greater for HFG (0.27 ± 0.03 m/s) than LFG (0.10 ± 0.02 m/s) (p ≤ 0.001). Cadence gain from preferred to fast pace did not differ between groups. However, HFG exhibited greater change in paretic (∆6.1 ± 1.37 cm; p < .001) and non-paretic step lengths (∆4.5 ± 1.37 cm; p = .003) than LFG. Spatiotemporal asymmetry did not change for either group. Fear of falling had moderately positive correlation with ∆paretic step length (r = 0.43; p = .004) and ∆non-paretic step length (r = 0.32; p = .035). CONCLUSIONS While both low- and high-functioning individuals used a step-lengthening strategy to walk at faster-than-preferred speeds, the gain in step lengths was limited in low-functioning individuals and was partially explained by falls-efficacy.
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Affiliation(s)
- Kanika Bansal
- Department of Physical Therapy, University of Florida, Gainesville, FL.,Brooks Rehabilitation, Clinical Research Center, Jacksonville, FL
| | - David J Clark
- Department of Physical Therapy, University of Florida, Gainesville, FL.,Malcom Randall VAMC, Brain Rehabilitation Center, Gainesville, FL
| | - Emily J Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL.,Brooks Rehabilitation, Clinical Research Center, Jacksonville, FL
| | - Christy Conroy
- Brooks Rehabilitation, Clinical Research Center, Jacksonville, FL
| | | | - Dorian K Rose
- Department of Physical Therapy, University of Florida, Gainesville, FL.,Brooks Rehabilitation, Clinical Research Center, Jacksonville, FL.,Malcom Randall VAMC, Brain Rehabilitation Center, Gainesville, FL
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Fellows RP, Bangen KJ, Graves LV, Delano-Wood L, Bondi MW. Pathological functional impairment: Neuropsychological correlates of the shared variance between everyday functioning and brain volumetrics. Front Aging Neurosci 2022; 14:952145. [PMID: 36620766 PMCID: PMC9816390 DOI: 10.3389/fnagi.2022.952145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Given that several non-cognitive factors can contribute to difficulties with everyday functioning, examining the extent to which cognition is associated with brain-related changes in everyday functioning is critical to accurate characterization of cognitive disorders. In this study, we examined neuropsychological correlates of the shared variance between everyday functioning and pathological indicators of cognitive aging using MRI brain volumetrics. Participants and methods Participants were 600 adults aged 55 and older without dementia [432 cognitively normal; 168 mild cognitive impairment (MCI)] from the National Alzheimer's Coordinating Center cohort who underwent neuropsychological testing, informant-rated everyday functioning, and brain MRI scanning at baseline. The shared variance between everyday functioning and brain volumetrics (i.e., hippocampal volume, white matter hyperintensity volume) was extracted using the predicted value from multiple regression. The shared variance was used as an indicator of pathological everyday functional impairment. The residual variance from the regression analysis was used to examine functional reserve. Results Larger white matter hyperintensity volumes (p = 0.002) and smaller hippocampal volumes (p < 0.001) were significantly correlated with worse informant-rated everyday functioning. Among individuals with MCI, worse performances on delayed recall (p = 0.013) and category fluency (p = 0.012) were significantly correlated with pathological functional impairment in multiple regression analysis. In the cognitively normal group, only worse auditory working memory (i.e., digit span backward; p = 0.025) significantly correlated with pathological functioning. Functional reserve was inversely related to anxiety (p < 0.001) in the MCI group and was associated with depressive symptoms (p = 0.003) and apathy (p < 0.001) in the cognitively normal group. Conclusion Subtle brain-related everyday functioning difficulties are evident in MCI and track with expected preclinical Alzheimer's disease cognitive phenotypes in this largely amnestic sample. Our findings indicate that functional changes occur early in the disease process and that interventions to target neuropsychiatric symptoms may help to bolster functional reserve in those at risk.
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Affiliation(s)
- Robert P. Fellows
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States,*Correspondence: Robert P. Fellows, ✉
| | - Katherine J. Bangen
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States,Research Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Lisa V. Graves
- Department of Psychology, California State University, San Marcos, CA, United States
| | - Lisa Delano-Wood
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Mark W. Bondi
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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Rodrigues EA, Christie GJ, Farzan F, Moreno S. Does cognitive aging follow an orchid and dandelion phenomenon? Front Aging Neurosci 2022; 14:986262. [PMID: 36299615 PMCID: PMC9588970 DOI: 10.3389/fnagi.2022.986262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
Cognitive reserve reflects the brain’s intrinsic adaptive capacity against the neurodegenerative effects of aging. The maintenance or enhancement of the brain’s cognitive reserve plays a crucial role in mitigating the severity of pathologies associated with aging. A new movement, social prescribing, which focuses on prescribing lifestyle activities as a treatment for patients, is growing in popularity as a solution against aging pathologies. However, few studies have demonstrated a clear impact of lifestyle activities on individual cognitive health, outside of floor and ceiling effects. Understanding who benefits from which lifestyle factors remains unclear. Here, we investigated the potential effects of lifestyle activities on individuals’ cognitive health from more than 3,530 older adults using a stratification method and advanced analysis technique. Our stratification methods allowed us to observe a new result: older adults who had relatively average cognitive scores were not impacted by lifestyle factors. By comparison, older adults with very high or very low cognitive scores were highly impacted by lifestyle factors. These findings expand the orchid and dandelion theory to the aging field, regarding the biological sensitivity of individuals to harmful and protective environmental effects. Our discoveries demonstrate the role of individual differences in the aging process and its importance for social prescribing programs.
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Affiliation(s)
- Emma A. Rodrigues
- School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC, Canada
| | | | - Faranak Farzan
- School of Mechatronics and Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Sylvain Moreno
- School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC, Canada
- Circle Innovation, Surrey, BC, Canada
- *Correspondence: Sylvain Moreno,
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Sex differences in risk factors that predict progression from mild cognitive impairment to Alzheimer's dementia. J Int Neuropsychol Soc 2022; 29:360-368. [PMID: 35968841 DOI: 10.1017/s1355617722000297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate whether cerebrospinal fluid biomarkers, apolipoprotein e4, neuroimaging abnormalities, and neuropsychological data differentially predict progression from mild cognitive impairment (MCI) to dementia for men and women. METHODS Participants who were diagnosed with MCI at baseline (n = 449) were classified as either progressing to Alzheimer's dementia at follow-up or as not progressing. Men and women were first compared using bivariate analyses. Sex-stratified Cox proportional hazard regressions were performed examining the relationship between baseline data and the likelihood of progressing to dementia. Sex interactions were subsequently examined. RESULTS Cox proportional hazard regression controlling for age and education indicated that all variables significantly predicted subsequent progression to dementia for men and women. Sex interactions indicated that only Rey Auditory Verbal Learning Test (RAVLT) delayed recall and Functional Activities Questionnaire (FAQ) were significantly stronger risk factors for women. When all variables were entered into a fully adjusted model, significant risk factors for women were Aβ42, hippocampal volume, RAVLT delayed recall, Boston Naming Test, and FAQ. In contrast, for men, Aβ42, p-tau181, p-tau181/Aβ42, hippocampal volume, category fluency and FAQ were significant risk factors. Interactions with sex were only significant for p-tau181/Aβ42 and RAVLT delayed recall for the fully adjusted model. CONCLUSIONS Men and women with MCI may to differ for which factors predict subsequent dementia although future analyses with greater power are needed to evaluate sex differences. We hypothesize that brain and cognitive reserve theories may partially explain these findings.
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Mendoza-Holgado C, Lavado-García J, López-Espuela F, Roncero-Martín R, Canal-Macías ML, Vera V, Aliaga I, Rey-Sánchez P, Pedrera-Zamorano JD, Moran JM. Cognitive Reserve Characteristics and Occupational Performance Implications in People with Mild Cognitive Impairment. Healthcare (Basel) 2021; 9:1266. [PMID: 34682946 PMCID: PMC8535347 DOI: 10.3390/healthcare9101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
The Cognitive Reserve hypothesis suggests that there are individual differences in the ability to cope with the pathologic changes in Alzheimer's Disease. The proportion of elderly individuals has increased in recent years; this increase emphasizes the importance of early detection of mild cognitive impairment and the promotion of healthy ageing. The purpose of our study is to characterize cognitive reserve and occupational performance implications in people with mild cognitive impairment. 125 patients with mild cognitive impairment were enrolled. The Montreal Cognitive Assessments (MoCA) was used to evaluate cognitive status and the Cognitive Reserve Index Questionnaire (CRIq) as an indicator of cognitive reserve. Higher level of education was associated with higher MoCA scores (r = 0.290, p = 0.001). Positive significant correlations were observed between MoCA and total CRIq (r = 0.385, p < 0.001) as well as its three sub-domains, education (r = 0.231, p = 0.010), working activity (r = 0.237, p = 0.008) and leisure time (r = 0.319, p < 0.001). This study findings provide the importance of considering socio-behavioral factors in cognitive status. This research helps to describe the importance of engaging occupationally along the whole life-course as a potential protective factor in ageing, and includes a perspective of occupational therapy regarding the hypothesis of cognitive reserve.
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Affiliation(s)
- Cristina Mendoza-Holgado
- Occupational Therapist in Health and Social Services Department, Government of Extremadura, 10001 Cáceres, Spain;
| | - Jesús Lavado-García
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain; (J.L.-G.); (R.R.-M.); (M.L.C.-M.); (I.A.); (P.R.-S.); (J.D.P.-Z.); (J.M.M.)
| | - Fidel López-Espuela
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain; (J.L.-G.); (R.R.-M.); (M.L.C.-M.); (I.A.); (P.R.-S.); (J.D.P.-Z.); (J.M.M.)
| | - Raúl Roncero-Martín
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain; (J.L.-G.); (R.R.-M.); (M.L.C.-M.); (I.A.); (P.R.-S.); (J.D.P.-Z.); (J.M.M.)
| | - María Luz Canal-Macías
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain; (J.L.-G.); (R.R.-M.); (M.L.C.-M.); (I.A.); (P.R.-S.); (J.D.P.-Z.); (J.M.M.)
| | - Vicente Vera
- Department of Stomatology II, School of Dentistry, Complutense University, 28040 Madrid, Spain;
| | - Ignacio Aliaga
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain; (J.L.-G.); (R.R.-M.); (M.L.C.-M.); (I.A.); (P.R.-S.); (J.D.P.-Z.); (J.M.M.)
| | - Purificación Rey-Sánchez
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain; (J.L.-G.); (R.R.-M.); (M.L.C.-M.); (I.A.); (P.R.-S.); (J.D.P.-Z.); (J.M.M.)
| | - Juan Diego Pedrera-Zamorano
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain; (J.L.-G.); (R.R.-M.); (M.L.C.-M.); (I.A.); (P.R.-S.); (J.D.P.-Z.); (J.M.M.)
| | - Jose M. Moran
- Metabolic Bone Diseases Research Group, Nursing Department, University of Extremadura, 10003 Cáceres, Spain; (J.L.-G.); (R.R.-M.); (M.L.C.-M.); (I.A.); (P.R.-S.); (J.D.P.-Z.); (J.M.M.)
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Alexopoulos P, Skondra M, Kontogianni E, Vratsista A, Frounta M, Konstantopoulou G, Aligianni SI, Charalampopoulou M, Lentzari I, Gourzis P, Kliegel M, Economou P, Politis A. Validation of the Cognitive Telephone Screening Instruments COGTEL and COGTEL+ in Identifying Clinically Diagnosed Neurocognitive Disorder Due to Alzheimer's Disease in a Naturalistic Clinical Setting. J Alzheimers Dis 2021; 83:259-268. [PMID: 34275904 PMCID: PMC8461705 DOI: 10.3233/jad-210477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Telephone-based neurocognitive instruments embody valuable tools in identifying cognitive impairment in research settings and lately also in clinical contexts due to the pandemic crisis. The accuracy of the Cognitive Telephone Screening Instrument (COGTEL) in detecting mild- (MiND) and major (MaND) neurocognitive disorder has not been studied yet. Objective: Comparison of the utility of COGTEL and COGTEL+, which is enriched with orientation items, with the modified Mini-Mental State Examination (3MS) in detecting MiND and MaND due to Alzheimer’s disease (AD) and assessment of the impact of COGTEL face-to-face-versus telephone administration on individual performance. Methods: The study included 197 cognitively intact individuals (CI), being at least 45 years old, 95 and 65 patients with MiND and MaND due to AD, respectively. In 20 individuals COGTEL was administered both in face-to-face and telephone sessions. Statistical analyses included proportional odds logistic regression models, stratified repeated random subsampling used to recursive partitioning to training and validation set (70/30 ratio), and an appropriate F-test. Results: All studied instruments were significant predictors of diagnostic outcome, but COGTEL+ and 3MS explained more variance relative to the original COGTEL. Except for the validation regression models including COGTEL in which the average misclassification error slightly exceeded 15%, in all other cases the average misclassification errors (%) were lower than 15%. COGTEL administration modality was not related to systematic over- or underestimation of performance on COGTEL. Conclusion: COGTEL+ is a valuable instrument in detecting MiND and MaND and can be administered in face-to-face or telephone sessions.
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Affiliation(s)
- Panagiotis Alexopoulos
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece.,Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany.,Psychogeriatric Unit for Neurocognitive Assessment and Caregiver Counselling, Patras Office of The Hellenic Red Cross, Patras, Greece.,Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled -FRODIZO, Patras, Greece
| | - Maria Skondra
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece.,Psychogeriatric Unit for Neurocognitive Assessment and Caregiver Counselling, Patras Office of The Hellenic Red Cross, Patras, Greece
| | - Evagellia Kontogianni
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Frounta
- Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled -FRODIZO, Patras, Greece
| | - Georgia Konstantopoulou
- Special Office for Health Consulting Services and Faculty of Education and Social Work, School of Humanities and Social Sciences, University of Patras, Patras, Greece
| | - Suzana Ioanna Aligianni
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Marina Charalampopoulou
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Iliana Lentzari
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Philippos Gourzis
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Matthias Kliegel
- Laboratory of Cognitive Aging, University of Geneva, Geneva, Switzerland
| | - Polychronis Economou
- Department of Civil Engineering (Statistics), School of Engineering, University of Patras, Patras, Greece
| | - Antonios Politis
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Medical School, Baltimore, MD, USA
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The interplay between depressive symptoms, cognitive function, activities of daily living and cognitive reserve in older adults. Int Psychogeriatr 2021; 33:759-761. [PMID: 33823954 DOI: 10.1017/s1041610221000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Introduction: Successful aging lies in cognitive and functional maintenance, and in the optimal performance of daily tasks that keep the elderly free of disability and dependence. However, there is little evidence for functional differences for gender and age, and how cognitive and physical demands in past working lives can affect them, to design more personalized occupational therapy interventions to prevent functional and cognitive impairment. Method: This observational descriptive study evaluated 367 older adults living in a community with subjective memory complaints and scored between 24 and 35 with the Spanish version of the “Mini-Mental State Examination (MEC-35)”. Basic activities of daily living (BADL) were studied with the Barthel Index, while instrumental ADL (IADL) were examined with the Lawton–Brody scale. Functional differences for gender, age, and physico-mental occupation were examined. Results: The significant differences found for gender indicated that men did better in BADL (p = 0.026) and women better performed IADL (p < 0.001). Differences between age groups suggest that the younger group (aged 64–75) obtained better results for BADL (p = 0.001) and IADL (p < 0.001). For physico-mental occupation, statistically significant differences were found only in IADL for mental (p = 0.034) and physical occupation (p = 0.005). Conclusions: Gender, age, and the cognitive and physical demands of occupational stages, can be important predictors of cognitive and functional impairment. These results can be generalized to other health centers in the province and to other Spanish Autonomous Communities because their socio-demographic variables are similar. It would be interesting to carry out multimodal personalized interventions that consider the factors that might affect functional impairment to preserve personal autonomy.
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Dubbelman MA, Verrijp M, Facal D, Sánchez‐Benavides G, Brown LJ, van der Flier WM, Jokinen H, Lee A, Leroi I, Lojo‐Seoane C, Milošević V, Molinuevo JL, Pereiro Rozas AX, Ritchie C, Salloway S, Stringer G, Zygouris S, Dubois B, Epelbaum S, Scheltens P, Sikkes SA. The influence of diversity on the measurement of functional impairment: An international validation of the Amsterdam IADL Questionnaire in eight countries. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12021. [PMID: 32420446 PMCID: PMC7219786 DOI: 10.1002/dad2.12021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To understand the potential influence of diversity on the measurement of functional impairment in dementia, we aimed to investigate possible bias caused by age, gender, education, and cultural differences. METHODS A total of 3571 individuals (67.1 ± 9.5 years old, 44.7% female) from The Netherlands, Spain, France, United States, United Kingdom, Greece, Serbia, and Finland were included. Functional impairment was measured using the Amsterdam Instrumental Activities of Daily Living (IADL) Questionnaire. Item bias was assessed using differential item functioning (DIF) analysis. RESULTS There were some differences in activity endorsement. A few items showed statistically significant DIF. However, there was no evidence of meaningful item bias: Effect sizes were low (ΔR 2 range 0-0.03). Impact on total scores was minimal. DISCUSSION The results imply a limited bias for age, gender, education, and culture in the measurement of functional impairment. This study provides an important step in recognizing the potential influence of diversity on primary outcomes in dementia research.
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Affiliation(s)
- Mark A. Dubbelman
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Merike Verrijp
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - David Facal
- Department of Developmental PsychologyUniversity of Santiago de CompostelaA CoruñaSpain
| | | | - Laura J.E. Brown
- Faculty of BiologyMedicine and HealthUniversity of ManchesterManchester Academic Science CentreManchesterUK
| | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam UMCAmsterdamThe Netherlands
| | - Hanna Jokinen
- Clinical NeurosciencesNeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Department of Psychology and LogopedicsFaculty of MedicineUniversity of HelsinkiFinland
| | - Athene Lee
- Butler HospitalWarren Alpert Medical School of Brown UniversityProvidenceRhode Island
| | - Iracema Leroi
- Faculty of BiologyMedicine and HealthUniversity of ManchesterManchester Academic Science CentreManchesterUK
| | - Cristina Lojo‐Seoane
- Department of Developmental PsychologyUniversity of Santiago de CompostelaA CoruñaSpain
| | | | - José Luís Molinuevo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
| | | | | | - Stephen Salloway
- Butler HospitalWarren Alpert Medical School of Brown UniversityProvidenceRhode Island
| | - Gemma Stringer
- Faculty of BiologyMedicine and HealthUniversity of ManchesterManchester Academic Science CentreManchesterUK
| | - Stelios Zygouris
- School of MedicineAristotle University of ThessalonikiThessalonikiGreece
- Network Aging ResearchHeidelberg UniversityHeidelbergGermany
| | - Bruno Dubois
- Department of NeurologyInstitut de la Mémoire et de la Maladie d'Alzheimer (IM2A) of the Pitié‐Salpêtrière Hospital & ARAMISSorbonne UniversityInria de ParisInstitut du cerveau et de lamoelle épinière (ICM)ParisFrance
| | - Stéphane Epelbaum
- Department of NeurologyInstitut de la Mémoire et de la Maladie d'Alzheimer (IM2A) of the Pitié‐Salpêtrière Hospital & ARAMISSorbonne UniversityInria de ParisInstitut du cerveau et de lamoelle épinière (ICM)ParisFrance
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Sietske A.M. Sikkes
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam UMCAmsterdamThe Netherlands
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Mulligan BP, Segalowitz SJ, Hofer SM, Smart CM. A multi-timescale, multi-method perspective on older adult neurocognitive adaptability. Clin Neuropsychol 2020; 34:643-677. [DOI: 10.1080/13854046.2020.1723706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Bryce P. Mulligan
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Sidney J. Segalowitz
- Psychology Department, Brock University, St. Catharines, Ontario, Canada
- The Jack and Nora Walker Centre for Lifespan Development Research, Brock University, St. Catharines, Ontario, Canada
| | - Scott M. Hofer
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Colette M. Smart
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
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Villeneuve SC, Houot M, Cacciamani F, Verrijp M, Dubois B, Sikkes S, Epelbaum S. Latent class analysis identifies functional decline with Amsterdam IADL in preclinical Alzheimer's disease. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:553-562. [PMID: 31650012 PMCID: PMC6804616 DOI: 10.1016/j.trci.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Trials in Alzheimer's disease (AD) now include participants at the earliest stages to prevent further decline. However, the lack of tools sensitive to subtle functional changes in early-stage AD hinders the development of new therapies as it is difficult to prove their clinical relevance. Methods We assessed functional changes over three years in 289 elderly memory complainers from the Investigation of Alzheimer's Predictors in subjective memory complainers cohort using the Amsterdam Instrumental-Activities-of-Daily-Living questionnaire (A-IADL-Q). Results No overall functional decline related to AD imaging markers was evidenced. However, five distinct classes of A-IADL-Q trajectories were identified. The largest class (212 [73.4%]) had stable A-IADL-Q scores over 3 years. A second group (23 [8.0%]) showed a persistent functional decline, higher amyloid load (P = .0005), and lower education (P = .0392). Discussion The A-IADL-Q identified a subtle functional decline in asymptomatic at-risk AD individuals. This could have important implications in the field of early intervention in AD.
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Affiliation(s)
- Sarah-Christine Villeneuve
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Center of excellence of neurodegenerative disease (CoEN) and National Reference Center for Rare or Early Dementias Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, Paris, France.,Department of Geriatry, Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Marion Houot
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Center of excellence of neurodegenerative disease (CoEN) and National Reference Center for Rare or Early Dementias Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, Paris, France
| | - Federica Cacciamani
- Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Inserm, U 1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Sorbonne Université, Paris, France.,Inria, Aramis project-team, Paris, France
| | - Merike Verrijp
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bruno Dubois
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Center of excellence of neurodegenerative disease (CoEN) and National Reference Center for Rare or Early Dementias Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, Paris, France.,Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Inserm, U 1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Sorbonne Université, Paris, France
| | - Sietske Sikkes
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stéphane Epelbaum
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Center of excellence of neurodegenerative disease (CoEN) and National Reference Center for Rare or Early Dementias Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, Paris, France.,Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Inserm, U 1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Sorbonne Université, Paris, France.,Inria, Aramis project-team, Paris, France
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Andrew MK, Tierney MC. The puzzle of sex, gender and Alzheimer’s disease: Why are women more often affected than men? WOMENS HEALTH 2018. [PMCID: PMC6311541 DOI: 10.1177/1745506518817995] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: There are impressive differences in the incidence, prevalence and experience of women and men with Alzheimer’s Disease (AD). Notably, two-thirds of those with AD, the most common form of dementia, are women. Our objective was to provide a literature-based framework to understand these sex and gender differences in AD. Methods: We conducted a narrative review to examine sex and gender influences on AD. Results: We present a framework to understanding why these sex and gender differences exist in AD. This includes the influence of longevity (women live longer than men), biological differences (hormonal differences, epigenetics and frailty), differences in cognitive performance (women and men tend to perform differently on some cognitive tests), and gendered social roles and opportunities (educational and occupational opportunities, functional roles post-retirement). Our review clearly indicates the complex interaction of these sex and gender differences and variability within each. Conclusions: Given these important sex and gender differences in AD, we provide recommendations and steps forward describing how both sex and gender should be considered in dementia diagnosis and management and in the design and implementation of dementia research, including studies of caregiving interventions and models of dementia care.
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Affiliation(s)
- Melissa K Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mary C Tierney
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Berezuk C, Ramirez J, Black SE, Zakzanis KK. Managing money matters: Managing finances is associated with functional independence in MCI. Int J Geriatr Psychiatry 2018; 33:517-522. [PMID: 29076183 DOI: 10.1002/gps.4817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/06/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous research suggests that overall experience participating in instrumental activities of daily living (IADLs) is associated with reduced IADL impairment in individuals with mild cognitive impairment, possibly because of an increased functional reserve. Given that difficulties managing finances tend to occur with mild cognitive impairment, this study explores whether experience managing one's finances is associated with independence across various IADLs. METHODS Participants with a screen or baseline diagnosis of mild cognitive impairment (n = 862) were taken from the Alzheimer's Disease Neuroimaging Initiative study. Functional dependence and experience were quantified from the Functional Activities Questionnaire. RESULTS No group differences between those with and without financial management experience existed in Mini-Mental State Examination scores, age, and years of education, although women were more likely to have experience managing finances (P < .001). Final chi-square analyses suggest that financial management experience is significantly associated with greater independence in the ability to follow TV, books, or magazines (P = .009) and remember appointments and important dates (P = .002). CONCLUSIONS Individuals who are rated as having experience in managing their finances were also rated as being less dependent in their ability to follow and understand TV and books and in their ability to remember appointments and important dates. Neither causation nor the mechanisms underlying this relationship can be discerned from these analyses. Therefore, further research is needed to investigate whether engaging in financial tasks protects against early financial impairment, potentially through an increased functional reserve.
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Affiliation(s)
- Courtney Berezuk
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sandra E Black
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Psychology, University of Toronto Scarborough, Toronto, Canada.,Institute of Medical Science, Faculty of Medicine (Neurology), University of Toronto, Toronto, Canada
| | - Konstantine K Zakzanis
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Canada.,Department of Psychology, University of Toronto Scarborough, Toronto, Canada
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