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Goldstein FC, Hajjar I, Summers A, Truong AD, Lee FFEH, Han JE, Walker TA. Frequency and correlates of subjective cognitive complaints and objective cognitive screening results in African American adults following COVID-19 infection. Brain Behav Immun Health 2023; 34:100691. [PMID: 37842136 PMCID: PMC10569942 DOI: 10.1016/j.bbih.2023.100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/24/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Background Subjective cognitive complaints are frequent following COVID-19 infection, but assessment of whether these complaints map onto objective cognitive findings may not be routine in busy clinical settings. Consequently, opportunities to confirm these complaints and to provide follow-up referrals and appropriate care may be missed, thereby impacting patients' functional independence and quality of life. African Americans are vulnerable to poor outcomes from COVID-19, and thus represent a minority group in whom subjective concerns are especially important to investigate. Towards this end, we examined the frequency and correlates of subjective complaints and objective screening results of African American patients referred to the Post-Acute Sequelae of SARS-CoV-2 (PASC) Clinic at Grady Memorial Hospital, a large county teaching hospital in Atlanta, Georgia. Methods Eighty seven African American patients (mean age = 52.5, SD = 10.5, range = 30-73) were evaluated between January 28, 2021-October 14, 2021 in the Grady PASC clinic. They ranged from 1 to 17 months post positive SARS-COV-2 antigen testing. Patients were administered a subjective cognitive complaint questionnaire (PROMIS Cognitive Function Scale Short Form 8a) as well as cognitive screening measures including the Mini-Cog (3 item recall, clock) and the Digit Symbol Substitution Test (timed visuomotor sequencing). Mood was assessed via the Patient Health Questionnaire-9, and anxiety via the Generalized Anxiety Disorders Scale. Published norms were used to identify clinically elevated scores. Results Sixty six (76%) patients denied experiencing meaningful cognitive concerns, and of these, 25 (38%) had positive cognitive screens indicating impaired performance on objective testing. Of 21 patients with subjectively elevated cognitive concerns, 17 (81%) also had positive cognitive screens. There were no significant differences in sociodemographic factors (p values = .07-.71), days post-acute positive SARS-COV-2 Antigen Test (p = .99), disease severity (p values = .67-.75), or COVID-19 comorbidity indices (medical conditions (p values = .20-.77), substance abuse (p = .79), psychiatric history (p values = .11-.99) in those with or without subjective complaints and objective cognitive findings. However, patients with subjective complaints and objective cognitive findings reported more post-COVID-19 anxiety (p = .02) and depression (p = .001). Conclusions Findings indicate a high concordance between subjective complaints on the PROMIS Cognitive Scale and objectively confirmed cognitive impairments in African Americans. Further, almost 40% who reported no cognitive complaints screened positive for cognitive impairment. Although depression and anxiety are associated with subjective complaints, they do not account for positive cognitive screening results, as those patients without depressive complaints also had similar rates of positive objective screens. The findings suggest that cognitive screening using assessment tools should be routinely performed in African Americans, especially those reporting cognitive symptoms on outcome scales. While future studies are needed to assess long-term outcomes, we highly recommend follow-ups in those with positive screens to characterize the specific domains that are impacted and that could affect activities of daily living and quality of life.
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Affiliation(s)
| | - Ihab Hajjar
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Aerica Summers
- Grady Post-COVID Clinic, Grady Memorial Hospital, Atlanta, GA, USA
| | - Alexander D. Truong
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - F. Frances Eun-Hyung Lee
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jenny E. Han
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Tiffany A. Walker
- Grady Post-COVID Clinic, Grady Memorial Hospital, Atlanta, GA, USA
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Goettel N, Wueest AS. Diagnosing delirium in perioperative and intensive care medicine. Curr Opin Anaesthesiol 2023; 36:491-499. [PMID: 37427443 DOI: 10.1097/aco.0000000000001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
PURPOSE OF REVIEW This article reviews the current literature on instruments used for screening and diagnosing delirium in perioperative and intensive care medicine. It summarizes recent findings to guide clinicians and researchers in choosing the most appropriate tools. RECENT FINDINGS The incidence of delirium in hospitalized patients ranges from 5% to over 50%, depending on the population of patients studied. Failure to diagnose delirium in a timely manner is associated with serious adverse outcomes, including death and institutionalization. Valid assessment tests are needed for delirium detection, as early identification and treatment of delirium may help to prevent complications. Currently, there are more than 30 available instruments, which have been developed to assist with the screening and diagnosis of delirium. However, these tools vary greatly in sensitivity, specificity, and administration time, and their overabundance challenges the selection of specific tool as well as direct comparisons and interpretation of results across studies. SUMMARY Overlooking or misdiagnosing delirium may result in poor patient outcomes. Familiarizing healthcare workers with the variety of delirium assessments and selecting the most appropriate tool to their needs is an important step toward improving awareness and recognition of delirium.
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Affiliation(s)
- Nicolai Goettel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Research, University of Basel
| | - Alexandra S Wueest
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
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Nyenhuis DL, Reckow J. Office- and Bedside-based Screening for Cognitive Impairment and the Dementias: Which Tools to Use, Interpreting the Results, and What Are the Next Steps? Clin Geriatr Med 2023; 39:15-25. [PMID: 36404027 DOI: 10.1016/j.cger.2022.07.002] [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] [Indexed: 11/24/2022]
Abstract
Elderly patients and their families are concerned about the patients' cognitive abilities, and cognitive screening is an efficient diagnostic tool, as long as clinicians administer the screens in a standardized manner and interpret the screen results accurately. The following brief summary reviews commonly used screening instruments and provides information about how to interpret screening test results. It concludes by showing how cognitive screening fits into a four-step process (Education, Screening, Follow-up, and Referral) of how to respond to patients with cognitive concerns.
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Affiliation(s)
- David L Nyenhuis
- Neuropsychology Section, Hauenstein Neuroscience Center, Mercy Health of West Michigan, 220 Cherry Street SE, Grand Rapids, MI 49503, USA.
| | - Jaclyn Reckow
- Department of Psychology, LCC International University, Kretingos g. 36, Klaipeda, Lithuania
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Ability of clock drawing errors on Mini-Cog test to predict development of delirium after major urological cancer surgery. Curr Urol 2023. [DOI: 10.1097/cu9.0000000000000177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Burfeind KG, Zarnegarnia Y, Tekkali P, O’Glasser AY, Quinn JF, Schenning KJ. Potentially Inappropriate Medication Administration Is Associated With Adverse Postoperative Outcomes in Older Surgical Patients: A Retrospective Cohort Study. Anesth Analg 2022; 135:1048-1056. [PMID: 35986676 PMCID: PMC9588532 DOI: 10.1213/ane.0000000000006185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The American Geriatrics Society (AGS) Beers Criteria is an explicit list of potentially inappropriate medications (PIMs) best avoided in adults ≥65 years of age. Cognitively impaired and frail surgical patients often experience poor outcomes after surgery, but the impacts of PIMs on these patients are unclear. Our objective was to assess whether perioperative PIM administration was associated with poor outcomes in geriatric surgical patients. We then evaluated the association between PIM administration and postoperative outcomes in subgroups of patients who were frail or cognitively impaired. METHODS We performed a retrospective cohort study of patients ≥65 years of age who underwent elective inpatient surgery at a large academic medical center from February 2018 to January 2020. Edmonton Frail Scale and Mini-Cog screening tools were administered to all patients at their preoperative clinic visit. A Mini-Cog score of 0 to 2 was considered cognitive impairment, and frailty was defined by an Edmonton Frail Scale score of ≥8. Patients were divided into 2 groups depending on whether they received at least 1 PIM (PIM+), based on the 2019 AGS Beers Criteria, in the perioperative period or none (PIM-). We assessed the association of preoperative frailty, cognitive impairment, and perioperative PIM administration with the length of hospital stay and discharge disposition using multiple regression analyses adjusted for age, sex, ASA physical status, and intensive care unit (ICU) admission. RESULTS Of the 1627 included patients (mean age, 73.7 years), 69.3% (n = 1128) received at least 1 PIM. A total of 12.7% of patients were frail, and 11.1% of patients were cognitively impaired; 64% of the frail patients and 58% of the cognitively impaired patients received at least 1 PIM. Perioperative PIM administration was associated with longer hospital stay after surgery (PIM-, 3.56 ± 5.2 vs PIM+, 4.93 ± 5.66 days; P < .001; 95% confidence interval [CI], 0.360-0.546). Frail patients who received PIMs had an average length of stay (LOS) that was nearly 2 days longer than frail patients who did not receive PIMs (PIM-, 4.48 ± 5.04 vs PIM+, 6.33 ± 5.89 days; P = .02). Multiple regression analysis revealed no significant association between PIM administration and proportion of patients discharged to a care facility (PIM+, 26.3% vs PIM-, 28.7%; P = .87; 95% CI, -0.046 to 0.054). CONCLUSIONS Perioperative PIM administration was common in older surgical patients, including cognitively impaired and frail patients. PIM administration was associated with an increased hospital LOS, particularly in frail patients. There was no association found between PIM administration and discharge disposition.
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Affiliation(s)
- Kevin G. Burfeind
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Yalda Zarnegarnia
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Praveen Tekkali
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Avital Y. O’Glasser
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
- Department of Medicine, Division of Hospital Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Joseph F. Quinn
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Katie J. Schenning
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
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Lin CY, Dracup K, Pelter MM, Biddle MJ, Moser DK. Association of psychological distress with reasons for delay in seeking medical care in rural patients with worsening heart failure symptoms. J Rural Health 2022; 38:713-720. [PMID: 33783853 PMCID: PMC10106011 DOI: 10.1111/jrh.12573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of depressive symptoms and anxiety on rural patients' decisions to seek care for worsening heart failure (HF) symptoms remains unknown. The purposes of this study were (1) to describe rural patients' reasons for delay in seeking care for HF, and (2) to determine whether depressive symptoms or anxiety was associated with patients' reasons for delay in seeking medical care for worsening symptoms. METHODS A total of 611 rural HF patients were included. Data on reasons for patient delay in seeking medical care (The Reasons for Delay Questionnaire), depressive symptoms (PHQ-9), and anxiety (BSI-ANX) were collected. Statistical analyses included chi-square and multiple regression. RESULTS A total of 85.4% of patients reported at least 1 reason for delay. Patients with higher levels of depressive symptoms were more likely to cite embarrassment, problems with transportation, and financial concerns as a reason for delay. Patients with anxiety not only cited nonsymptom-related reasons but also reported symptom-related reasons for delay in seeking care (ie, symptoms seemed vague, not sure of symptoms, symptoms didn't seem to be serious enough, and symptoms were different from the last episode). In multiple regression, patients with greater depressive symptoms and anxiety had a greater number of reasons for delay in seeking care (P = .003 and P = .023, respectively). CONCLUSIONS Our findings suggest that enhancement of patients' symptom appraisal abilities and improvement in psychological distress may result in a reduction in delay in seeking medical care for worsening symptoms in rural patients with HF.
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Affiliation(s)
- Chin-Yen Lin
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Kathleen Dracup
- School of Nursing, University of California, San Francisco, California
| | - Michele M. Pelter
- School of Nursing, University of California, San Francisco, California
| | | | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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Yajima S, Nakanishi Y, Matsumoto S, Ookubo N, Tanabe K, Kataoka M, Masuda H. The Mini-Cog: A simple screening tool for cognitive impairment useful in predicting the risk of delirium after major urological cancer surgery. Geriatr Gerontol Int 2022; 22:319-324. [PMID: 35253337 DOI: 10.1111/ggi.14367] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/02/2022] [Accepted: 02/12/2022] [Indexed: 11/28/2022]
Abstract
AIM The purpose of this study was to evaluate the impact of the mini-cognitive assessment instrument (Mini-Cog) on postoperative delirium after major urological cancer surgery. METHODS In this single-center retrospective observational study, medical records were collected for patients who underwent major urologic cancer surgery at our department between 2020 and 2021, and underwent preoperative cognitive screening based on the Mini-Cog test (n = 331). The probable cognitive impairment is defined as a Mini-Cog score of <3. Univariate and multivariate logistic regression analysis were used to identify the risk factors for postoperative delirium. RESULTS Patients with probable cognitive impairment were 60 (18%). Postoperative delirium occurred in 26 patients (8%). Using multivariate analysis, the Mini-Cog score of <3 (odds ratio [OR] = 12.7; P < 0.001), decline of instrumental activities of daily living (OR = 3.0; P = 0.04) and preoperative benzodiazepine use (OR = 8.3; P < 0.001) were independent risk factors for postoperative delirium. For predicting postoperative delirium, Mini-Cog score with a cutoff value of <3 granting sensitivity of 69.2%, specificity of 86.2%, positive predictive value of 30.0% and negative predictive value of 97.1%. CONCLUSIONS The Mini-Cog test is a simple screening tool with only two components (a delayed, three-word recall task and a clock drawing test): it is useful in identifying potential cases of cognitive decline and patients at risk for postoperative delirium along with other information routinely collected preoperatively. Effective screening using the Mini-Cog test opens the possibility to provide optimal urologic care for older patients Geriatr Gerontol Int 2022; 22: 319-324.
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Affiliation(s)
- Shugo Yajima
- National Cancer Center Hospital East, Chiba, Japan
| | | | | | - Naoya Ookubo
- National Cancer Center Hospital East, Chiba, Japan
| | - Kenji Tanabe
- National Cancer Center Hospital East, Chiba, Japan
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Levy B, Priest A, Delaney T, Hogan J, Herrawi F. Toward Pre-Diagnostic Detection of Dementia in Primary Care. J Alzheimers Dis 2022; 86:479-490. [DOI: 10.3233/jad-215242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Preventing dementia warrants the pragmatic engagement of primary care. Objective: This study predicted conversion to dementia 12 months before diagnosis with indicators that primary care can utilize within the practical constraints of routine practice. Methods: The study analyzed data from the Alzheimer’s Disease Neuroimaging Initiative (Total sample = 645, converting participants = 54). It predicted the conversion from biological (plasma neurofilament light chain), cognitive (Trails Making Test– B), and functional (Functional Activities Questionnaire) measures, in addition to demographic variables (age and education). Results: A Gradient Booster Trees classifier effectively predicted the conversion, based on a Synthetic Minority Oversampling Technique (n = 1,290, F1 Score = 92, AUC = 94, Recall = 87, Precision = 97, Accuracy = 92). Subsequent analysis indicated that the MCI False Positive group (i.e., non-converting participants with cognitive impairment flagged by the model for prospective conversion) scored significantly lower on multiple cognitive tests (Montreal Cognitive Assessment, p < 0.002; ADAS-13, p < 0.0004; Rey Auditory Verbal Learning Test, p < 0.002/0.003) than the MCI True Negative group (i.e., correctly classified non-converting participants with cognitive impairment). These groups also differed in CSF tau levels (p < 0.04), while consistent effect size differences emerged in the all-pairwise comparisons of hippocampal volume and CSF Aβ1 - 42. Conclusion: The model effectively predicted 12-month conversion to dementia and further identified non-converting participants with MCI, in the False Positive group, at relatively higher neurocognitive risk. Future studies may seek to extend these results to earlier prodromal phases. Detection of dementia before diagnosis may be feasible and practical in primary care settings, pending replication of these findings in diverse clinical samples.
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Affiliation(s)
- Boaz Levy
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Amanda Priest
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Tyler Delaney
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Jacqueline Hogan
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Farahdeba Herrawi
- Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA
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Torres-Castro S, Mena-Montes B, González-Ambrosio G, Zubieta-Zavala A, Torres-Carrillo NM, Acosta-Castillo GI, Espinel-Bermúdez MC. Spanish-language screening scales: A critical review. Neurologia 2022; 37:53-60. [PMID: 29753565 DOI: 10.1016/j.nrl.2018.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Dementia is a chronic, degenerative disease with a strong impact on families and health systems. The instruments currently in use for measuring cognitive impairment have different psychometric characteristics in terms of application time, cut-off point, reliability, and validity. The objective of this review is to describe the characteristics of the validated, Spanish-language versions of the Mini-Cog, Clock-Drawing Test, and Mini-Mental State Examination scales for cognitive impairment screening. DEVELOPMENT We performed a three-stage literature search of articles published on Medline since 1953. We selected articles on validated, Spanish-language versions of the scales that included data on reliability, validity, sensitivity, and specificity. CONCLUSIONS The 3 screening tools assessed in this article provide support for primary care professionals. Timely identification of mild cognitive impairment and dementia is crucial for the prognosis of these patients.
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Affiliation(s)
- S Torres-Castro
- Instituto Nacional de Geriatría, Institutos Nacionales de Salud de México, Secretaría de Salud, Ciudad de México, México.
| | - B Mena-Montes
- Instituto Nacional de Geriatría, Institutos Nacionales de Salud de México, Secretaría de Salud, Ciudad de México, México
| | - G González-Ambrosio
- Instituto Nacional de Geriatría, Institutos Nacionales de Salud de México, Secretaría de Salud, Ciudad de México, México
| | - A Zubieta-Zavala
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - N M Torres-Carrillo
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - G I Acosta-Castillo
- Instituto Nacional de Neurología y Neurocirugía, Institutos Nacionales de Salud de México, Secretaría de Salud, Ciudad de México, México
| | - M C Espinel-Bermúdez
- Unidad de Investigación Médica en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Guadalajara, México
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González DA, Gonzales MM, Jennette KJ, Soble JR, Fongang B. Cognitive screening with functional assessment improves diagnostic accuracy and attenuates bias. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12250. [PMID: 34934799 PMCID: PMC8652409 DOI: 10.1002/dad2.12250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Cognitive screening measures often lack sensitivity and are hampered by inequities across ethnoracial groups. A multitrait multimethod (MTMM) classification may attenuate these shortcomings. METHODS A sample of 7227 participants across the diagnostic spectrum were selected from the National Alzheimer's Coordinating Center cohort. Random forest ensemble methods were used to predict diagnosis across the sample and within Black American (n = 1025) and non-Hispanic White groups (n = 5263) based on: (1) a demographically corrected Montreal Cognitive Assessment (MoCA), (2) MoCA and Functional Assessment Questionnaire (FAQ), (3) MoCA and FAQ with demographic correction. RESULTS The MTMM approach with demographic correction had the highest diagnostic accuracy for the cognitively unimpaired (area under curve [AUC] [95% confidence interval (CI)]): 0.906 [0.892, 0.920]) and mild cognitive impairment (AUC: 0.835 [0.810, 0.860]) groups and reduced racial disparities. DISCUSSION With further validation, the MTMM approach combining cognitive screening and functional status assessment may serve to improve diagnostic accuracy and extend opportunities for early intervention with greater equity.
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Affiliation(s)
- David Andrés González
- Department of NeurologyUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative DiseasesUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Mitzi M. Gonzales
- Department of NeurologyUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative DiseasesUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Kyle J. Jennette
- Department of PsychiatryUniversity of Illinois College of MedicineChicagoIllinoisUSA
| | - Jason R. Soble
- Department of PsychiatryUniversity of Illinois College of MedicineChicagoIllinoisUSA
- Department of NeurologyUniversity of Illinois College of MedicineChicagoIllinoisUSA
| | - Bernard Fongang
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative DiseasesUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
- Department of Biochemistry and Structural BiologyUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
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O’Connell ML, Coppinger T, Lacey S, Arsenic T, McCarthy AL. The Gender-Specific Relationship between Nutritional Status, Physical Activity and Functional Mobility in Irish Community-Dwelling Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168427. [PMID: 34444176 PMCID: PMC8392852 DOI: 10.3390/ijerph18168427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 11/16/2022]
Abstract
Research suggests that both nutrition and physical activity can protect mobility in older adults, but it is yet to be determined whether these relationships are affected by gender. Thus, we investigated the gender-specific relationship between nutritional status, physical activity level and functional mobility in Irish older adults. A cross-sectional study was undertaken in 176 community-dwelling older adults (73.6 ± 6.61 years) living in Cork, Ireland. Nutritional status was measured using the Mini Nutritional Assessment-Short Form (MNA-SF) and physical activity was assessed via the Physical Activity Scale for the Elderly (PASE). Functional mobility was measured using the Timed Up and Go (TUG) test. The gender-stratified relationship between variables was assessed using Pearson's correlations and multiple linear regression. Partial correlations (p < 0.05) were observed for TUG with PASE score in both genders, and with MNA-SF score in females, only. Multiple regression showed that physical activity was a predictor of TUG in both genders (β = 0.257 for males, β = 0.209 for females, p < 0.05), while nutritional status was a predictor of TUG in females, only (β = -0.168, p = 0.030). Our results suggest that physical activity is associated with functional mobility in both genders, while the relationship between nutritional status and mobility may be specific to older females. These findings may be of interest for the design of functional preservation strategies.
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Affiliation(s)
- Maeve Lorraine O’Connell
- Department of Biological Sciences, Munster Technological University, Rossa Avenue, T12 P928 Cork, Ireland; (T.A.); (A.L.M.)
- Correspondence:
| | - Tara Coppinger
- Department of Sport, Leisure and Childhood Studies, Munster Technological University, Rossa Avenue, T12 P928 Cork, Ireland;
| | - Seán Lacey
- Department of Mathematics, Munster Technological University, Rossa Avenue, T12 P928 Cork, Ireland;
| | - Tijana Arsenic
- Department of Biological Sciences, Munster Technological University, Rossa Avenue, T12 P928 Cork, Ireland; (T.A.); (A.L.M.)
| | - Aoife Louise McCarthy
- Department of Biological Sciences, Munster Technological University, Rossa Avenue, T12 P928 Cork, Ireland; (T.A.); (A.L.M.)
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Chan CC, Fage BA, Burton JK, Smailagic N, Gill SS, Herrmann N, Nikolaou V, Quinn TJ, Noel-Storr AH, Seitz DP. Mini-Cog for the detection of dementia within a secondary care setting. Cochrane Database Syst Rev 2021; 7:CD011414. [PMID: 34260060 PMCID: PMC8278979 DOI: 10.1002/14651858.cd011414.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The diagnosis of Alzheimer's disease dementia and other dementias relies on clinical assessment. There is a high prevalence of cognitive disorders, including undiagnosed dementia in secondary care settings. Short cognitive tests can be helpful in identifying those who require further specialist diagnostic assessment; however, there is a lack of consensus around the optimal tools to use in clinical practice. The Mini-Cog is a short cognitive test comprising three-item recall and a clock-drawing test that is used in secondary care settings. OBJECTIVES The primary objective was to determine the accuracy of the Mini-Cog for detecting dementia in a secondary care setting. The secondary objectives were to investigate the heterogeneity of test accuracy in the included studies and potential sources of heterogeneity. These potential sources of heterogeneity will include the baseline prevalence of dementia in study samples, thresholds used to determine positive test results, the type of dementia (Alzheimer's disease dementia or all causes of dementia), and aspects of study design related to study quality. SEARCH METHODS We searched the following sources in September 2012, with an update to 12 March 2019: Cochrane Dementia Group Register of Diagnostic Test Accuracy Studies, MEDLINE (OvidSP), Embase (OvidSP), BIOSIS Previews (Web of Knowledge), Science Citation Index (ISI Web of Knowledge), PsycINFO (OvidSP), and LILACS (BIREME). We made no exclusions with regard to language of Mini-Cog administration or language of publication, using translation services where necessary. SELECTION CRITERIA We included cross-sectional studies and excluded case-control designs, due to the risk of bias. We selected those studies that included the Mini-Cog as an index test to diagnose dementia where dementia diagnosis was confirmed with reference standard clinical assessment using standardised dementia diagnostic criteria. We only included studies in secondary care settings (including inpatient and outpatient hospital participants). DATA COLLECTION AND ANALYSIS We screened all titles and abstracts generated by the electronic database searches. Two review authors independently checked full papers for eligibility and extracted data. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool. We extracted data into two-by-two tables to allow calculation of accuracy metrics for individual studies, reporting the sensitivity, specificity, and 95% confidence intervals of these measures, summarising them graphically using forest plots. MAIN RESULTS Three studies with a total of 2560 participants fulfilled the inclusion criteria, set in neuropsychology outpatient referrals, outpatients attending a general medicine clinic, and referrals to a memory clinic. Only n = 1415 (55.3%) of participants were included in the analysis to inform evaluation of Mini-Cog test accuracy, due to the selective use of available data by study authors. There were concerns related to high risk of bias with respect to patient selection, and unclear risk of bias and high concerns related to index test conduct and applicability. In all studies, the Mini-Cog was retrospectively derived from historic data sets. No studies included acute general hospital inpatients. The prevalence of dementia ranged from 32.2% to 87.3%. The sensitivities of the Mini-Cog in the individual studies were reported as 0.67 (95% confidence interval (CI) 0.63 to 0.71), 0.60 (95% CI 0.48 to 0.72), and 0.87 (95% CI 0.83 to 0.90). The specificity of the Mini-Cog for each individual study was 0.87 (95% CI 0.81 to 0.92), 0.65 (95% CI 0.57 to 0.73), and 1.00 (95% CI 0.94 to 1.00). We did not perform meta-analysis due to concerns related to risk of bias and heterogeneity. AUTHORS' CONCLUSIONS This review identified only a limited number of diagnostic test accuracy studies using Mini-Cog in secondary care settings. Those identified were at high risk of bias related to patient selection and high concerns related to index test conduct and applicability. The evidence was indirect, as all studies evaluated Mini-Cog differently from the review question, where it was anticipated that studies would conduct Mini-Cog and independently but contemporaneously perform a reference standard assessment to diagnose dementia. The pattern of test accuracy varied across the three studies. Future research should evaluate Mini-Cog as a test in itself, rather than derived from other neuropsychological assessments. There is also a need for evaluation of the feasibility of the Mini-Cog for the detection of dementia to help adequately determine its role in the clinical pathway.
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Affiliation(s)
- Calvin Ch Chan
- School of Medicine, Queen's University, Kingston, Canada
| | - Bruce A Fage
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jennifer K Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Nadja Smailagic
- Institute of Public Health, University of Cambridge , Cambridge, UK
| | - Sudeep S Gill
- Department of Medicine, Queen's University, Kingston, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | | | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Dallas P Seitz
- Department of Psychiatry, Queen's University, Kingston, Canada
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Seitz DP, Chan CC, Newton HT, Gill SS, Herrmann N, Smailagic N, Nikolaou V, Fage BA. Mini-Cog for the detection of dementia within a primary care setting. Cochrane Database Syst Rev 2021; 7:CD011415. [PMID: 34261197 PMCID: PMC8406662 DOI: 10.1002/14651858.cd011415.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Alzheimer's disease and other forms of dementia are becoming increasingly common with the aging of most populations. The majority of individuals with dementia will first present for care and assessment in primary care settings. There is a need for brief dementia screening instruments that can accurately detect dementia in primary care settings. The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings. OBJECTIVES To determine the accuracy of the Mini-Cog for detecting dementia in a primary care setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Register of Diagnostic Test Accuracy Studies, MEDLINE, Embase and four other databases, initially to September 2012. Since then, four updates to the search were performed using the same search methods, and the most recent was January 2017. We used citation tracking (using the databases' 'related articles' feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data. SELECTION CRITERIA We only included studies that evaluated the Mini-Cog as an index test for the diagnosis of Alzheimer's disease dementia or related forms of dementia when compared to a reference standard using validated criteria for dementia. We only included studies that were conducted in primary care populations. DATA COLLECTION AND ANALYSIS We extracted and described information on the characteristics of the study participants and study setting. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria we evaluated the quality of studies, and we assessed risk of bias and applicability of each study for each domain in QUADAS-2. Two review authors independently extracted information on the true positives, true negatives, false positives, and false negatives and entered the data into Review Manager 5 (RevMan 5). We then used RevMan 5 to determine the sensitivity, specificity, and 95% confidence intervals. We summarized the sensitivity and specificity of the Mini-Cog in the individual studies in forest plots and also plotted them in a receiver operating characteristic plot. We also created a 'Risk of bias' and applicability concerns graph to summarize information related to the quality of included studies. MAIN RESULTS There were a total of four studies that met our inclusion criteria, including a total of 1517 total participants. The sensitivity of the Mini-Cog varied between 0.76 to 1.00 in studies while the specificity varied between 0.27 to 0.85. The included studies displayed significant heterogeneity in both methodologies and clinical populations, which did not allow for a meta-analysis to be completed. Only one study (Holsinger 2012) was found to be at low risk of bias on all methodological domains. The results of this study reported that the sensitivity of the Mini-Cog was 0.76 and the specificity was 0.73. We found the quality of all other included studies to be low due to a high risk of bias with methodological limitations primarily in their selection of participants. AUTHORS' CONCLUSIONS There is a limited number of studies evaluating the accuracy of the Mini-Cog for the diagnosis of dementia in primary care settings. Given the small number of studies, the wide range in estimates of the accuracy of the Mini-Cog, and methodological limitations identified in most of the studies, at the present time there is insufficient evidence to recommend that the Mini-Cog be used as a screening test for dementia in primary care. Further studies are required to determine the accuracy of Mini-Cog in primary care and whether this tool has sufficient diagnostic test accuracy to be useful as a screening test in this setting.
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Affiliation(s)
- Dallas P Seitz
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Calvin Ch Chan
- School of Medicine, Queen's University, Kingston, Canada
| | - Hailey T Newton
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Sudeep S Gill
- Department of Medicine, Queen's University, Kingston, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Nadja Smailagic
- Institute of Public Health, University of Cambridge , Cambridge, UK
| | | | - Bruce A Fage
- Department of Psychiatry, University of Toronto, Toronto, Canada
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14
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A Real-Time Clinical Decision Support System, for Mild Cognitive Impairment Detection, Based on a Hybrid Neural Architecture. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5545297. [PMID: 34257699 PMCID: PMC8257364 DOI: 10.1155/2021/5545297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/04/2021] [Indexed: 01/15/2023]
Abstract
Clinical procedure for mild cognitive impairment (MCI) is mainly based on clinical records and short cognitive tests. However, low suspicion and difficulties in understanding test cut-offs make diagnostic accuracy being low, particularly in primary care. Artificial neural networks (ANNs) are suitable to design computed aided diagnostic systems because of their features of generating relationships between variables and their learning capability. The main aim pursued in that work is to explore the ability of a hybrid ANN-based system in order to provide a tool to assist in the clinical decision-making that facilitates a reliable MCI estimate. The model is designed to work with variables usually available in primary care, including Minimental Status Examination (MMSE), Functional Assessment Questionnaire (FAQ), Geriatric Depression Scale (GDS), age, and years of education. It will be useful in any clinical setting. Other important goal of our study is to compare the diagnostic rendering of ANN-based system and clinical physicians. A sample of 128 MCI subjects and 203 controls was selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI). The ANN-based system found the optimal variable combination, being AUC, sensitivity, specificity, and clinical utility index (CUI) calculated. The ANN results were compared with those from medical experts which include two family physicians, a neurologist, and a geriatrician. The optimal ANN model reached an AUC of 95.2%, with a sensitivity of 90.0% and a specificity of 84.78% and was based on MMSE, FAQ, and age inputs. As a whole, physician performance achieved a sensitivity of 46.66% and a specificity of 91.3%. CUIs were also better for the ANN model. The proposed ANN system reaches excellent diagnostic accuracy although it is based only on common clinical tests. These results suggest that the system is especially suitable for primary care implementation, aiding physicians work with cognitive impairment suspicions.
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15
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Tiwary N, Treggiari MM, Yanez ND, Kirsch JR, Tekkali P, Taylor CC, Schenning KJ. Agreement Between the Mini-Cog in the Preoperative Clinic and on the Day of Surgery and Association With Postanesthesia Care Unit Delirium: A Cohort Study of Cognitive Screening in Older Adults. Anesth Analg 2021; 132:1112-1119. [PMID: 33002933 DOI: 10.1213/ane.0000000000005197] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cognitive impairment is common in older surgical patients and is associated with postoperative delirium. However, cognitive function is inconsistently assessed preoperatively, leading to missed opportunities to recognize vulnerable patients. We designed a prospective cohort study to assess the agreement of the Mini-Cog screening tool administered in the preoperative clinic (clinic-day test) or immediately before surgery (surgery-day test) and to determine whether a positive screening for cognitive dysfunction in the surgery-day test is associated with postoperative delirium in the postanesthesia care unit (PACU). METHODS This was a cohort study of patients aged 65-89 years, scheduled for elective, inpatient surgery under general anesthesia between June 20, 2018 and August 3, 2018. Mini-Cog test scores were obtained during a clinic-day test and surgery-day test. The Short Confusion Assessment Method was performed in the PACU. Agreement between Mini-Cog clinic-day and surgery-day test scores was estimated using an ordinally weighted kappa statistic, κ. Multivariable logistic regression was used to determine whether there was an association between a positive screen for cognitive impairment and PACU delirium. Odds ratio analysis was performed to determine whether the Mini-Cog score was associated with PACU delirium. RESULTS Of 128 patients meeting eligibility criteria, 80 patients were enrolled. Ten had cognitive impairment based on the Mini-Cog clinic-day test score, while 70 did not. Age, sex, race, education level, subjective memory impairment, and American Society of Anesthesiologists (ASA) physical status were equivalent in the 2 groups. The mean number of days between the clinic-day score and the surgery-day score was 8.4 days (standard deviation [SD] = 6.9). Mini-Cog clinic-day and surgery-day scores had high agreement (κ = 0.78; 95% confidence interval [CI], 0.69-0.87; P < .001), and both scores were highly predictive of PACU delirium. Patients with Mini-Cog surgery-day scores compatible with cognitive impairment (Mini-Cog scores ≤2) had an estimated 12.8 times higher odds of PACU delirium compared to patients with normal cognitive function or Mini-Cog scores >2 (odds ratio [OR] = 12.8; 95% CI, 2.6-63.8, P = .002). Similarly, patients with Mini-Cog clinic-day test scores compatible with cognitive impairment had an estimated 29 times higher odds of PACU delirium compared to patients with normal cognitive function (OR = 29.0; 95% CI, 2.6-63.8, P < .001). CONCLUSIONS These data support the approach of using the Mini-Cog on the day of surgery to screen for cognitive impairment in older patients. Importantly, Mini-Cog surgery-day test scores compatible with cognitive impairment (≤2) were strongly associated with PACU delirium.
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Affiliation(s)
- Nayan Tiwary
- From the New York Medical College School of Medicine, Valhalla, New York
| | - Miriam M Treggiari
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon.,Department of Anesthesiology, Yale University, New Haven, Connecticut
| | - N David Yanez
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon.,Department of Anesthesiology, Yale University, New Haven, Connecticut
| | - Jeffrey R Kirsch
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon.,Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Praveen Tekkali
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Cornelia C Taylor
- Department of Internal Medicine, Portland Providence Medical Center, Portland, Oregon
| | - Katie J Schenning
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
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16
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O'Connell ML, Coppinger T, Lacey S, Walton J, Arsenic T, McCarthy AL. Associations between Food Group Intake and Physical Frailty in Irish Community-Dwelling Older Adults. Nutr Metab Insights 2021; 14:11786388211006447. [PMID: 33854330 PMCID: PMC8013632 DOI: 10.1177/11786388211006447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Certain nutrients have shown protective effects against frailty, but less is known about the influence of individual food groups. Thus, this study aimed to investigate the relationship between the intake of different food groups and physical frailty in a cohort of community-dwelling older adults in Cork, Ireland. Methods One hundred and forty-two (n = 81 females, n = 61 males, age 74.1 ± 6.80 years) Irish community-dwelling volunteers aged ⩾65 years participated in this cross-sectional study. Dietary intake was assessed using a validated food frequency questionnaire (FFQ). Frailty was identified as having 3 or more of the following criteria: weight loss, exhaustion, weakness, slow walking speed and low physical activity. Relationships between intakes of food groups and frailty score were determined using Spearman's rank (and partial rank) correlations and ordinal logistic regression analysis. Results Negative Spearman's rank correlations were observed between frailty score and fish and fish products, fruit and vegetables and nuts and seeds, while positive correlations were found between frailty score and potatoes, fats and oils and sugars, preserves and snacks (P < .05). After adjustment for confounders, partial rank correlations remained statistically significant (P < .05) for all of the above dietary variables, with the exception of nuts and seeds (P > .05). Following ordinal logistic regression, the odds ratios (ORs) (95%CI) for frailty incidence for those in the lowest tertile of food group intake compared to the highest were; 3.04 (1.09-8.85) for fish and fish products, 4.34 (1.54-13.13) for fruit and vegetables, 1.52 (0.58-4.15) for nuts and seeds, 0.54 (0.19-1.51) for potatoes, 0.58 (0.17-1.95) for fats and oils and 0.49 (0.16-1.47) for sugars, preserves and snacks. Conclusion This study suggests that intakes of selected food groups are independently associated with frailty. These findings may hold significant relevance for the development of future frailty prevention strategies.
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Affiliation(s)
| | - Tara Coppinger
- Department of Sport, Leisure and Childhood Studies, Cork Institute of Technology, Cork, Ireland
| | - Seán Lacey
- Department of Mathematics, Cork Institute of Technology, Cork, Ireland
| | - Janette Walton
- Department of Biological Sciences, Cork Institute of Technology, Cork, Ireland
| | - Tijana Arsenic
- Department of Biological Sciences, Cork Institute of Technology, Cork, Ireland
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17
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O'Connell ML, Coppinger T, Lacey S, Arsenic T, McCarthy AL. The nutritional status and dietary intake of free-living seniors: A cross-sectional study. Clin Nutr ESPEN 2021; 43:478-486. [PMID: 34024558 DOI: 10.1016/j.clnesp.2021.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Older adults are a population group at risk of inadequate nutrition due to reduced appetite, malabsorption, taste alterations and social factors. Yet, dietary investigations in Irish older adults are scarce. The aim of this study was to analyse the nutritional status and dietary intake of a sample of community-dwelling Irish elderly, in addition to the effect of age and gender on dietary intake in this age group. METHODS A cross-sectional study was performed in 162 (n = 91 female, n = 71 male, age 73.8 ± 6.8 years) adults aged 65 years and over in a region of Southern Ireland. Nutritional status was measured using the Mini Nutritional Assessment - Short Form (MNA-SF). Dietary intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). RESULTS 21.0% and 1.2% of the study population were at risk of malnutrition and malnourished, respectively. A high prevalence of dietary insufficiencies was observed. The most common insufficiencies reported were energy (54.9%), fibre (82.7%), calcium (58.6%), magnesium (62.3%), iron (54.9%), folate (66.0%), vitamin D (93.2%) and vitamin E (61.1%). Increasing age did not significantly influence nutrient intakes in males, while vitamin C and vitamin D intakes decreased with age in females, and the incidence of dietary folate insufficiency was higher in the oldest females. Gender differences in dietary intake were evident, with a higher prevalence of dietary inadequacy in male subjects. Excessive intake of sugars, snacks and fats was observed, particularly in males, while dairy recommendations were not being met. Dietary supplement use was rare (27.2%). CONCLUSIONS The poor dietary quality of this cohort may have significant health implications. Public health strategies to improve the diets of older adults are warranted, with a particular focus on increasing micronutrient intakes.
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Affiliation(s)
- Maeve Lorraine O'Connell
- Department of Biological Sciences, Cork Institute of Technology, Rossa Avenue, Bishopstown, Cork, Ireland.
| | - Tara Coppinger
- Department of Sport, Leisure and Childhood Studies, Cork Institute of Technology, Rossa Avenue, Bishopstown, Cork, Ireland
| | - Seán Lacey
- Department of Mathematics, Cork Institute of Technology, Rossa Avenue, Bishopstown, Cork, Ireland
| | - Tijana Arsenic
- Department of Biological Sciences, Cork Institute of Technology, Rossa Avenue, Bishopstown, Cork, Ireland
| | - Aoife Louise McCarthy
- Department of Biological Sciences, Cork Institute of Technology, Rossa Avenue, Bishopstown, Cork, Ireland
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18
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Lee YC, Lin YT, Chiu EC. A comparison of test-retest reliability of four cognitive screening tools in people with dementia. Disabil Rehabil 2021; 44:4090-4095. [PMID: 33689519 DOI: 10.1080/09638288.2021.1891466] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to compare the test-retest reliability and minimal detectable change (MDC) of the Mini-Mental State Examination (MMSE), the Short Portable Mental Status Questionnaire (SPMSQ), the Montreal Cognitive Assessment (MoCA), and the Saint Louis University Status Examination (SLUMS) in a single sample of people with dementia. METHODS Sixty people with dementia were assessed twice two weeks apart, and the test-retest reliability was examined using the intraclass correlation coefficient (ICC) for four screening tools. The MDC95 value was calculated based on the standard error of measurement to estimate the random measurement error. RESULTS The ICC values for screening tools were 0.86-0.90. The MDC95 values (MDC95%) were 5.0 (17.2%), 2.74 (27%), 4.71(20%), and 6.26 (24%) for the MMSE, SPMSQ, MoCA, and SLUMS, respectively. CONCLUSIONS Overall, the four screening tools were similar in test-retest reliability which imply that the MMSE, MoCA, SPMSQ, and SLUMS were reliable in monitoring cognitive function in people with dementia. The results of the direct comparisons of test-retest reliability of the four screening tools provide useful information for both clinicians and researchers to select an appropriate cognitive screening tool.Implications for RehabilitationThe MMSE, MoCA, SPMSQ, and SLUMS are equally reliable and thus they could be used to monitor the cognitive function in people with dementia.The MDC values are useful in determining whether a real change has occurred between repeated assessments for people with dementia.
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Affiliation(s)
- Ya-Chen Lee
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yi-Te Lin
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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19
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Madoc-Jones I, Wadd S, Elliott L, Whittaker A, Adnum L, Close C, Seddon J, Dutton M, McCann M, Wilson F. Factors influencing routine cognitive impairment screening in older at-risk drinkers: Findings from a qualitative study in the United Kingdom. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:344-352. [PMID: 32662912 DOI: 10.1111/hsc.13093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/22/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
Cognitive Impairment (CI) screening is recommended for those engaged in harmful levels of alcohol use. However, there is a lack of evidence on implementation. This paper explores the barriers and facilitators to CI screening experienced across a service specifically for older drinkers. The findings draw on data gathered as part of an evaluation of a multilevel programme to reduce alcohol-related harm in adults aged 50 and over in five demonstration areas across the United Kingdom. It is based on qualitative interviews and focus groups with 14 service providers and 22 service users. Findings are presented thematically under the section headings: acceptability of screening, interpretation and making sense of screening and treatment options. It is suggested that engagement with CI screening is most likely when its fit with agency culture and its purpose is clear; where service providers have the technical skills to administer and discuss the results of screening with service users; and where those undertaking screening have had the opportunity to reflect on their own experience of being screened. Engagement with CI screening is also most likely where specific intervention pathways and engagement practices can be accessed to respond to assessed need.
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Affiliation(s)
| | - Sarah Wadd
- University of Bedfordshire, Bedfordshire, UK
| | | | | | | | | | | | | | | | - Fiona Wilson
- Wrexham Glyndwr University Plas Coch campus, Wrexham, UK
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20
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Arruda F, Rosselli M, Greig MT, Loewenstein DA, Lang M, Torres VL, Vélez-Uribe I, Conniff J, Barker WW, Curiel RE, Adjouadi M, Duara R. The Association Between Functional Assessment and Structural Brain Biomarkers in an Ethnically Diverse Sample With Normal Cognition, Mild Cognitive Impairment, or Dementia. Arch Clin Neuropsychol 2021; 36:51-61. [PMID: 32890393 DOI: 10.1093/arclin/acaa065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/13/2020] [Accepted: 07/27/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the association between the functional activities questionnaire (FAQ) and brain biomarkers (bilateral hippocampal volume [HV], bilateral entorhinal volume [ERV], and entorhinal cortical thickness [ERT]) in cognitively normal (CN) individuals, mild cognitive impairment (MCI), or dementia. METHOD In total, 226 participants (137 females; mean age = 71.76, SD = 7.93; Hispanic Americans = 137; European Americans = 89) were assessed with a comprehensive clinical examination, a neuropsychological battery, a structural magnetic resonance imaging, and were classified as CN or diagnosed with MCI or dementia. Linear regression analyses examined the association between functional activities as measured by the FAQ on brain biomarkers, including HV, ERV, and ERT, controlling for age, education, global cognition, gender, and ethnicity. RESULTS The FAQ significantly predicted HV, ERV, and ERT for the entire sample. However, this association was not significant for ERV and ERT when excluding the dementia group. The FAQ score remained a significant predictor of HV for the non-dementia group. Age, education, gender, ethnicity, Montreal Cognitive Assessment score, and FAQ were also significant predictors of HV for the overall sample, suggesting that younger Hispanic females with fewer years of education, higher global mental status, and better functioning, were more likely to have larger HV. CONCLUSION FAQ scores were related to HV in older adults across clinical groups (CN, MCI, and dementia), but its association with the entorhinal cortex was driven by individuals with dementia. Demographic variables, including ethnicity, additionally influenced these associations.
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Affiliation(s)
- Fernanda Arruda
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Mónica Rosselli
- Department of Psychology, Florida Atlantic University, Davie, FL, USA.,1Florida Alzheimer's Disease Research Center, Miami Beach, FL, USA
| | - Maria T Greig
- 1Florida Alzheimer's Disease Research Center, Miami Beach, FL, USA.,Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - David A Loewenstein
- 1Florida Alzheimer's Disease Research Center, Miami Beach, FL, USA.,Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Merike Lang
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Valeria L Torres
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Idaly Vélez-Uribe
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Joshua Conniff
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Warren W Barker
- 1Florida Alzheimer's Disease Research Center, Miami Beach, FL, USA.,Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Rosie E Curiel
- 1Florida Alzheimer's Disease Research Center, Miami Beach, FL, USA.,Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Malek Adjouadi
- 1Florida Alzheimer's Disease Research Center, Miami Beach, FL, USA.,Engineering Center, Florida International University, Miami, FL, USA
| | - Ranjan Duara
- 1Florida Alzheimer's Disease Research Center, Miami Beach, FL, USA.,Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
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Burden RS, Galloway LN, Rothpletz AM, Glasheen KA, Preminger JE. The Development of an Internet-Based Decision Coaching Guide to Encourage Audiology Care: The Results of a Participatory Design Approach. Am J Audiol 2020; 29:546-563. [PMID: 32946253 DOI: 10.1044/2020_aja-19-00066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose The purpose of the research described here is to create a theoretically based, interactive online program to motivate adults with untreated hearing loss to seek audiology care. We describe the results of the participatory design (PD) approach used to increase uptake and adherence to the Internet-based program. Method Using information gathered from field experts (n = 7), a program outline was generated by the study team. In keeping with PD principles, multiple focus groups and panels consisting of persons with hearing loss (n = 26), frequent communication partners (n = 6), audiologists (n = 9), and other area experts (n = 16) revised and expanded both content and design of the program in an iterative fashion. Results The proposed program was modified multiple times based on the input of stakeholders throughout the PD process. In particular, the scope of the program shifted from focusing on self-management strategies to decision coaching regarding the choice to visit an audiologist. Other specific program content and activities were modified based on stakeholder input. Conclusions The program evolved dramatically through the influence and input of multiple stakeholders as a result of the implementation of PD principles.
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Affiliation(s)
- Rebecca S. Burden
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, University of Louisville, KY
| | - Laura N. Galloway
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, University of Louisville, KY
| | - Ann M. Rothpletz
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, University of Louisville, KY
| | - Keira A. Glasheen
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, University of Louisville, KY
| | - Jill E. Preminger
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, University of Louisville, KY
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
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Yin L, Ren Y, Wang X, Li Y, Hou T, Liu K, Cong L, Zhang Q, Wang Y, Jiang Z, Du Y. The power of the Functional Activities Questionnaire for screening dementia in rural-dwelling older adults at high-risk of cognitive impairment. Psychogeriatrics 2020; 20:427-436. [PMID: 32092787 DOI: 10.1111/psyg.12524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 11/29/2022]
Abstract
AIM A simple approach to detecting dementia in its early stages may help improve patient care. We therefore aimed to assess the power of the Functional Activities Questionnaire (FAQ) for screening dementia among rural-dwelling older adults who are at high-risk for cognitive impairment. METHODS This study included 961 participants at a high-risk for dementia who had been identified from a population-based survey of Chinese rural residents. All participants were aged 65 years and older and positive for cognitive impairment according to the Mini-Mental State Examination or the Ascertain Dementia 8-item Informant Questionnaire screening tests. The FAQ scale was used to evaluate daily activities. Dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria. Receiver operating characteristic curve analyses were used to determine the FAQ's optimal cut-offs for dementia. The power (or accuracy) of the FAQ for screening dementia was analyzed in the total sample and in subgroups categorized by age, gender, and educational level. RESULTS Of the 961 participants, 84 (8.7%) were clinically diagnosed with dementia. Among individuals who were positive for cognitive impairment on the Mini-Mental State Examination or the Ascertain Dementia 8-item Informant Questionnaire, the parameters for an FAQ cut-off score ≥6 as a means of discriminating those with dementia from those without dementia were area under curve = 0.899, sensitivity = 94.1%, specificity = 75.1%, positive likelihood ratio = 3.78, and accuracy = 0.768. The discriminant abilities of the FAQ scale varied with age, gender, and educational level. The discriminant parameters of the FAQ scale were similar overall among individuals who were positive on either the Mini-Mental State Examination or the Ascertain Dementia 8-item Informant Questionnaire test alone. CONCLUSION The FAQ scale has high discriminative power to screen for dementia among rural older residents with suspected cognitive impairment.
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Affiliation(s)
- Ling Yin
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yifei Ren
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yunxia Li
- School of Public Health, Shandong University, Jinan, China
| | - Tingting Hou
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Keke Liu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Qinghua Zhang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Ziying Jiang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Torres-Castro S, Mena-Montes B, González-Ambrosio G, Zubieta-Zavala A, Torres-Carrillo N, Acosta-Castillo G, Espinel-Bermúdez M. Spanish-language cognitive screening tests: a critical review. NEUROLOGÍA (ENGLISH EDITION) 2020; 37:53-60. [DOI: 10.1016/j.nrleng.2018.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/01/2018] [Indexed: 10/25/2022] Open
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Hilz MJ, Wang R, Liu M, Muresanu D, Flanagan S, Winder K, Hösl K, Hummel T. Emotional and Autonomic Processing of Olfactory Stimuli Is Compromised in Patients with a History of Mild Traumatic Brain Injury. J Neurotrauma 2020; 37:125-138. [PMID: 31298614 DOI: 10.1089/neu.2018.6215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patients with a history of mild traumatic brain injury (post-mTBI patients) may have enduring cardiovascular-autonomic dysregulation and emotional problems. Olfactory stimulation (OS) triggers emotional and cardiovascular-autonomic responses that might be compromised in post-mTBI patients. We therefore evaluated these responses to OS in post-mTBI patients. In 17 post-mTBI patients (interval since mTBI: 32.4 ± 6.8 months) and 17 age- and sex-matched controls, we recorded respiration, electrocardiographic RR intervals, and systolic and diastolic blood pressures (BPsys, BPdia) before and during pleasant vanilla stimulation and unpleasant hydrogen sulphide (H2S) stimulation. Participants rated OS-related pleasantness, arousal, intensity, and familiarity on 9-point Likert scales. Analyses of variance (ANOVAs) with post hoc analyses compared parameters within each group before and during OS. To assess associations between pleasantness, arousal, intensity, and familiarity, we correlated OS scores within groups (significance: p < 0.05). Baseline parameters were similar between groups. Only in controls, vanilla stimulation significantly lowered BPsys and BPdia, whereas H2S stimulation lowered RR intervals. Vanilla-related pleasantness scores were lower, intensity scores were higher in patients than controls. During vanilla stimulation, pleasantness scores correlated negatively with arousal scores in controls, whereas familiarity scores correlated positively with intensity scores in patients. During H2S stimulation, familiarity scores correlated negatively with pleasantness scores in controls, whereas pleasantness scores correlated negatively with arousal scores in mTBI patients. Post-mTBI patients could not change BP or RR intervals during OS but perceived vanilla stimuli as less pleasant and more intense than did controls. Associations between pleasantness, arousal, intensity, and familiarity differed between groups suggesting different activation of the olfactory network and the central autonomic network upon OS. Subtle lesions within these networks might cause persistent changes in emotional and cognitive odor perception and cardiovascular responses.
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Affiliation(s)
- Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ruihao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Mao Liu
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Dafin Muresanu
- Department of Clinical Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Steven Flanagan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, New York
| | - Klemens Winder
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Katharina Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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25
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Chan CCH, Fage BA, Burton JK, Smailagic N, Gill SS, Herrmann N, Nikolaou V, Quinn TJ, Noel‐Storr AH, Seitz DP. Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a secondary care setting. Cochrane Database Syst Rev 2019; 9:CD011414. [PMID: 31521064 PMCID: PMC6744952 DOI: 10.1002/14651858.cd011414.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The diagnosis of Alzheimer's disease dementia and other dementias relies on clinical assessment. There is a high prevalence of cognitive disorders, including undiagnosed dementia in secondary care settings. Short cognitive tests can be helpful in identifying those who require further specialist diagnostic assessment; however, there is a lack of consensus around the optimal tools to use in clinical practice. The Mini-Cog is a short cognitive test comprising three-item recall and a clock-drawing test that is used in secondary care settings. OBJECTIVES The primary objective was to determine the diagnostic accuracy of the Mini-Cog for detecting Alzheimer's disease dementia and other dementias in a secondary care setting. The secondary objectives were to investigate the heterogeneity of test accuracy in the included studies and potential sources of heterogeneity. These potential sources of heterogeneity will include the baseline prevalence of dementia in study samples, thresholds used to determine positive test results, the type of dementia (Alzheimer's disease dementia or all causes of dementia), and aspects of study design related to study quality. SEARCH METHODS We searched the following sources in September 2012, with an update to 12 March 2019: Cochrane Dementia Group Register of Diagnostic Test Accuracy Studies, MEDLINE (OvidSP), Embase (OvidSP), BIOSIS Previews (Web of Knowledge), Science Citation Index (ISI Web of Knowledge), PsycINFO (OvidSP), and LILACS (BIREME). We made no exclusions with regard to language of Mini-Cog administration or language of publication, using translation services where necessary. SELECTION CRITERIA We included cross-sectional studies and excluded case-control designs, due to the risk of bias. We selected those studies that included the Mini-Cog as an index test to diagnose dementia where dementia diagnosis was confirmed with reference standard clinical assessment using standardised dementia diagnostic criteria. We only included studies in secondary care settings (including inpatient and outpatient hospital participants). DATA COLLECTION AND ANALYSIS We screened all titles and abstracts generated by the electronic database searches. Two review authors independently checked full papers for eligibility and extracted data. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool. We extracted data into two-by-two tables to allow calculation of accuracy metrics for individual studies, reporting the sensitivity, specificity, and 95% confidence intervals of these measures, summarising them graphically using forest plots. MAIN RESULTS Three studies with a total of 2560 participants fulfilled the inclusion criteria, set in neuropsychology outpatient referrals, outpatients attending a general medicine clinic, and referrals to a memory clinic. Only n = 1415 (55.3%) of participants were included in the analysis to inform evaluation of Mini-Cog test accuracy, due to the selective use of available data by study authors. There were concerns related to high risk of bias with respect to patient selection, and unclear risk of bias and high concerns related to index test conduct and applicability. In all studies, the Mini-Cog was retrospectively derived from historic data sets. No studies included acute general hospital inpatients. The prevalence of dementia ranged from 32.2% to 87.3%. The sensitivities of the Mini-Cog in the individual studies were reported as 0.67 (95% confidence interval (CI) 0.63 to 0.71), 0.60 (95% CI 0.48 to 0.72), and 0.87 (95% CI 0.83 to 0.90). The specificity of the Mini-Cog for each individual study was 0.87 (95% CI 0.81 to 0.92), 0.65 (95% CI 0.57 to 0.73), and 1.00 (95% CI 0.94 to 1.00). We did not perform meta-analysis due to concerns related to risk of bias and heterogeneity. AUTHORS' CONCLUSIONS This review identified only a limited number of diagnostic test accuracy studies using Mini-Cog in secondary care settings. Those identified were at high risk of bias related to patient selection and high concerns related to index test conduct and applicability. The evidence was indirect, as all studies evaluated Mini-Cog differently from the review question, where it was anticipated that studies would conduct Mini-Cog and independently but contemporaneously perform a reference standard assessment to diagnose dementia. The pattern of test accuracy varied across the three studies. Future research should evaluate Mini-Cog as a test in itself, rather than derived from other neuropsychological assessments. There is also a need for evaluation of the feasibility of the Mini-Cog for the diagnosis of dementia to help adequately determine its role in the clinical pathway.
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Affiliation(s)
- Calvin CH Chan
- Queen's UniversitySchool of Medicine49 King Street EastKingstonONCanadaK7L 2Z5
| | - Bruce A Fage
- University of TorontoDepartment of PsychiatryTorontoONCanada
| | - Jennifer K Burton
- University of GlasgowAcademic Geriatric Medicine, Institute of Cardiovascular and Medical SciencesNew Lister Building, Glasgow Royal InfirmaryGlasgowUKG4 0SF
| | - Nadja Smailagic
- University of CambridgeInstitute of Public HealthForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Sudeep S Gill
- Queen's UniversityDepartment of MedicineSt. Mary's of the Lake Hospital340 Union StreetKingstonONCanadaK7L 5A2
| | - Nathan Herrmann
- Sunnybrook Research InstituteHurvitz Brain Sciences Research Program2075 Bayview AvenueRoom FG‐05TorontoONCanadaM4N 3M5
| | | | - Terry J Quinn
- University of GlasgowInstitute of Cardiovascular and Medical SciencesNew Lister CampusGlasgow Royal InfirmaryGlasgowUKG4 0SF
| | - Anna H Noel‐Storr
- University of OxfordRadcliffe Department of MedicineRoom 4401c (4th Floor)John Radcliffe Hospital, HeadingtonOxfordUKOX3 9DU
| | - Dallas P Seitz
- Queen's UniversityDepartment of Psychiatry752 King Street WestKingstonONCanadaK7L 4X3
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Borson S, Sehgal M, Chodosh J. Monetizing the MoCA: What Now? J Am Geriatr Soc 2019; 67:2229-2231. [PMID: 31478562 DOI: 10.1111/jgs.16158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 08/13/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Soo Borson
- University of Washington School of Medicine, Psychiatry and Behavioral Sciences, Seattle, Washington
| | - Mandi Sehgal
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, NYU School of Medicine, New York, New York.,US Department of Veterans Affairs, Veterans Health Administration, VA New York Harbor Healthcare System, New York, New York
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27
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Martinez-Ruiz A, Huang Y, Gee S, Jamieson H, Cheung G. Individual risk factors for possible undetected dementia amongst community-dwelling older people in New Zealand. DEMENTIA 2018; 19:750-765. [PMID: 29989431 DOI: 10.1177/1471301218786277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is general acknowledgement of the importance of early diagnosis of dementia, yet there are still high rates of undetected dementia internationally. The aim of this cross-sectional study was to determine the sociodemographic characteristics associated with possible undetected dementia in a large sample of community-dwelling older New Zealanders. The sample consisted of older people (age ≥ 65) who had received the homecare version of the international Residential Home Care Assessment version 9.1 over a two-year period and who were screened positive for possible dementia on the international Residential Assessment’s Cognitive Performance Scale. People with possible alternative explanations for impaired cognitive performance such as depression and other neurological conditions were excluded from analysis. The 5202 eligible individuals were categorized into two groups: (1) those with a recorded diagnosis of dementia (64%) and (2) those without a recorded diagnosis of dementia (i.e. possible undetected dementia group) (36%). Logistic regression was used to evaluate the association between individual characteristics and possible undetected dementia. Significant risk factors for being in the possible undetected dementia group included Asian ethnicity, living alone, not having participated in long-standing social activities recently, major life stressors, and limited accessibility of their house. The knowledge gained from this study could enable targeting of services and resources for the groups at risk of undetected dementia to have a more equitable access to early diagnosis.
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Affiliation(s)
- Adrian Martinez-Ruiz
- National Institute of Geriatrics of Mexico, México.,University of Auckland, New Zealand
| | - Ying Huang
- University of Auckland, New Zealand.,University of Auckland, New Zealand
| | - Susan Gee
- Canterbury District Health Board, New Zealand.,University of Auckland, New Zealand
| | - Hamish Jamieson
- University of Otago, New Zealand.,University of Auckland, New Zealand
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Li X, Dai J, Zhao S, Liu W, Li H. Comparison of the value of Mini-Cog and MMSE screening in the rapid identification of Chinese outpatients with mild cognitive impairment. Medicine (Baltimore) 2018; 97:e10966. [PMID: 29851846 PMCID: PMC6392520 DOI: 10.1097/md.0000000000010966] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Patients with mild cognitive impairment (MCI) are at high risk of dementia, but early identification and active intervention can reduce its morbidity and the incidence of dementia. There is currently no suitable neuropsychological assessment scale to effectively identify MCI in neurological outpatient departments in China. The Mini-Mental State Examination (MMSE) is often used to screen for MCI in outpatient departments in China.To compare the value of Mini-Cog and MMSE in screening patients for MCI in a neurological outpatient department, and determine differences in the value of Mini-Cog for different ages and educational levels.This was a retrospective study of 229 patients with suspected MCI who visited the Cangzhou Central Hospital between March 2012 and April 2016. The MCI group included 119 patients diagnosed with MCI and 110 cases without MCI (non-MCI group). The MCI patients were subgrouped as 40 to 60 years of age, 61 to 80 years, and >80 years; and as without education, ≤6 years education, and >6 years education. All subjects were assessed using the Mini-Cog and MMSE.There were significant differences in Mini-Cog (P < .05) and MMSE (P < .05) between the MCI and non-MCI groups. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index (85.71%, 79.41%, 0.8108, 0.8438, and 0.6550) of Mini-Cog were all higher than those of MMSE (64.76%, 71.57%, 0.7010, 0.6364, and 0.3370) in identifying MCI, but there was no significant difference in specificity (P > .05). Mini-Cog was better than MMSE (P < .05) for MCI patients with different ages and education levels.These results showed that the Mini-Cog was superior to MMSE in identifying MCI patients. Mini-Cog was less affected by age and education level than MMSE. The Mini-Cog assessment was short (3-4 minutes) and easily accepted by the patients. Mini-Cog could be more suitable for application in outpatient department in primary hospitals.
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Depression increases subjective stigma of chronic pain. J Affect Disord 2018; 229:456-462. [PMID: 29331708 PMCID: PMC5807144 DOI: 10.1016/j.jad.2017.12.085] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/21/2017] [Accepted: 12/31/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Individuals suffering from mental as well as physical conditions often face stigma, which can adversely affect functioning, treatment seeking, and emotional health. We compared levels of stigma experienced by individuals with depression and/or chronic pain, to contrast the perception of stigma experienced by the sufferers with that of individuals who have never experienced these conditions, and to determine whether depression is related to greater experience of stigma for chronic pain. METHODS Four groups of participants (N=236) took part in the study: depression only, chronic pain only, comorbid depression and chronic pain, and healthy controls. Participants underwent a clinical interview and completed a stigma measure that assessed general self-stigma, public stigma, treatment stigma, secrecy, and stigmatizing experiences. RESULTS Healthy controls largely underestimated the stigma experienced by individuals with depression, but were not inaccurate in estimating stigma experienced by individuals with chronic pain. Further, individuals with chronic pain alone generally perceived less stigma for their condition than did those with depression alone. However, comorbid individuals perceived worse stigma of chronic pain compared to individuals with chronic pain alone, suggesting that depression may affect the stigma felt by sufferers of conditions other than depression. LIMITATIONS Social desirability may have influenced stigma scores. Comparing several groups required adapting a standardized instrument. CONCLUSIONS Results suggest that depression may play a role in the social experience of having a health condition, as well as indicate that the general public continues to fail to appreciate the negative social pressures experienced by individuals with mental health conditions.
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Seitz DP, Chan CCH, Newton HT, Gill SS, Herrmann N, Smailagic N, Nikolaou V, Fage BA. Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a primary care setting. Cochrane Database Syst Rev 2018; 2:CD011415. [PMID: 29470861 PMCID: PMC6491332 DOI: 10.1002/14651858.cd011415.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Alzheimer's disease and other forms of dementia are becoming increasingly common with the aging of most populations. The majority of individuals with dementia will first present for care and assessment in primary care settings. There is a need for brief dementia screening instruments that can accurately diagnose dementia in primary care settings. The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings. OBJECTIVES To determine the diagnostic accuracy of the Mini-Cog for diagnosing Alzheimer's disease dementia and related dementias in a primary care setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Register of Diagnostic Test Accuracy Studies, MEDLINE, Embase and four other databases, initially to September 2012. Since then, four updates to the search were performed using the same search methods, and the most recent was January 2017. We used citation tracking (using the databases' 'related articles' feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data. SELECTION CRITERIA We only included studies that evaluated the Mini-Cog as an index test for the diagnosis of Alzheimer's disease dementia or related forms of dementia when compared to a reference standard using validated criteria for dementia. We only included studies that were conducted in primary care populations. DATA COLLECTION AND ANALYSIS We extracted and described information on the characteristics of the study participants and study setting. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria we evaluated the quality of studies, and we assessed risk of bias and applicability of each study for each domain in QUADAS-2. Two review authors independently extracted information on the true positives, true negatives, false positives, and false negatives and entered the data into Review Manager 5 (RevMan 5). We then used RevMan 5 to determine the sensitivity, specificity, and 95% confidence intervals. We summarized the sensitivity and specificity of the Mini-Cog in the individual studies in forest plots and also plotted them in a receiver operating characteristic plot. We also created a 'Risk of bias' and applicability concerns graph to summarize information related to the quality of included studies. MAIN RESULTS There were a total of four studies that met our inclusion criteria, including a total of 1517 total participants. The sensitivity of the Mini-Cog varied between 0.76 to 1.00 in studies while the specificity varied between 0.27 to 0.85. The included studies displayed significant heterogeneity in both methodologies and clinical populations, which did not allow for a meta-analysis to be completed. Only one study (Holsinger 2012) was found to be at low risk of bias on all methodological domains. The results of this study reported that the sensitivity of the Mini-Cog was 0.76 and the specificity was 0.73. We found the quality of all other included studies to be low due to a high risk of bias with methodological limitations primarily in their selection of participants. AUTHORS' CONCLUSIONS There is a limited number of studies evaluating the accuracy of the Mini-Cog for the diagnosis of dementia in primary care settings. Given the small number of studies, the wide range in estimates of the accuracy of the Mini-Cog, and methodological limitations identified in most of the studies, at the present time there is insufficient evidence to recommend that the Mini-Cog be used as a screening test for dementia in primary care. Further studies are required to determine the accuracy of Mini-Cog in primary care and whether this tool has sufficient diagnostic test accuracy to be useful as a screening test in this setting.
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Affiliation(s)
- Dallas P Seitz
- Queen's UniversityDepartment of Psychiatry752 King Street WestKingstonONCanadaK7L 4X3
| | - Calvin CH Chan
- Queen's UniversitySchool of Medicine49 King Street EastKingstonONCanadaK7L 2Z5
| | - Hailey T Newton
- Queen's UniversityDepartment of Psychiatry752 King Street WestKingstonONCanadaK7L 4X3
| | - Sudeep S Gill
- Queen's UniversityDepartment of MedicineSt. Mary's of the Lake Hospital340 Union StreetKingstonONCanadaK7L 5A2
| | - Nathan Herrmann
- Sunnybrook Research InstituteHurvitz Brain Sciences Research Program2075 Bayview AvenueRoom FG‐05TorontoONCanadaM4N 3M5
| | - Nadja Smailagic
- University of CambridgeInstitute of Public HealthForvie SiteRobinson WayCambridgeUKCB2 0SR
| | | | - Bruce A Fage
- University of TorontoDepartment of PsychiatryTorontoONCanada
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Abstract
PURPOSE OF THE REVIEW The purpose of this review was to examine the recent literature on detecting cognitive impairment in patients with heart failure (HF) and the evidence indicating any ramifications of cognitive impairment on patient engagement in HF self-care. RECENT FINDINGS Mild cognitive impairment (MCI) is common in HF and impacts on patients' engagement in self-care, yet it is frequently not detected. The use of screening tools, even when brief, improves detection of MCI. However, the most sensitive, specific and feasible screening measure to use in practice is yet to be identified. A full neuropsychological assessment is required to determine a diagnosis of cognitive impairment and to identify the specific areas of cognitive deficit. In patients with HF, there appears to be differing clusters of cognitive deficits. Identification of these deficits may help inform the application of specific cognitive training strategies to ameliorating cognitive changes in HF patients and potentially enhance engagement in self-care. Screening for cognitive impairment is crucial in the management of HF patients to ensure that potential self-care deficits are prevented. The optimal screening tool is yet to be identified.
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Relationship between self-care and comprehensive understanding of heart failure and its signs and symptoms. Eur J Cardiovasc Nurs 2017; 17:496-504. [DOI: 10.1177/1474515117745056] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Although incomplete understanding of heart failure and its signs and symptoms appears to be a barrier to successful self-care, there are few studies examining the relationship between self-care and levels of comprehensive understanding of heart failure and its signs and symptoms. Aim: To determine whether incomplete understanding of heart failure and its signs and symptoms is associated with self-care in heart failure patients who were recently discharged from the hospital due to heart failure exacerbation. Methods: Patients completed the nine-item European Heart Failure Self-care Behavior scale and questionnaire to assess knowledge of heart failure and its signs and symptoms. Three groups were formed by their different levels of understanding of heart failure and its signs and symptoms. Multivariable linear regression was used to determine whether these three levels of understanding groups predicted self-care after controlling for demographic and clinical variables. Results: Of 571 patients 22.1%, 40.1% and 37.8% had poor, moderate, and complete understanding, respectively. Compared with patients in the poor understanding group, patients in complete and moderate understanding groups were more likely to have better adherence to self-care activities (standardized β = −0.14, 95% confidence interval −3.41, −0.47; standardized β = −0.19, 95% confidence interval −4.26, −1.23, respectively). Conclusions: Fewer than half of the patients had a comprehensive understanding of heart failure and its signs and symptoms, which was associated with poor self-care. Our study suggests that patient education should include contents to promote comprehensive understanding of heart failure and its symptoms, as well as the importance of self-care behaviors.
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Kimchi EY, Hshieh TT, Guo R, Wong B, O'Connor M, Marcantonio ER, Metzger ED, Strauss J, Arnold SE, Inouye SK, Fong TG. Consensus Approaches to Identify Incident Dementia in Cohort Studies: Systematic Review and Approach in the Successful Aging after Elective Surgery Study. J Am Med Dir Assoc 2017; 18:1010-1018.e1. [PMID: 28927945 PMCID: PMC5701828 DOI: 10.1016/j.jamda.2017.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To survey the current methods used to ascertain dementia and mild cognitive impairment (MCI) in longitudinal cohort studies, to categorize differences in approaches and to identify key components of expert panel methodology in current use. METHODS We searched PubMed for the past 10 years, from March 6, 2007 to March 6, 2017 using a combination of controlled vocabulary and keyword terms to identify expert panel consensus methods used to diagnose MCI or dementia in large cohort studies written in English. From these results, we identified a framework for reporting standards and describe as an exemplar the clinical consensus procedure used in an ongoing study of elective surgery patients (the Successful Aging after Elective Surgery study). RESULTS Thirty-one articles representing unique cohorts were included. Among published methods, membership of experts panel varied significantly. There was more similarity in what types of information was use to ascertain disease status. However, information describing the diagnostic decision process and resolution of disagreements was often lacking. CONCLUSIONS Methods used for expert panel diagnosis of MCI and dementia in large cohort studies are widely variable, and there is a need for more standardized reporting of these approaches. By describing the procedure in which our expert panel achieved consensus diagnoses, we hope to encourage the development and publication of well-founded and reproducible methods for diagnosis of MCI and dementia in longitudinal studies.
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Affiliation(s)
- Eyal Y Kimchi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tammy T Hshieh
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ray Guo
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Bonnie Wong
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Margaret O'Connor
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Edward R Marcantonio
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Eran D Metzger
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jason Strauss
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Boston, MA
| | - Steven E Arnold
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sharon K Inouye
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tamara G Fong
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Makhani SS, Kim FY, Liu Y, Ye Z, Li JL, Revenig LM, Vaughan CP, Johnson TM, García PS, Ogan K, Master VA. Cognitive Impairment and Overall Survival in Frail Surgical Patients. J Am Coll Surg 2017; 225:590-600.e1. [PMID: 28826805 DOI: 10.1016/j.jamcollsurg.2017.07.1066] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The definition of frailty, as modeled by the Fried criteria, has been limited primarily to the physical domain. The purpose of this study was to assess the additive value of cognitive function with existing frailty criteria to predict poor postoperative outcomes in a large multidisciplinary cohort of patients undergoing major operations. STUDY DESIGN A 4-level composite frailty scoring system was created via the combination of the Fried frailty score and the Emory Clock Draw Test to assess preoperative frailty and cognitive impairment, respectively. Overall survival was defined as months from date of operation to date of death or last follow-up. RESULTS This study included 330 patients undergoing major operations; mean age was 58 years and a total of 53 patient deaths occurred during 4-year follow-up. Among the robust cohort, 20 of 168 patients died (11.9%), and among those who were both physically frail and cognitively impaired, 11 of 26 patients died (42.3%). Multivariable analysis demonstrated the physically frail and cognitively impaired cohort to have a 3.92 higher risk of death (95% CI 1.66 to 9.26) compared with the cohort of robust patients (p = 0.002). Kaplan-Meier survival curves reveal an overall difference in long-term survival (log-rank p < 0.0001), driven mainly by the high risk of mortality among patients with both physical frailty and cognitive impairment. CONCLUSIONS The use of a combined frailty and cognitive assessment score has a more powerful potential to predict adult patients at higher risk of overall survival than either measurement alone. The addition of cognitive assessment to physical frailty measure can lead to improved preoperative decision making and possibly early intervention, as well as more accurate patient counseling.
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Affiliation(s)
| | - Frances Y Kim
- Department of Urology, Emory University, Atlanta, GA
| | - Yuan Liu
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Zixun Ye
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jessica L Li
- School of Medicine, Emory University, Atlanta, GA
| | | | - Camille P Vaughan
- Department of Medicine, Emory University, Atlanta, GA; Birmingham/Atlanta Veterans Affairs Geriatric Research Education and Clinical Center, Atlanta, GA
| | - Theodore M Johnson
- Department of Medicine, Emory University, Atlanta, GA; Department of Family and Preventative Medicine, Emory University, Atlanta, GA; Birmingham/Atlanta Veterans Affairs Geriatric Research Education and Clinical Center, Atlanta, GA
| | - Paul S García
- Department of Anesthesiology, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | - Kenneth Ogan
- Department of Urology, Emory University, Atlanta, GA
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Cornelis E, Gorus E, Beyer I, Bautmans I, De Vriendt P. Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool. PLoS Med 2017; 14:e1002250. [PMID: 28291801 PMCID: PMC5349421 DOI: 10.1371/journal.pmed.1002250] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/02/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Assessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL. METHODS AND FINDINGS The construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65-93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840-.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805-.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978-1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759-.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study. CONCLUSIONS This evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.
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Affiliation(s)
- Elise Cornelis
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Occupational Therapy, Artevelde University College Ghent, Ghent, Belgium
| | - Ellen Gorus
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Ingo Beyer
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Ivan Bautmans
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Patricia De Vriendt
- Frailty in Ageing Research Group (FRIA), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Occupational Therapy, Artevelde University College Ghent, Ghent, Belgium
- Department of Gerontology (GERO), Vrije Universiteit Brussel, Brussels, Belgium
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Lee KS, Moser DK, Pelter MM, Nesbitt T, Dracup K. Self-care in rural residents with heart failure: What we are missing. Eur J Cardiovasc Nurs 2016; 16:326-333. [PMID: 27566598 DOI: 10.1177/1474515116666439] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As heart failure (HF) is a progressive, debilitating condition, life-long self-care is required to achieve good outcomes. Rural residents with HF encounter more challenges with adherence to self-care than their urban counterparts because of rural-urban inequalities related to socioeconomic resources and access to health care. To date, investigators have focused on self-care in HF patients in urban settings, although factors related to self-care may be different between rural and urban residents. AIM The aim of this study was to explore the variables related to self-care in HF patients living in rural areas. METHODS A total of 580 patients in the USA were included in this analysis. We included 12 variables reflecting four aspects that affect patients' decisions to perform self-care: health literacy, psychosocial status, current symptom status, and aging status. We measured self-care using the European Heart Failure Self-Care Scale-9. RESULTS Depressive symptoms (β = 0.28, 95% confidence interval (CI): 0.16 to 0.45), lower perceived control (β = -0.15, 95% CI: -0.32 to -0.08), better symptom status (β = -0.11, 95% CI: -0.13 to -0.003), and annual income of <$20,000 (β = 0.11, 95% CI: 0.38-2.97) were negatively associated with self-care in rural residents with HF. The model with 12 variables explained 7.1% of the variance in self-care. CONCLUSIONS The variables included in the model did not sufficiently explain self-care among rural dwellers with HF. Given that all variables in the model were intrapersonal-level factors, more investigations that incorporate interpersonal factors (e.g. cultural beliefs and access to care) are needed in order to improve our understanding of self-care in HF patients living in rural areas.
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Affiliation(s)
- Kyoung Suk Lee
- 1 Chungnam National University, College of Nursing, Daejeon, South Korea
| | - Debra K Moser
- 2 University of Kentucky, College of Nursing, Lexington, KY, USA
| | - Michele M Pelter
- 3 University of California, San Francisco, School of Nursing, San Francisco, CA, USA
| | - Thomas Nesbitt
- 4 University of California, School of Medicine Davis, Davis, CA USA
| | - Kathleen Dracup
- 3 University of California, San Francisco, School of Nursing, San Francisco, CA, USA
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Toward the processing speed theory of activities of daily living in healthy aging: normative data of the Functional Activities Questionnaire. Aging Clin Exp Res 2016; 28:239-47. [PMID: 26231091 DOI: 10.1007/s40520-015-0413-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to describe an instrumental activities of daily living (IADL) measure: Functional Activities Questionnaire (FAQ), which is often used in clinical settings as a self- or informant-based measure of IADL. However, the FAQ's relationship with age or education in healthy aging has not been investigated. METHODS FAQ and a neuropsychological battery were administered to old and very old Czech adults (n = 540). Participants met strict inclusion criteria for the absence of any active or past neurodegenerative disorders. RESULTS FAQ is significantly dependent on age and education, but not gender. Younger subjects and those with higher education have the lowest scores in the FAQ and show a higher degree of functional independence. FAQ moderately correlates with speed of processing, visual-perceptual and executive functions measures (Trail Making Tests, Stroop Test) and depressive symptoms, but not with episodic memory (WMS-III logical memory). We present normative percentile values for different age groups from 60 to 96 years of age. CONCLUSIONS The present study shows conclusively that IADL measures, such as FAQ, should not be used without appropriate normative data, especially in very old adults. Thus, it has the ability to differentiate functional dependence due to age-related decline from neurodegenerative disease.
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Mazancova AF, Nikolai T, Stepankova H, Kopecek M, Bezdicek O. The Reliability of Clock Drawing Test Scoring Systems Modeled on the Normative Data in Healthy Aging and Nonamnestic Mild Cognitive Impairment. Assessment 2016; 24:945-957. [DOI: 10.1177/1073191116632586] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Clock Drawing Test (CDT) is a commonly used tool in clinical practice and research for cognitive screening among older adults. The main goal of the present study was to analyze the interrater reliability of three different CDT scoring systems (by Shulman et al., Babins et al., and Cohen et al.). We used a clock with a predrawn circle. The CDT was evaluated by three independent raters based on the normative data set of healthy older and very old adults and patients with nonamnestic mild cognitive impairment (naMCI; N = 438; aged 61-94). We confirmed a high interrater reliability measured by the intraclass correlation coefficients (ICCs): Shulman ICC = .809, Babins ICC = .894, and Cohen ICC = .862, all p < .001. We found that age and education levels have a significant effect on CDT performance, yet there was no influence of gender. Finally, the scoring systems differentiated between naMCI and age- and education-matched controls: Shulman’s area under the receiver operating characteristic curve (AUC) = .84, Cohen AUC = .71, all p < .001; and a slightly lower discriminative ability was shown by Babins: AUC = .65, p = .012.
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Affiliation(s)
- Adela Fendrych Mazancova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Tomas Nikolai
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Hana Stepankova
- National Institute of Mental Health, Klecany, Czech Republic
| | | | - Ondrej Bezdicek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
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Bratzke LC, Moser DK, Pelter MM, Paul SM, Nesbitt TS, Cooper LS, Dracup KA. Evidence-Based Heart Failure Medications and Cognition. J Cardiovasc Nurs 2016; 31:62-8. [PMID: 25419943 PMCID: PMC4440853 DOI: 10.1097/jcn.0000000000000216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The etiology of cognitive impairment in heart failure (HF) is controversial and likely multifactorial. Physicians may hesitate to prescribe evidence-based HF medication because of concerns related to potential negative changes in cognition among a population that is already frequently impaired. We conducted a study to determine if prescription of evidence-based HF medications (specifically, β-blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blocking agents, diuretics, and aldosterone inhibitors) was associated with cognition in a large HF sample. METHODS A total of 612 patients completed baseline data collection for the Rural Education to Improve Outcomes in Heart Failure clinical trial, including information about medications. Global cognition was evaluated using the Mini-Cog. RESULTS The sample mean (SD) age was 66 (13) years, 58% were men, and 89% were white. Global cognitive impairment was identified in 206 (34%) of the 612 patients. Prescription of evidence-based HF medications was not related to global cognitive impairment in this sample. This relationship was maintained even after adjusting for potential confounders (eg, age, education, and comorbid burden). CONCLUSION Prescription of evidence-based HF medications is not related to low scores on a measure of global cognitive function in rural patients with HF.
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Affiliation(s)
| | | | | | | | | | - Lawton S. Cooper
- National Institutes of Health, National Heart, Lung, and Blood Institute
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Kallumpuram S, Sudhir Kumar CT, Khan B, Gavins V, Khan A, Iliffe S. Targeted case finding for dementia in primary care: Surrey Downs dementia diagnosis project. BMJ QUALITY IMPROVEMENT REPORTS 2015; 4:bmjquality_uu209827.w4086. [PMID: 26893884 PMCID: PMC4752712 DOI: 10.1136/bmjquality.u209827.w4086] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/02/2015] [Indexed: 12/02/2022]
Abstract
Currently less than half of the estimated number of people with dementia in England receive a formal diagnosis of dementia or have contact with specialist dementia services. Case finding focused on high risk groups may be an effective way to identify the undiagnosed. This joint Surrey Downs Clinical Commissioning Group and Surrey and Borders NHS Foundation Trust quality improvement project aimed to increase the rate of dementia diagnosis across Surrey Downs using specialist link nurses (SLNs). Thirty three GP surgeries covering the entire Surrey Downs area took part in the project. Individuals at high risk of developing dementia were identified from GP electronic disease registers, and were offered screening at their GP practices by SLNs, using a combination of mini cognitive test (Mini-Cog) and functional assessment questionnaire (FAQ). Suitable individuals who screened positive were seen by their GP and where appropriate referred to secondary care services for further evaluation. Based on the presence of risk factors, 6657 (11.9%) people were identified from a total population of 55 845 over 65s, and 1980 (29.7%) completed the screening assessment. Three hundred and fifty eight (18.1%) individuals screened positive and were referred to their GP, who referred 205 (57.2%) of them to the memory services for further assessment. Of those referred, 164 (80%) had a comprehensive specialist assessment. Forty one (20%) declined further assessment, and their GPs were informed. The mean age of the cohort who completed the comprehensive assessment was 82.3 years (SD=4.26), and were predominantly white and male. Fifty four (32.9%) had mild cognitive disorder (MCD), and 101 (61.6%) patients were diagnosed with dementia. The most common dementia was mixed type (43; 42.6%), followed by Alzheimer's dementia (32; 31.7%). The most common risk factor among patients with cognitive impairment (MCD or dementia) was hypertension (69; 44.5 %), followed by ischemic heart disease (64, 41.3%). Nurse led case finding for cognitive impairment in a high risk population identifies people with dementia who are not yet formally diagnosed. The combined use of brief instruments to assess cognitive functioning and functional capabilities is helpful in identifying individuals with possible dementia.
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Affiliation(s)
| | | | - Bilal Khan
- Surrey and Borders Partnership NHS Trust
| | | | - Aalia Khan
- Surrey and Borders Partnership NHS Trust
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Moser DK, Robinson S, Biddle MJ, Pelter MM, Nesbitt TS, Southard J, Cooper L, Dracup K. Health Literacy Predicts Morbidity and Mortality in Rural Patients With Heart Failure. J Card Fail 2015; 21:612-8. [PMID: 25908018 DOI: 10.1016/j.cardfail.2015.04.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients hospitalized with heart failure are often readmitted. Health literacy may play a substantial role in the high rate of readmissions. The purpose of this study was to examine the association of health literacy with the composite end point of heart failure readmission rates and all-cause mortality in patients with heart failure living in rural areas. METHODS AND RESULTS Rural adults (n = 575), hospitalized for heart failure within the past 6 months, completed the Short Test of Functional Health Literacy in Adults (STOFHLA) to measure health literacy and were followed for ≥2 years. The percentage of patients with the end point of heart failure readmission or all-cause death was different (P = .001) among the 3 STOFHLA score levels. Unadjusted analysis revealed that patients with inadequate and marginal health literacy were 1.94 (95% confidence interval [CI] 1.43-2.63; P < .001) times, and 1.91 (95% CI 1.36-2.67; P < .001) times, respectively, more likely to experience the outcome. After adjustment for covariates, health literacy remained a predictor of outcomes. Of the other covariates, worse functional class, higher comorbidity burden, and higher depression score predicted worse outcomes. CONCLUSIONS Inadequate or marginal health literacy is a risk factor for heart failure rehospitalization or all-cause mortality among rural patients with heart failure.
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Affiliation(s)
- Debra K Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky.
| | | | - Martha J Biddle
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | | | | | | | - Lawton Cooper
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
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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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Brooks P, Spillane JJ, Dick K, Stuart-Shor E. Developing a strategy to identify and treat older patients with postoperative delirium. AORN J 2014; 99:257-73; quiz 274-6. [PMID: 24472589 DOI: 10.1016/j.aorn.2013.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 07/16/2013] [Accepted: 12/17/2013] [Indexed: 12/27/2022]
Abstract
Postoperative delirium is one of the most common adverse outcomes in elderly patients undergoing surgery and is associated with increased morbidity, length of stay, and patient care costs. The purpose of this quality improvement project was to evaluate the effectiveness of a multicomponent strategy to identify and treat general surgical patients 65 years of age or older at risk for and who develop postoperative delirium at Cape Cod Hospital, a community hospital in southern New England. We evaluated 96 patients using the Mini-Cog assessment tool preoperatively and the Confusion Assessment Method (CAM) delirium screening tool or CAM-Intensive Care Unit (CAM-ICU) assessment tool postoperatively. Patients who tested positive during preoperative assessment underwent a postoperative delirium management protocol. We summarized data using descriptive statistics. The results showed an association between compliance and outcomes. High compliance with implementation of CAM and CAM-ICU assessment tools resulted in increased identification of postoperative delirium in the older surgical population. The use of screening tools helped facilitate early identification of postoperative delirium in elderly surgical patients.
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Bezdicek O, Libon DJ, Stepankova H, Panenkova E, Lukavsky J, Garrett KD, Lamar M, Price CC, Kopecek M. Development, validity, and normative data study for the 12-word Philadelphia Verbal Learning Test [czP(r)VLT-12] among older and very old Czech adults. Clin Neuropsychol 2014; 28:1162-81. [PMID: 25247611 DOI: 10.1080/13854046.2014.952666] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the present study was to assess the validity of a 12-word Czech version of the Philadelphia (repeatable) Verbal Learning Test [czP(r)VLT-12]. The construction of the czP(r)VLT-12 was modeled after the California Verbal Learning Test (CVLT) and the nine-word Philadelphia (repeatable) Verbal Learning Test [P(r)VLT]. The czP(r)VLT-12 was constructed from a large corpus of old (60-74) and very old (75-96) Czech adults (n = 540). Participants met strict inclusion criteria for the absence of any active or past neurodegenerative disorders and performed within normal limits on other neuropsychological measures. Principal component analysis (PCA) and correlations between czP(r)VLT-12 factor structure and other memory tests were conducted. The czP(r)VLT-12 produced a four-factor solution, accounting for 70.90% of variance, with factors related to: (1) recall, (2) extra-list intrusion errors/recognition foils, (3) interference, and (4) acquisition rate; a solution similar to the CVLT and P(r)VLT. Increasing age resulted in a decline in most czP(r)VLT-12 indices, women outperformed men, and higher education led to higher scores. Memory performance in normal aging did not correlate with instrumental activities of daily living. Low, but significant, correlations were seen with other tests of cognitive performance (divergent validity). Appendices are available that provide normed percentile estimates of individual czP(r)VLT-12 performance stratified by age, education, and gender. In accordance with previous studies, these results demonstrate the usefulness of czP(r)VLT-12 in assessing declarative memory in older adults.
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Affiliation(s)
- Ondrej Bezdicek
- a Department of Neurology and Centre of Clinical Neuroscience , First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague , 128 21 Prague, Czech Republic
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Nesbitt T, Doctorvaladan S, Southard JA, Singh S, Fekete A, Marie K, Moser DK, Pelter MM, Robinson S, Wilson MD, Cooper L, Dracup K. Correlates of quality of life in rural patients with heart failure. Circ Heart Fail 2014; 7:882-7. [PMID: 25146960 DOI: 10.1161/circheartfailure.113.000577] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is abundant research indicating poor physical, psychological, and social functioning of patients with chronic heart failure (HF), a reality that can lead to poor health-related quality of life (QoL). Little is known about the experience of rural patients with HF. METHODS AND RESULTS This study was part of a randomized clinical trial titled Rural Education to Improve Outcomes in Heart Failure (REMOTE-HF) designed to test an education and counseling intervention to improve self-care in patients with HF. We evaluated 612 rural patients. Multiple validated questionnaires were administered to assess patient perceptions of health and health literacy. Baseline factors were collected and compared with baseline QoL measures only. Patients' health-related QoL was assessed using the Minnesota Living with Heart Failure scale. The data were analyzed using a general linear model to test the association of various patient characteristics with QoL in rural patients with HF. Patients were 65.8 (+12.9) years of age. The majority were men (58.7%), married (56.4%), and had completed a high-school education (80.9%). Factors associated with reduced QoL among this population include geographic location, younger age, male sex, higher New York Heart Association class, worse HF knowledge, poorer perceived control, and symptoms of depression or anxiety. The data provided no evidence of an association between left ventricular ejection fraction and QoL. CONCLUSIONS This study of rural patients with HF confirms previously identified factors associated with perceptions of QoL. However, further study is warranted with an urban control group. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00415545.
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Affiliation(s)
- Thomas Nesbitt
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Sahar Doctorvaladan
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Jeffrey A Southard
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.).
| | - Satinder Singh
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Anne Fekete
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Kate Marie
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Debra K Moser
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Michelle M Pelter
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Susan Robinson
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Machelle D Wilson
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Lawton Cooper
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Kathleen Dracup
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
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An assessment by the Statin Cognitive Safety Task Force: 2014 update. J Clin Lipidol 2014; 8:S5-16. [DOI: 10.1016/j.jacl.2014.02.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 02/28/2014] [Indexed: 12/13/2022]
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Bertens LCM, Broekhuizen BDL, Naaktgeboren CA, Rutten FH, Hoes AW, van Mourik Y, Moons KGM, Reitsma JB. Use of expert panels to define the reference standard in diagnostic research: a systematic review of published methods and reporting. PLoS Med 2013; 10:e1001531. [PMID: 24143138 PMCID: PMC3797139 DOI: 10.1371/journal.pmed.1001531] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/03/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In diagnostic studies, a single and error-free test that can be used as the reference (gold) standard often does not exist. One solution is the use of panel diagnosis, i.e., a group of experts who assess the results from multiple tests to reach a final diagnosis in each patient. Although panel diagnosis, also known as consensus or expert diagnosis, is frequently used as the reference standard, guidance on preferred methodology is lacking. The aim of this study is to provide an overview of methods used in panel diagnoses and to provide initial guidance on the use and reporting of panel diagnosis as reference standard. METHODS AND FINDINGS PubMed was systematically searched for diagnostic studies applying a panel diagnosis as reference standard published up to May 31, 2012. We included diagnostic studies in which the final diagnosis was made by two or more persons based on results from multiple tests. General study characteristics and details of panel methodology were extracted. Eighty-one studies were included, of which most reported on psychiatry (37%) and cardiovascular (21%) diseases. Data extraction was hampered by incomplete reporting; one or more pieces of critical information about panel reference standard methodology was missing in 83% of studies. In most studies (75%), the panel consisted of three or fewer members. Panel members were blinded to the results of the index test results in 31% of studies. Reproducibility of the decision process was assessed in 17 (21%) studies. Reported details on panel constitution, information for diagnosis and methods of decision making varied considerably between studies. CONCLUSIONS Methods of panel diagnosis varied substantially across studies and many aspects of the procedure were either unclear or not reported. On the basis of our review, we identified areas for improvement and developed a checklist and flow chart for initial guidance for researchers conducting and reporting of studies involving panel diagnosis. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Loes C. M. Bertens
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
- * E-mail:
| | - Berna D. L. Broekhuizen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | | | - Frans H. Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Arno W. Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Yvonne van Mourik
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Karel G. M. Moons
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Johannes B. Reitsma
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
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Use of the MC-FAQ and MMSE-FAQ in cognitive screening of older African Americans, Hispanic Americans, and European Americans. Am J Geriatr Psychiatry 2012; 20:955-62. [PMID: 22996060 DOI: 10.1097/jgp.0b013e31825d0935] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the performance of the Mini-Cog-Functional Activities Questionnaire (MC-FAQ) and the Mini-Mental State Examination-Functional Activities Questionnaire (MMSE-FAQ) in cognitive screening of a multiethnic sample of older adults. DESIGN This is a descriptive psychometric study. SETTING Cognitive screening was done in senior centers, at health fairs, and within the nine participating memory disorder centers in the State of Florida. PARTICIPANTS African American, Hispanic American, and European American older adults who participated in this screening were matched on gender, age within 3 years and education within 3 years yielding a sample of 225. MEASUREMENTS The MC-FAQ is a combination of the Mini-Cog and Functional Activities Questionnaire. The MMSE-FAQ combines the MMSE with the FAQ. The Geriatric Depression Scale was used to assess depressive symptoms. RESULTS African Americans reported significantly less depressive symptoms (F[2, 217] = 10.31, p <0.001) and European Americans had significantly higher mean MMSE scores than the other two groups (F[2, 222] = 3.33, p = 0.037). Participants did not differ by ethnic group on the MC-FAQ or MMSE-FAQ classifications of normal, mild cognitive impairment, or dementia. Age, years of education, and depressive symptoms were significant predictors of MC-FAQ and MMSE-FAQ classifications. CONCLUSIONS The results suggest that these combinations of screening measures may have less culture bias than the MMSE alone. Sensitivity and specificity should be evaluated in these groups with confirmatory neurological and psychiatric diagnosis.
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Hampstead BM, Sathian K, Phillips PA, Amaraneni A, Delaune WR, Stringer AY. Mnemonic strategy training improves memory for object location associations in both healthy elderly and patients with amnestic mild cognitive impairment: a randomized, single-blind study. Neuropsychology 2012; 26:385-99. [PMID: 22409311 PMCID: PMC3348454 DOI: 10.1037/a0027545] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [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 evaluate the efficacy of mnemonic strategy training versus a matched-exposure control condition and to examine the relationship between training-related gains, neuropsychological abilities, and medial temporal lobe volumetrics in patients with amnestic mild cognitive impairment (aMCI) and age-matched healthy controls. METHOD Twenty-three of 45 screened healthy controls and 29 of 42 screened patients with aMCI were randomized to mnemonic strategy or matched-exposure groups. Groups were run in parallel, with participants blind to the other intervention. All participants completed five sessions within 2 weeks. Memory testing for object-location associations (OLAs) was performed during sessions one and five and at a 1-month follow-up. During Sessions 2-4, participants received either mnemonic strategy training or a matched number of exposures with corrective feedback for a total of 45 OLAs. Structural magnetic resonance imaging was performed in most participants, and medial temporal lobe volumetrics were acquired. RESULTS Twenty-one healthy controls and 28 patients with aMCI were included in data analysis. Mnemonic strategy training was significantly more beneficial than matched exposure immediately after training, p = .006, partial η2 = .16, and at 1 month, p < .001, partial η2 = .35, regardless of diagnostic group (healthy group or aMCI group). Although patients with aMCI demonstrated gains comparable to the healthy control groups, their overall performance generally remained reduced. Mnemonic strategy-related improvement was correlated positively with baseline memory and executive functioning and negatively with inferior lateral ventricle volume in patients with aMCI; no significant relationships were evident in matched-exposure patients. CONCLUSION Mnemonic strategies effectively improve memory for specific content for at least 1 month in patients with aMCI.
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Robinson S, Moser D, Pelter MM, Nesbitt T, Paul SM, Dracup K. Assessing health literacy in heart failure patients. J Card Fail 2012; 17:887-92. [PMID: 22041324 DOI: 10.1016/j.cardfail.2011.06.651] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/15/2011] [Accepted: 06/29/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Health literacy has important implications for health interventions and clinical outcomes. The Shortened Test of Functional Health Literacy in Adults (S-TOFHLA) is a timed test used to assess health literacy in many clinical populations. However, its usefulness in heart failure (HF) patients, many of whom are elderly with compromised cognitive function, is unknown. We investigated the relationship between the S-TOFHLA total score at the recommended 7-minute limit and with no time limit (NTL). METHODS AND RESULTS We enrolled 612 rural-dwelling adults with HF (mean age 66.0 ± 13.0 years, 58.8% male). Characteristics affecting health literacy were identified by multiple regression. Percentage of correct scores improved from 71% to 86% (mean percent change 15.1 ± 18.1%) between the 7-minute and NTL scores. Twenty-seven percent of patients improved ≥1 literacy level with NTL scores (P < .001). Demographic variables explained 24.2% and 11.1% of the variance in % correct scores in the 7-minute and the NTL scores, respectively. Female gender, younger age, higher education, and higher income were related to higher scores. CONCLUSION Patients with HF may be inaccurately categorized as having low or marginal health literacy when the S-TOFHLA time limits are enforced. New ways to assess health literacy in older adults are needed.
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Affiliation(s)
- Susan Robinson
- University of California, San Francisco, San Francisco, California, USA.
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