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Souza NAPD, Simões Neto JP, Dourado MCN. The Relationship Between Decision-Making Capacity and Awareness in People with Young-Onset Alzheimer's Disease. J Alzheimers Dis 2024; 101:671-680. [PMID: 39213057 DOI: 10.3233/jad-231324] [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: 09/04/2024]
Abstract
Background Young-onset AD (YOAD) typically occurs before the age of 65 and affects less than 6% of all people diagnosed with AD. There is a lack of research on differences between decision-making capacity and awareness according to age at onset of dementia. Objective We investigated the relationship between decision-making capacity and awareness domains in people with young- (YOAD) and late-onset Alzheimer's disease (LOAD). Methods A cross-sectional study included 169 consecutively selected people with AD and their caregivers (124 people with LOAD and 45 people with YOAD). Results People with YOAD were more cognitively impaired, but more aware of their cognitive deficits and health condition, with moderate effect sizes. All people with AD presented deficits in the domains of decision-making capacity, with more impairment in understanding. There was a relationship between understanding and awareness domains, such that awareness was particularly important for decision-making capacity in the YOAD group. Conclusions Better awareness involved better understanding in the YOAD group. Clinically, our findings shed light on the need to consider the differences in the domains of awareness and their relationship with other clinical aspects such as decision-making capacity according to age at onset of AD. Furthermore, our data can suggest hypotheses for larger and more robust prospective studies.
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Affiliation(s)
- Natalie Aparecida Pereira de Souza
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Pedro Simões Neto
- Department of Sociology and Political Science, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Marcia Cristina Nascimento Dourado
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Sommerlad A, Grothe J, Umeda S, Ikeda M, Kanemoto H, Livingston G, Luppa M, Rankin KP, Riedel-Heller SG, Röhr S, Suzuki M, Huntley J. Awareness of Social Functioning in People with Dementia and Its Association with Dementia Severity: Multi-Center Cross-Sectional Study. J Alzheimers Dis 2024; 100:1183-1193. [PMID: 39031360 DOI: 10.3233/jad-240311] [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: 07/22/2024]
Abstract
Background People with dementia commonly have impaired social functioning and may not recognize this. This lack of awareness may result in worse outcomes for the person and their family carers. Objective We aimed to characterize awareness of social functioning in dementia and describe its association with dementia severity. Methods Multi-center cross-sectional study of people aged >65 years with dementia and family informants recruited from Germany, Japan and the United Kingdom. We used the Social Functioning in Dementia (SF-DEM) scale, assessing "spending time with other people" (domain 1), "communicating with other people" (domain 2), and "sensitivity to other people" (domain 3), and calculated lack of awareness into social functioning as the discrepancy between patient and informant ratings. Results 108 participants with dementia (50.9% women), mean age = 78.9 years, and mean MMSE score = 22.7. Patient and informant domain 1 ratings did not differ, but patient-rating was higher than carers for domain 2 (11.2 versus 10.1; p = 0.003) and domain 3 (9.7 versus 8.1; p < 0.001). Sixty people with dementia overestimated their overall social functioning, 30 underestimated, and 18 gave ratings congruent with their informant. Performance on the MMSE and its sub-domains was not associated with SF-DEM discrepancy score. Conclusions We found that awareness of social functioning in dementia was a multidimensional concept, which varies according to subdomains of social functioning. Clinicians should help family members understand and adapt by explaining their relative with dementia's lack of awareness about aspects of their social functioning.
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Affiliation(s)
- Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Jessica Grothe
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany
| | - Sumiyo Umeda
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Psychiatry, Daini Osaka Police Hospital, Osaka, Japan
- Department of Psychiatry and Mental Health, Sumitomo Hospital, Osaka, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Graduate School of Medicine, Osaka University, Osaka, Japan
- Health and Counseling Center, Osaka University, Osaka, Japan
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Melanie Luppa
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany
| | - Katherine P Rankin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, USA
| | - Steffi G Riedel-Heller
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany
| | - Susanne Röhr
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany
- Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
- School of Psychology, Massey University, Auckland, New Zealand
| | - Maki Suzuki
- Department of Behavioral Neurology and Neuropsychiatry, United Graduate School of Child Development, Osaka University, Osaka, Japan
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- The Medical School, University of Exeter, Exeter, UK
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Baptista MAT, Lacerda IB, Belfort T, Nogueira MML, de Oliveira Silva F, Dourado MCN. Awareness of Disease and Its Domains in Young-onset and Late-onset Dementia: The Role of Executive Function. Alzheimer Dis Assoc Disord 2023; 37:200-206. [PMID: 37561987 DOI: 10.1097/wad.0000000000000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/23/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Executive function (EF) involves a general cognitive process linked to strategic organization and control of complex goal-oriented tasks. In young-onset dementia (YOD), especially Alzheimer's disease, the symptoms that stand out in the initial stage are deficits in attention, visual-spatial function, praxis, and language. The present study aims to investigate what components of EF differ in young and late-onset dementia (LOD) and its impact on awareness and its domains. METHODS Using a cross-sectional design, we included 44 people with YOD and 70 with LOD. We assessed awareness and its domains, cognition, dementia severity, EF, functionality, and neuropsychiatric symptoms. RESULTS The YOD group was more impaired in general cognition ( P =0.017) and had a worse performance in Wechsler Digit Span Backward (DSB) ( P =0.007) and Phonemic fluency task (FAS) ( P =0.046) tests. In the LOD group, deficits in EF had a greater impact on awareness and on most domains (awareness total score, cognitive functioning and health condition, functional activity impairments and social function). CONCLUSIONS Our study findings support the heterogeneity of awareness, not only with regard to the difference between the domains and the measures of EF, but also to the groups studied.
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Affiliation(s)
- Maria Alice Tourinho Baptista
- Center for Alzheimer's disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Martyr A, Gamble LD, Nelis SM, Collins R, Alexander CM, Morris RG, Quinn C, Pentecost C, Rusted JM, Victor C, Thom JM, Matthews FE, Clare L. Predictors of Awareness of Functional Ability in People with Dementia: The Contribution of Personality, Cognition, and Neuropsychiatric Symptoms - Findings from the IDEAL Program. Dement Geriatr Cogn Disord 2022; 51:221-232. [PMID: 35533657 DOI: 10.1159/000524607] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/07/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Discrepancy scores reflecting the difference between parallel ratings made by people living with dementia (PwD) in the mild-to-moderate stages and by their informants provide a way to investigate awareness of functional ability in relation to activities of daily living (ADL). METHODS Two measures of ADL (Functional Activities Questionnaire; Dependence Scale) were completed by 1,227 PwD and their informants in the IDEAL cohort study baseline assessment. Self-rated and informant-rated scores were used to calculate discrepancies, which were used as an indicator of awareness of functional ability. Smaller discrepancy scores were considered to reflect greater awareness on the part of PwD. PwD completed questionnaires on depression, personality, comorbidities, neuropsychiatric symptoms, and completed a measure of cognition. Informants provided ratings of stress. Univariable and multiple regressions were used to investigate factors related to ADL discrepancy. RESULTS A similar pattern of associations were found for both ADL discrepancy scores. Smaller discrepancy scores were associated with higher levels of depression, higher neuroticism, fewer neuropsychiatric symptoms, higher comorbidity, lower carer stress, and receipt of less than 1 hour of care per day from the informant. DISCUSSION/CONCLUSION There was a clear pattern of factors that were associated with greater awareness for both measures of functional ability. These factors associated with smaller discrepancy scores could be used to identify PwD who might benefit from targeted interventions to support their independence.
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Affiliation(s)
- Anthony Martyr
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sharon M Nelis
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Rachel Collins
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Catherine M Alexander
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Robin G Morris
- Department of Psychology, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Claire Pentecost
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom
| | - Jennifer M Rusted
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Christina Victor
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, United Kingdom.,NIHR Applied Research Collaboration South-West Peninsula, Exeter, United Kingdom
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Grothe J, Luppa M, Dietzel J, Schomerus G, Sommerlad A, Riedel-Heller SG, Röhr S. Psychometric Evaluation of the German Version of the Social Functioning in Dementia Scale. J Alzheimers Dis 2022; 86:1231-1241. [PMID: 35180127 DOI: 10.3233/jad-215557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dementia is one of the most common and most severe disorder in old age. In addition to cognitive decline and functional impairment, changes in social functioning occur in the course of dementia. Currently, there is no valid instrument in German language to assess social functioning in individuals with dementia. OBJECTIVE We aim to adapt and psychometrically evaluate a German version of the Social Functioning in Dementia Scale (SF-DEM). METHODS First, a multi-step and team-based translation process based on the TRAPD model was performed. Second, we interviewed dyads of individuals with mild dementia and caregivers to test the internal consistency, test-retest reliability, interrater reliability, construct validity, and acceptance of the German version of the SF-DEM. RESULTS The internal consistency of the patient-rated (α= 0.72) and the caregiver-rated (α= 0.76) SF-DEM is at an acceptable level. The interrater reliability was excellent for both versions (patients: ICC = 0.98, CI [0.95-0.99]; caregiver: ICC = 0.95, CI [0.89-0.98]) and the test-retest reliability was moderate (patients: ICC = 0.57, CI [0.26-0.77]; caregiver: ICC = 0.58, CI [0.27-0.78]). Caregiver-rated SF-DEM correlated strong with LSNS-6 (rs = 0.60, p < 0.01), QoL-AD (marriage: rs = 0.61, p < 0.01; friends: rs = 0.51, p = 0.01). In addition, the SF-DEM was accepted by the participants. CONCLUSION The German SF-DEM is a valid, reliable, and acceptable instrument to assess social functioning in individuals with dementia. Further research should address the psychometric properties in individuals with more severe dementia.
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Affiliation(s)
- Jessica Grothe
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Jens Dietzel
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Leipzig, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Leipzig, Germany
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany.,Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
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