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Baratono S, Press D. What Are the Key Diagnostic Cognitive Impairment and Dementia Subtypes and How to Integrate all of the Diagnostic Data to Establish a Diagnosis? Clin Geriatr Med 2023; 39:77-90. [PMID: 36404034 DOI: 10.1016/j.cger.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Diagnosis of dementia requires a detailed history, physical examination, imaging, and sometimes neuropsychological testing or ancillary tests. Mild cognitive impairment is defined as an objective impairment in cognitive performance but preserved ability to do activities of daily living. Dementia is diagnosed once impairment in activities of daily living develops. Common types of dementia covered here include mild cognitive impairment, Alzheimer's disease, Lewy body dementia, frontotemporal dementia, the primary progressive aphasias, and vascular dementia.
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Affiliation(s)
- Sheena Baratono
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Brookline, MA 02215, USA
| | - Daniel Press
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Brookline, MA 02215, USA.
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Smid J, Studart-Neto A, César-Freitas KG, Dourado MCN, Kochhann R, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Caramelli P, Bertolucci PHF, Chaves MLF, Brucki SMD, Nitrini R, Resende EDPF, Vale FAC. Subjective cognitive decline, mild cognitive impairment, and dementia - syndromic approach: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s101en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
ABSTRACT This consensus, performed by the Brazilian Academy of Neurology (BAN) will approach practically how to evaluate patients with cognitive complaints and how to clinically and etiologically diagnose the three clinical syndromes associated with the different stages of cognitive decline: subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia. This BAN consensus discusses SCD diagnosis for the first time, updates MCI and dementia diagnoses, recommends the adequate cognitive tests and the relevant etiological work-up and care of patients with cognitive decline at different levels of care within the Brazilian Unified Health System. We also review the main assessment instruments used in Brazil and Latin America.
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Affiliation(s)
| | | | | | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brasil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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Smid J, Studart-Neto A, César-Freitas KG, Dourado MCN, Kochhann R, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Caramelli P, Bertolucci PHF, Chaves MLF, Brucki SMD, Nitrini R, Resende EDPF, Vale FAC. Declínio cognitivo subjetivo, comprometimento cognitivo leve e demência - diagnóstico sindrômico: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Dement Neuropsychol 2022; 16:1-24. [DOI: 10.1590/1980-5764-dn-2022-s101pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/03/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
RESUMO Este consenso realizado pela Academia Brasileira de Neurologia (ABN) abordará de maneira prática como avaliar pacientes com queixas cognitivas e como realizar o diagnóstico clínico e etiológico das três síndromes clínicas associadas aos estágios de declínio cognitivo: declínio cognitivo subjetivo (DCS), comprometimento cognitivo leve (CCL) e demência. O diagnóstico de DCS é discutido pela primeira vez em consenso da ABN e as atualizações para o diagnóstico de CCL e demência são abordadas, bem como a recomendação para o uso de testes cognitivos apropriados, investigação etiológica pertinente e cuidados aos pacientes com declínio cognitivo nos diferentes níveis de atenção do Sistema Único de Saúde. Foi realizada pesquisa dos principais instrumentos de avaliação utilizados em nosso meio e na América Latina.
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Affiliation(s)
| | | | | | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brasil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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Echeverría A, Cauas R, Díaz B, Sáez C, Cárcamo M. Herramientas de evaluación de actividades de la vida diaria instrumentales en población adulta: revisión sistemática. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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González DA, Gonzales MM, Resch ZJ, Sullivan AC, Soble JR. Comprehensive Evaluation of the Functional Activities Questionnaire (FAQ) and Its Reliability and Validity. Assessment 2021; 29:748-763. [PMID: 33543638 PMCID: PMC8339133 DOI: 10.1177/1073191121991215] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The Functional Activities Questionnaire (FAQ) is a collateral-report measure of difficulties in activities of daily living. Despite its widespread use, psychometric analyses have been limited in scope, piecemeal across samples, and limited primarily to classical test theory. This article consolidated and expanded psychometric analyses using tools from generalizability and item response theories among 27,916 individuals from the National Alzheimer's Coordinating Center database who completed the FAQ. Reliability was evaluated with internal consistency, test-retest, and generalizability analyses. Validity was assessed via convergence with neurocognitive measures, classification accuracy with impairment stage, and confirmatory factor and item response theory analyses. Demographics did not impact scores and there was strong evidence for reliability (0.52-0.95), though coefficients were attenuated when restricted in range to diagnostic groups (e.g., normal cognition). There were strong correlations with neurocognitive measures (rs: -.30 to -.59), strong classification accuracy (areas under the curve: .81-.99), and a single-factor model had excellent fit. All items evidenced strong item response theory discrimination and provided significant information regarding functional disability, albeit within a relatively restricted range. The FAQ is a reliable and valid measure of activities of daily living concerns for use in clinical/research settings. It best assesses mild levels of functional difficulty, which is helpful in distinguishing normal cognition from mild cognitive impairment and dementia.
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Affiliation(s)
| | - Mitzi M Gonzales
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Zachary J Resch
- University of Illinois College of Medicine, Chicago, IL, USA
| | - A Campbell Sullivan
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jason R Soble
- University of Illinois College of Medicine, Chicago, IL, USA
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Hermes-Pereira A, Ferreira P, Santos MCFBD, Fagundes PA, Gonçalves APB, Rados DV, Castilhos RM, Schilling LP, Chaves MLF, Umpierre R, Kochhann R, Schumacher-Schuh AF. Protocol for a randomized clinical trial: telephone-based psychoeducation and support for female informal caregivers of patients with dementia. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: The burden felt by informal caregivers of patients with dementia is a source of physical, emotional, and financial problems. Face-to-face interventions for caregivers have accessibility limitations that may prevent them from receiving adequate care. Telehealth tools can be a solution to this problem. We will compare a telephone psychoeducational and support intervention protocol to usual care for informal female caregivers of patients with dementia treated at specialized outpatient clinics. METHODS: In this single-blind randomized clinical trial, the intervention group will receive one weekly call for 8 weeks that addresses issues such as disease education, communication with the patient, and problematic behaviors. The control group will receive printed material on problematic behaviors in dementia. The primary outcome will be the difference in caregiver burden between baseline and 8 weeks, which will be assessed by blinded investigators through the Zarit Burden Interview scale. Caregiver burden at 16 weeks after baseline, depression, anxiety, and quality of life at 8 and 16 weeks are secondary outcomes. CONCLUSIONS: We expect the intervention to reduce caregiver burden. These results could lead to public health programs for improving dementia care in lower-middle-income countries. Ethics and dissemination: This trial was approved by an independent ethics committee. The results will be published in an international peer-reviewed medical journal. Trial registration number: NCT03260608.
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Trindade PGE, Santos RL, Johannessen A, Neto JPS, Dourado MCN. Awareness of Functional Status: People with Alzheimer's Disease Abilities to Self-Report Impairment in Activities of Daily Living. J Alzheimers Dis Rep 2020; 4:405-415. [PMID: 33283162 PMCID: PMC7683098 DOI: 10.3233/adr-200227] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Awareness of functional status may underlie specific profiles and differences related to stage severity in individuals with Alzheimer's disease (AD). OBJECTIVE This study aimed to assess self-reported experiences of awareness of functional activity in people with mild and moderate AD. METHODS This is a mixed methods approach. The qualitative part was conducted through semi-structured interviews concerning the experiences and awareness of deficits in 38 older adults with mild or moderate AD. The quantitative approach included a comparison between groups with regard to concerns of awareness and clinic and demographic data. RESULTS Impairment on awareness of disease and awareness of functional deficits was observed even in the mild stages of AD. There was also a noticeable progression of impairments of both kinds of awareness from mild to moderate stage of disease. The majority of participants with mild and moderate AD were partially aware of their functional deficits. Both groups of participants reported some negative impact; however, they were not able to entirely describe their functional status. Also, deficits to recognize the need for help with hygiene and general tasks were observed. Significant differences were found in awareness of need for help with general tasks and awareness of need for help with hygiene tasks. CONCLUSION People with mild and moderate AD may describe their aware of the disease better than specific functional deficits, and most of them can provide some reports concerning to the impact of the disease.
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Affiliation(s)
| | - Raquel Luiza Santos
- Center for Alzheimer’s Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Brazil
| | - Aud Johannessen
- Norwegian Advisory Unit for Aging and Health Vestfold Health Trust, Tønsberg, Norway
- University College of Southeast Norway
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Ferreira CD, Gadelha MJN, Fonsêca ÉKGD, Silva JSCD, Torro N, Fernández-Calvo B. Long-term memory of haptic and visual information in older adults. AGING NEUROPSYCHOLOGY AND COGNITION 2020; 28:65-77. [PMID: 31891286 DOI: 10.1080/13825585.2019.1710450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The present study examined haptic and visual memory capacity for familiar objects through the application of an intentional free-recall task with three-time intervals in a sample of 78 healthy older adults without cognitive impairment. A wooden box and a turntable were used for the presentation of haptic and visual stimuli, respectively. The procedure consisted of two phases, a study phase that consisted of the presentation of stimuli, and a test phase (free-recall task) performed after one hour, one day or one week. The analysis of covariance (ANCOVA) indicated that there was a main effect only for the time intervals (F (2,71) = 12.511, p = .001, η2 = 0.261), with a lower recall index for the interval of one week compared to the other intervals. We concluded that the memory capacity between the systems (haptic and visual) is similar for long retrieval intervals (hours to days).
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Affiliation(s)
- Cyntia Diógenes Ferreira
- Laboratory of Cognitive Science and Perception, Department of Psychology, Federal University of Paraiba , João Pessoa, Brazil
| | | | | | | | - Nelson Torro
- Laboratory of Cognitive Science and Perception, Department of Psychology, Federal University of Paraiba , João Pessoa, Brazil
| | - Bernardino Fernández-Calvo
- Laboratory of aging and neuropsychological disorder, Department of Psychology, Federal University of Paraiba , João Pessoa, Brazil
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Contador I, Fernández-Calvo B, Rueda-Revé L, Olazarán J, Bermejo-Pareja F. Characterizing functional alterations in instrumental activities of daily living using latent class analysis: a population-based study (NEDICES). Aging Ment Health 2020; 24:41-48. [PMID: 30450947 DOI: 10.1080/13607863.2018.1512082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background and Objectives: The existence of different patterns of functional impairment in older adults has scarcely been addressed. This research investigates major patterns of functional impairment based on Pfeffer's Functional Activity Questionnaire (FAQ).Research Design and Methods: The participants come from NEDICES (Neurological Disorders in Central Spain), a prospective population-based cohort study. A total of 3837 individuals without dementia who completed the Spanish version of the FAQ was selected. Latent Class Analysis (LCA) was carried out to examine potential cluster subgroups based on FAQ responses.Results: The FAQ showed good internal consistency (Cronbach's alpha: 0.86) and moderate correlation (r = -.40) with cognitive performance on the Mini-Mental State Examination (MMSE-37). The response patterns revealed the presence of three latent classes: absence of functional alteration (Class 1), established functional alteration (Class 2), and minimal functional alteration (Class 3). Moreover, the probability of resolving Items 2 ('shopping alone for…'), 3 ('heating water…'), 4 ('preparing a balanced meal'), and 9 ('travelling out of neighbourhood…') was close to 0% for Class 2 membership, while those with the lowest probability of resolution for Class 3 were Items 2 and 9. Items 3 and 4 were the best to discriminate between different grades of functional alterations (Class 2 vs. Class 3).Discussion and Implications: Our findings indicate that the combination of overall FAQ score and item response pattern may help to classify individuals with different subtypes of functional impairment. The Spanish version of the FAQ is a useful tool for detection of functional impairment in older adults.
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Affiliation(s)
- Israel Contador
- Faculty of Psychology,Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, Spain
| | | | - Laura Rueda-Revé
- Faculty of Psychology,Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, Spain
| | - Javier Olazarán
- Department of Neurology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Félix Bermejo-Pareja
- Research Institute of Hospital '12 de Octubre' (i + 12), Madrid, Spain.,The Biomedical Research Centre Network for Neurodegenerative Diseases (CIBERNED), Carlos III Research Institute, Madrid, Spain.,Faculty of Medicine, Complutense University, Madrid, Spain
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Silva JSCD, Barbosa FF, Fonsêca ÉKGD, Albuquerque FDS, Cheke LG, Fernández-Calvo B. Load effect on what-where-when memory in younger and older adults. AGING NEUROPSYCHOLOGY AND COGNITION 2019; 27:841-853. [PMID: 31809651 DOI: 10.1080/13825585.2019.1700207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Episodic memory (EM) is a subsystem responsible for storing and evoking information about the "What", "Where" and "When" elements of an event in an integrated way. This capacity depends of structures with hippocampus and prefrontal cortex. The effect of aging on some capacities mediated by these areas, such as the influence of the number of objects on the coding of EM, remains unexplored. The present study examined the memory recall capacity of young and older adults in an EM task which used the number of 2, 4 and 6 items associated with specific space-temporal contexts. The young adults showed better performance coefficients than the older adults in all tasks, regardless of the load used, for all questions, except the "What" type. The group differences increase with load augmentation, stabilizing from the tasks with 4 items. In short, the EM efficiency, evaluated through What-Where-When Task, depends on the quantity information encoding.
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Affiliation(s)
| | - Flávio Freitas Barbosa
- Laboratory of memory and cognition studies, Department of Psychology, Federal University of Paraiba , João Pessoa, Brazil
| | | | - Fabíola Da Silva Albuquerque
- Laboratory of memory and cognition studies, Department of Physiology and Pathology, Federal University of Paraiba , João Pessoa, Brazil
| | - Lucy G Cheke
- Cognition and Motivated Behaviour Lab, Department of Psychology, University of Cambrigde , Cambrigde, UK
| | - Bernardino Fernández-Calvo
- Laboratory of aging and neuropsychological disorder, Department of Psychology, Federal University of Paraiba , João Pessoa, Brazil
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Ansai JH, Andrade LPD, Masse FAA, Gonçalves J, Takahashi ACDM, Vale FAC, Rebelatto JR. Risk Factors for Falls in Older Adults With Mild Cognitive Impairment and Mild Alzheimer Disease. J Geriatr Phys Ther 2019; 42:E116-E121. [DOI: 10.1519/jpt.0000000000000135] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jomar RT, Lourenço RA, Lopes CDS. [Dimensional structure of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR)]. CAD SAUDE PUBLICA 2018; 34:e00209917. [PMID: 30427420 DOI: 10.1590/0102-311x00209917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/18/2018] [Indexed: 11/21/2022] Open
Abstract
This study aimed to assess the dimensional structure and internal consistency of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR) for measurement of functional capacity in the elderly, based on the informant's report. This was a cross-sectional study with 525 non-institutionalized elderly informants, in which confirmatory factor analyses (CFA) and exploratory/confirmatory factor analyses (E/CFA) modeled according to CFA principles were used to identify the most parsimonious model and that with the best fit. The internal consistency of the FAQ-BR was assessed by composite reliability, and correlations between its dimensions were examined to investigate discriminant factor validity. CFA did not corroborate the unidimensional structure as originally proposed. Next, E/CFA fit a bidimensional structure that was reassessed by CFA, displaying a model without cross loads as the most parsimonious and with adequate fit indices. The internal consistency of FAQ-BR was considered satisfactory, and the correlation between its dimensions was acceptable. These findings are important, since they demonstrate the scale's capacity to capture the elderly's functional capacity construct in a different sociocultural context from that in which it was originally developed. The FAQ-BR can thus be considered an appropriate bidimensional instrument for measuring the elderly's functional capacity based on the informant's report, and its use in studies with similar populations is recommended.
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Gonçalves J, Ansai JH, Masse FAA, Vale FAC, Takahashi ACDM, Andrade LPD. Dual-task as a predictor of falls in older people with mild cognitive impairment and mild Alzheimer's disease: a prospective cohort study. Braz J Phys Ther 2018; 22:417-423. [PMID: 29636306 PMCID: PMC6158075 DOI: 10.1016/j.bjpt.2018.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/07/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND A dual-task tool with a challenging and daily secondary task, which involves executive functions, could facilitate the screening for risk of falls in older people with mild cognitive impairment or mild Alzheimer's disease. OBJECTIVE To verify if a motor-cognitive dual-task test could predict falls in older people with mild cognitive impairment or mild Alzheimer's disease, and to establish cutoff scores for the tool for both groups. METHODS A prospective study was conducted with community-dwelling older adults, including 40 with mild cognitive impairment and 38 with mild Alzheimer's disease. The dual-task test consisted of the Timed up and Go Test associated with a motor-cognitive task using a phone to call. Falls were recorded during six months by calendar and monthly telephone calls and the participants were categorized as fallers or non-fallers. RESULTS In the Mild cognitive impairment Group, fallers presented higher values in time (35.2s), number of steps (33.7 steps) and motor task cost (116%) on dual-task compared to non-fallers. Time, number of steps and motor task cost were significantly associated with falls in people with mild cognitive impairment. Multivariate analysis identified higher number of steps spent on the test to be independently associated with falls. A time greater than 23.88s (sensitivity=80%; specificity=61%) and a number of steps over 29.50 (sensitivity=65%; specificity=83%) indicated prediction of risk of falls in the Mild cognitive impairment Group. Among people with Alzheimer's disease, no differences in dual-task between fallers and non-fallers were found and no variable of the tool was able to predict falls. CONCLUSION The dual-task predicts falls only in older people with mild cognitive impairment.
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Affiliation(s)
- Jessica Gonçalves
- Departamento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Juliana Hotta Ansai
- Curso de Fisioterapia, Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.
| | | | | | | | - Larissa Pires de Andrade
- Departamento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
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Akosile CO, Mgbeojedo UG, Maruf FA, Okoye EC, Umeonwuka IC, Ogunniyi A. Depression, functional disability and quality of life among Nigerian older adults: Prevalences and relationships. Arch Gerontol Geriatr 2017; 74:39-43. [PMID: 28954240 DOI: 10.1016/j.archger.2017.08.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/22/2017] [Accepted: 08/26/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ageing is associated with increased morbidity, depression and decline in function. These may consequently impair the quality of life (QoL) of older adults. PURPOSE This study was used to investigate the prevalence of functional disability, depression, and level of quality of life of older adults residing in Uyo metropolis and its environs, Nigeria. METHOD This cross sectional survey involved 206 (116 females and 90 males) older adults with mean age of 69.8±6.7. The World Health Organization Quality of Life-OLD, Functional status Questionnaire (FSQ) and Geriatric Depression Scale (GDS) were used to measure quality of life, functional disability and depression respectively. Data was analysed using frequency counts and percentages and Spearman rank-order correlation coefficient, at 0.05 alpha level. RESULTS 45.5% of participants had depression, and at least 30% had functional disability in at least one domain, but their quality of life was fairly good (>60.0%) across all domains. Significant correlation existed between depression scores and individual quality of life and functional disability domains and between overall QoL and each functional disability domain (p<0.001). CONCLUSIONS Depression and functional disability were quite prevalent among sampled older adults but their QOL was not too severely affected. Since the constructs were interrelated, it seems interventions targeted at depression and functional status may invariably enhance the quality of life of the older adults.
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Affiliation(s)
- Christopher Olusanjo Akosile
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria; Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria.
| | - Ukamaka Gloria Mgbeojedo
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Fatai Adesina Maruf
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Emmanuel Chiebuka Okoye
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Ifeanyi Chuka Umeonwuka
- Department of Medical Rehabilitation, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria
| | - Adesola Ogunniyi
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
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Cognitive performance of community-dwelling oldest-old individuals with major depression: the Pietà study. Int Psychogeriatr 2017; 29:1507-1513. [PMID: 28566108 DOI: 10.1017/s1041610217000850] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individuals with late-life depression (LLD) may present cognitive symptoms. We sought to determine whether a brief cognitive battery (BCB) could identify cognitive and functional deficits in oldest-old individuals with LLD and a low level of education. METHODS We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil. We used the MINI and GDS-15 to diagnose major depression and evaluate its severity, respectively. The cognitive evaluation comprised the Mini-Mental State Examination (MMSE), BCB, clock-drawing test, category fluency test (animals) and Pfeffer's Functional Activities Questionnaire (FAQ). RESULTS Fifty-four (11.6%) of the included individuals were diagnosed with LLD; on average, these participants were aged 81.0 ± 4.8 years and had 3.9 ± 3.4 years of schooling, and 77.8% of the subjects with LLD were female. Depressed individuals scored lower than subjects without dementia/depression on the MMSE overall (p < 0.001) and on several of the MMSE subscales, namely, time (p < 0.001) and spatial orientation (p = 0.021), attention/calculation (p = 0.019), and language (p = 0.004). Individuals with LLD performed worse on the incidental and (p = 0.011) immediate memory (p = 0.046) and learning tasks (p = 0.039) of the BCB. Individuals with LLD also performed worse on the category fluency test (p = 0.006), clock-drawing test (p = 0.011) and FAQ (p < 0.001). Depression severity was negatively correlated with incidental memory (ρ = -0.412; p = 0.003) and positively correlated with FAQ score (ρ = 0.308; p = 0.035). In the multiple regression analysis, only temporal orientation and FAQ score remained independently associated with LLD. CONCLUSION Individuals with depression and a low level of education presented several cognitive and functional deficits. Depression severity was negatively correlated with incidental memory and functionality. Our findings serve as a description of the presence of cognitive dysfunction in individuals with LLD and suggest that these deficits may be identified based on the results of a BCB.
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Dos Santos GD, Forlenza OV, Ladeira RB, Aprahamian I, Almeida JG, Lafer B, Nunes PV. Caregiver burden in older adults with bipolar disorder: relationship to functionality and neuropsychiatric symptoms. Psychogeriatrics 2017; 17:317-323. [PMID: 28130857 DOI: 10.1111/psyg.12241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/04/2016] [Accepted: 11/21/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND There are few studies addressing caregivers of bipolar disorder (BD) patients, especially patients who are older adults with an increased need for care, often given by a relative. The aim of this study was to describe which factors increase caregiver burden among caregivers of elderly BD outpatients. METHODS Patients were older than 60 years and met the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, criteria for BD. They were evaluated for current mood, cognitive and other neuropsychiatric symptoms, functionality, medical comorbidities, quality of life, years since BD diagnosis, and number of psychiatric admissions. The caregiver who spent the greatest time with each patient was evaluated with the Zarit Caregiver Burden Interview. The caregivers' global health, mood symptoms, quality of life, and tasks performed for the patient were also assessed. RESULTS Thirty-six BD patients and their caregivers were assessed. The Zarit Caregiver Burden Interview was positively correlated with patients' neuropsychiatric symptoms (r = 0.508, P = 0.002) and functional impairment (r = 0.466, P = 0.004). The Zarit Caregiver Burden Interview was also correlated with caregivers' own depression (r = 0.576, P < 0.001), anxiety (r = 0.360, P = 0.031), quality of life (r = -0.406, P = 0.014), medical comorbidities (r = 0.387, P = 0.020), and number of tasks that they completed for the patient (r = 0.480, P = 0.003). CONCLUSIONS In this group of elderly BD patients, caregiver burden was more associated with symptoms frequently seen in others diseases as in dementia than with depressive, manic, or anxiety symptoms, which are often used as treatment outcomes measures goals in BD. Potential treatable and modifiable factors associated with caregiver burden could be caregivers' depression, anxiety, and medical comorbidities, as well as support for caregivers in terms of services and social relationships.
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Affiliation(s)
- Glenda D Dos Santos
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Orestes V Forlenza
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Rodolfo B Ladeira
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Ivan Aprahamian
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Jouce G Almeida
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Beny Lafer
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Paula V Nunes
- Faculty of Medicine, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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17
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de Paula JJ, Oliveira TD, Querino EHG, Malloy-Diniz LF. The Five Digits Test in the assessment of older adults with low formal education: construct validity and reliability in a Brazilian clinical sample. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2017; 39:173-179. [DOI: 10.1590/2237-6089-2016-0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 04/16/2017] [Indexed: 11/22/2022]
Abstract
Abstract Introduction In the assessment of older adults with very low formal education, typical tests of selective attention and inhibitory control are biased by reading abilities. In this sense, we aim to assess the psychometric characteristics of the Five Digits Test (FDT), a numerical Stroop paradigm, in older adults without cognitive disorders, with mild cognitive impairment, and with dementia. Methods We assessed 211 Brazilian older adults with low formal education using the FDT and other cognitive measures. Construct validity and reliability were assessed by correlations and internal consistency. Results The FDT test had weak correlations with crystalized intelligence tests and moderate-high correlations with fluid intelligence measures and tests of global cognitive status and executive functions. The split-half coefficient of reliability showed high internal consistency (>0.900). Conclusion Together, the results suggest that the FDT is a valid and reliable measure for the assessment of processing speed and executive functions in older adults with low formal education.
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Affiliation(s)
- Jonas Jardim de Paula
- Faculdade de Ciências Médicas de Minas Gerais, Brazil; Universidade Federal de Minas Gerais, Brazil
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18
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Karzmark P, Deutsch GK. Accuracy statistics in predicting Independent Activities of Daily Living (IADL) capacity with comprehensive and brief neuropsychological test batteries. APPLIED NEUROPSYCHOLOGY. ADULT 2017. [PMID: 28631986 DOI: 10.1080/23279095.2017.1286347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This investigation was designed to determine the predictive accuracy of a comprehensive neuropsychological and brief neuropsychological test battery with regard to the capacity to perform instrumental activities of daily living (IADLs). Accuracy statistics that included measures of sensitivity, specificity, positive and negative predicted power and positive likelihood ratio were calculated for both types of batteries. The sample was drawn from a general neurological group of adults (n = 117) that included a number of older participants (age >55; n = 38). Standardized neuropsychological assessments were administered to all participants and were comprised of the Halstead Reitan Battery and portions of the Wechsler Adult Intelligence Scale-III. A comprehensive test battery yielded a moderate increase over base-rate in predictive accuracy that generalized to older individuals. There was only limited support for using a brief battery, for although sensitivity was high, specificity was low. We found that a comprehensive neuropsychological test battery provided good classification accuracy for predicting IADL capacity.
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Affiliation(s)
- Peter Karzmark
- a Department of Neurology and Neurological Sciences, Stanford Health Care , Palo Alto , California , USA
| | - Gayle K Deutsch
- a Department of Neurology and Neurological Sciences, Stanford Health Care , Palo Alto , California , USA
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19
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de Paula JJ, Malloy-Diniz LF, Romano-Silva MA. Reliability of working memory assessment in neurocognitive disorders: a study of the Digit Span and Corsi Block-Tapping tasks. BRAZILIAN JOURNAL OF PSYCHIATRY 2017; 38:262-3. [PMID: 27579598 PMCID: PMC7194262 DOI: 10.1590/1516-4446-2015-1879] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/13/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Jonas J de Paula
- Instituto Nacional de Ciência e Tecnologia em Medicina Molecular (INCT-MM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Departamento de Psicologia, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Leandro F Malloy-Diniz
- Instituto Nacional de Ciência e Tecnologia em Medicina Molecular (INCT-MM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Departamento de Saúde Mental, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
| | - Marco A Romano-Silva
- Instituto Nacional de Ciência e Tecnologia em Medicina Molecular (INCT-MM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Departamento de Saúde Mental, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
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20
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Ansai JH, Andrade LP, Rossi PG, Takahashi ACM, Vale FAC, Rebelatto JR. Gait, dual task and history of falls in elderly with preserved cognition, mild cognitive impairment, and mild Alzheimer's disease. Braz J Phys Ther 2017; 21:144-151. [PMID: 28460713 PMCID: PMC5537456 DOI: 10.1016/j.bjpt.2017.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 11/25/2022] Open
Abstract
Dual tasks can be applicable to assess elderly with mild Alzheimer's disease. Patients with preserved cognition and mild cognitive impairment presented with similar mobility. Specific local and consequences of falls were identified for each cognitive group.
Background Studies with functional and applicable methods and new cognitive demands involving executive function are needed to improve screening, prevention and rehabilitation of cognitive impairment and falls. Objective to identify differences in gait, dual task performances, and history of falls between elderly people with preserved cognition, mild cognitive impairment and mild Alzheimer's disease. Method A cross-sectional study was conducted. The sample consisted of 40 community-dwelling older adults with preserved cognition, 40 older adults with mild cognitive impairment, and 38 older adults with mild Alzheimer's disease. The assessment consisted of anamneses, gait (measured by the 10-meter walk test), dual task (measured by the Timed Up and Go Test associated with the motor-cognitive task of calling a phone number), and history of falls in the past year. Results There were no differences among all groups for all variables. However, the Alzheimer's disease Group performed significantly worse in the dual task than the other groups. No item of dual task could distinguish people with preserved cognition from those with mild cognitive impairment. The groups with cognitive impairment included more fallers, and specific characteristics in history of falls between groups were identified. Conclusion Dual task could distinguish Alzheimer's disease patients specifically from other cognitive profiles.
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Affiliation(s)
- Juliana H Ansai
- Departamento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Larissa P Andrade
- Departamento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Paulo G Rossi
- Departamento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Anielle C M Takahashi
- Departamento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Francisco A C Vale
- Departmento de Medicina, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - José R Rebelatto
- Departamento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
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21
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Menéndez-González M, Álvarez-Avellón T. Editorial: Neuropsychology and Neuropsychiatry of Neurodegenerative Disorders. Front Aging Neurosci 2015; 7:227. [PMID: 26733862 PMCID: PMC4679848 DOI: 10.3389/fnagi.2015.00227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/23/2015] [Indexed: 12/13/2022] Open
Affiliation(s)
- Manuel Menéndez-González
- Unidad de Neurología, Hospital Álvarez-BuyllaMieres, Spain; Departamento de Morfología y Biología Celular, Universidad de OviedoOviedo, Spain; Instituto de Neurociencias del Principado de Asturias, Universidad de OviedoOviedo, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de ChileTalca, Chile
| | - Tania Álvarez-Avellón
- Departamento de Psicología, Universidad de OviedoOviedo, Spain; Neuropsicología, VitalAsturGijón, Spain
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22
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de Paula JJ, Diniz BS, Bicalho MA, Albuquerque MR, Nicolato R, de Moraes EN, Romano-Silva MA, Malloy-Diniz LF. Specific cognitive functions and depressive symptoms as predictors of activities of daily living in older adults with heterogeneous cognitive backgrounds. Front Aging Neurosci 2015; 7:139. [PMID: 26257644 PMCID: PMC4507055 DOI: 10.3389/fnagi.2015.00139] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 07/06/2015] [Indexed: 12/28/2022] Open
Abstract
Cognitive functioning influences activities of daily living (ADL). However, studies reporting the association between ADL and neuropsychological performance show inconsistent results regarding what specific cognitive domains are related to each specific functional domains. Additionally, whether depressive symptoms are associated with a worse functional performance in older adults is still under explored. We investigated if specific cognitive domains and depressive symptoms would affect different aspects of ADL. Participants were 274 older adults (96 normal aging participants, 85 patients with mild cognitive impairment, and 93 patients probable with mild Alzheimer's disease dementia) with low formal education (∼4 years). Measures of ADL included three complexity levels: Self-care, Instrumental-Domestic, and Instrumental-Complex. The specific cognitive functions were evaluated through a factorial strategy resulting in four cognitive domains: Executive Functions, Language/Semantic Memory, Episodic Memory, and Visuospatial Abilities. The Geriatric Depression Scale measured depressive symptoms. Multiple linear regression analysis showed executive functions and episodic memory as significant predictors of Instrumental-Domestic ADL, and executive functions, episodic memory and language/semantic memory as predictors of Instrumental-Complex ADL (22 and 28% of explained variance, respectively). Ordinal regression analysis showed the influence of specific cognitive functions and depressive symptoms on each one of the instrumental ADL. We observed a heterogeneous pattern of association with explained variance ranging from 22 to 38%. Different instrumental ADL had specific cognitive predictors and depressive symptoms were predictive of ADL involving social contact. Our results suggest a specific pattern of influence depending on the specific instrumental daily living activity.
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Affiliation(s)
- Jonas J de Paula
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Psychology, Faculdade de Ciências Médicas de Minas Gerais Belo Horizonte, Brazil
| | - Breno S Diniz
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Maria A Bicalho
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Maicon Rodrigues Albuquerque
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Physical Education, Universidade Federal de Viçosa Viçosa, Brazil
| | - Rodrigo Nicolato
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Edgar N de Moraes
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Marco A Romano-Silva
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Leandro F Malloy-Diniz
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
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