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Karlawish J, Peterson A, Kleid M, Harkins K, Largent EA, Stites SD, Coykendall C, Clapp JT. Caregiver Accounts of Lucid Episodes in Persons With Advanced Dementia. Gerontologist 2024; 64:gnad170. [PMID: 38134428 DOI: 10.1093/geront/gnad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Paradoxical lucidity is defined as an instance of unexpected lucid behavior in a person who is assumed to be noncommunicative due to a progressive and pathophysiologic dementing process. To inform studies of the prevalence, characteristics, and impact of these behaviors, this interview study examined caregivers' experiences of witnessing paradoxical lucidity. RESEARCH DESIGN AND METHODS Participants were family caregivers of persons living with advanced dementia caused by a neurodegenerative disease producing significant impairments in communication. Semistructured interviews elicited the caregivers' experiences of plausible lucid episodes. Data analysis used a thematic analysis approach. RESULTS Most caregivers reported at least 1 episode of lucidity. Episodes were typically brief. Most involved utterances, but nonverbal behaviors were also common. The mental capacities associated with these behaviors included recognition, awareness of surroundings, recognizing others' emotions, and goal-directed behavior. Most caregivers' reactions were positive. Episodes did not lead to changes in major medical decisions but instead to efforts to either modify or reinforce daily caregiving efforts. DISCUSSION AND IMPLICATIONS Episodes of lucidity were common, a finding seen in other studies. If prevalence studies confirm this, the qualifier "paradoxical" should be eliminated. The caregivers' familiarity with the person living with dementia allowed them to attribute meaning to subtle behaviors that might not otherwise be detected or considered lucid. Clinicians who care for persons with advanced-stage dementia should routinely ask caregivers about episodes of lucid communication and their emotional reactions.
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Affiliation(s)
- Jason Karlawish
- Division of Geriatrics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Peterson
- Department of Philosophy, Institute for Philosophy and Public Policy, George Mason University, Fairfax, Virginia, USA
| | - Melanie Kleid
- Division of Geriatrics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristin Harkins
- Division of Geriatrics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shana D Stites
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cameron Coykendall
- Division of Geriatrics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin T Clapp
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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O'Brien K, Coykendall C, Kleid M, Harkins K, Chin N, Clapp JT, Karlawish J. Determinants of Plasma Alzheimer's Disease Biomarker Use by Primary Care Providers and Dementia Specialists. J Gen Intern Med 2024:10.1007/s11606-023-08583-9. [PMID: 38169023 DOI: 10.1007/s11606-023-08583-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The efficiencies of plasma Alzheimer's disease (AD) biomarkers could facilitate early AD diagnosis. Unfortunately, limited knowledge exists about whether and how they would be used by clinicians. OBJECTIVE To identify and compare determinants of plasma AD biomarker use reported by primary care providers and dementia specialists. DESIGN Semi-structured interviews with clinicians organized using Rogers' Diffusion of Innovations theory and analyzed using an iterative coding approach. PARTICIPANTS The subjects were internal and family medicine, neurology, and geriatrics providers with varying degrees of expertise in dementia diagnosis and care. MAIN MEASURES Factors influencing a clinician's decision to use or not use plasma AD biomarkers in clinical practice. KEY RESULTS We interviewed 30 clinicians (16 family or internal medicine providers, 8 geriatricians, and 6 neurologists). Fifteen were dementia specialists. Hesitance to use plasma AD biomarkers was due to perceived lack of effective treatments for AD, limited access to supports, and stigma. Plasma AD biomarkers would be more readily adopted by clinicians with dementia expertise. CONCLUSIONS Several factors will influence clinical use of plasma AD biomarkers. Some of them may inform the design of interventions to promote the effective and appropriate clinical translation of these tests.
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Affiliation(s)
- Kyra O'Brien
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. kyra.o'
| | - Cameron Coykendall
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Melanie Kleid
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kristin Harkins
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nathaniel Chin
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Justin T Clapp
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jason Karlawish
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Largent EA, Peterson A, Harkins K, Coykendall C, Kleid M, Abera M, Stites SD, Karlawish J, Clapp JT. "A Raw Blessing" - Caregivers' Experiences Providing Care to Persons Living with Dementia in the COVID-19 Pandemic. J Law Med Ethics 2023; 51:626-640. [PMID: 38088630 PMCID: PMC10827343 DOI: 10.1017/jme.2023.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
The COVID-19 pandemic has been devastating for people living with dementia (PLWD) and their caregivers. While prior research has documented these effects, it has not delved into their specific causes or how they are modified by contextual variation in caregiving circumstances.
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Stites SD, Gurian A, Coykendall C, Largent EA, Harkins K, Karlawish J, Coe NB. Gender of Study Partners and Research Participants Associated With Differences in Study Partner Ratings of Cognition and Activity Level. J Gerontol B Psychol Sci Soc Sci 2023; 78:1318-1329. [PMID: 36790294 PMCID: PMC10394983 DOI: 10.1093/geronb/gbad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES Studies of Alzheimer's disease typically include "study partners" (SPs) who report on participants' cognition and function. Prior studies show SP reports differ depending on the relationship between the SP and participant, that is, spouse or adult child. Adult children SPs are typically female. Could differing reports be due to gender? Knowing this may help explain variability in measurement. METHODS The Aging, Demographics, and Memory Study enrolled a subset of participants from the Health and Retirement Study. Each participant had an SP. Bivariate and multivariable regression models compared 718 SP-participant dyads. RESULTS In analyses of 4 groups defined by SP and participant gender, dyads composed of 2 women were less likely to identify as White (75.8%, 95% confidence interval [CI], 70.4-80.5) than dyads composed of 2 men (93.3%, 95% CI, 81.2-97.8). In analyses adjusted for the severity of cognitive and functional impairment, women SPs rated women participants as more active than they rated men, mean 2.15 (95% CI, 2.07-2.22) versus mean 2.30 (95% CI, 2.24-2.37), respectively, on a 4-point scale. Similarly, men SPs rated women participants as more active than they rated men, mean 2.1 (95% CI, 2.0-2.2) and mean 2.4 (95% CI, 2.3-2.5), respectively. In an analysis of cognitively unimpaired participants, women SPs rated participants' memory worse than men SPs did (p < .05). DISCUSSION SP and participant gender influence SPs' reports of another person's cognition and activity level. Our findings expand what is understood about how nondisease factors influence measures of disease severity.
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Affiliation(s)
- Shana D Stites
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna Gurian
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cameron Coykendall
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily A Largent
- Division of Geriatric Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristin Harkins
- Division of Geriatric Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason Karlawish
- Penn Memory Center, Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Norma B Coe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wojdak C, Silvey P, Coykendall C, Lin YS, Bansal A, Shannon K, Wagner H, McIntosh S, Block RC. Indicators of Self-Determination in Therapeutic Songwriting Lyrics Created by Adults with High LDL Cholesterol. J Music Ther 2023:7080467. [PMID: 36932986 DOI: 10.1093/jmt/thad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Individuals with low-density lipoprotein cholesterol ≥190 mg/dL are at high risk for atherosclerotic cardiovascular disease events. Our goal was to determine if adults with this condition would express important psychological, health, and motivation themes when generating lyrics during music therapy. Thirty-one participants each created their own original song with the help of a music therapist. The lyrics were analyzed using a deductive approach guided by Self-Determination Theory (specifically the satisfaction or frustration of basic psychological needs): (1) for each entire song (macro-analysis) and (2) line-by-line (micro-analysis). Song lyrics generated during music therapy sessions by patients with a low-density lipoprotein cholesterol ≥190 mg/dL revealed the presence of the three basic needs (autonomy, competence, and relatedness) of Self-Determination Theory. The most prevalent theme identified in the macro-analysis of songs was autonomy satisfaction, coded in 25 songs (27.17% of all macro codes), and followed by competence satisfaction in 17 songs (18.48%) and relatedness satisfaction in 15 songs (16.3%). Line-by-line micro-analysis of lyrics revealed that at least one basic need of Self-Determination Theory was present in 277 of the unique lyric lines (50%); 107 (19%) for relatedness, 101 (18%) for autonomy, and 69 (13%) for competence. Need satisfaction occurred more frequently than need frustration in both analyses. However, depending on the level of analysis (macro or micro), results differed as to which themes were most prevalent. These results indicate that therapeutic songwriting may be a unique way to identify the basic psychological needs that, when satisfied, indicate self-determination.
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Affiliation(s)
| | - Philip Silvey
- Eastman School of Music, University of Rochester, Rochester, NY, USA
| | - Cameron Coykendall
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.,Department of Surgery, University of Rochester, Rochester, NY, USA
| | - Yifei S Lin
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.,College of Arts and Sciences Undergraduate Programs, University of Rochester, Rochester, NY, USA
| | - Amit Bansal
- Department of Medicine, Rochester Regional Health, Rochester, NY, USA
| | | | - Heather Wagner
- School of Fine and Performing Arts, State University of New York at New Paltz, New Paltz, NY, USA
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Robert C Block
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.,Cardiology Division, Department of Medicine, University of Rochester, Rochester, NY, USA
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Stites SD, Cao H, James R, Harkins K, Coykendall C, Flatt JD. A systematic review of measures of gender and biological sex: Exploring candidates for Alzheimer's disease and related dementias (AD/ADRD) research. Alzheimers Dement (Amst) 2023; 15:e12359. [PMID: 36845632 PMCID: PMC9943901 DOI: 10.1002/dad2.12359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/19/2022] [Accepted: 08/23/2022] [Indexed: 02/24/2023]
Abstract
Background Gender and biological sex are social and structural determinants of health and umbrella concepts encompassing many distinct attributes. This systematic review summarizes measures of gender and biological sex published in the biomedical literature. The goal was to identify measures that may be useful to researchers studying Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD). Methods A search of PubMed, Embase, and PsycINFO (ProQuest platform) databases from 2000 to 2021 identified 1454 articles, which were then screened by five independent reviewers. Measures of gender and biological sex are summarized according to theoretical commitments and psychometric properties. Results Twenty-nine measures were identified that assessed gender-related constructs, and 4 were identified that assessed biological factors. Self-report instruments characterized aspects of gender, such as gender stereotypes, norms, and ideologies. One measure was developed with a focus on older adults (65+ years). Discussion We offer recommendations to guide measurement of gender in AD/ADRD research, including how the use of specific existing measures may help advance AD/ADRD research. The lack of gender measures for older adults limits AD/ADRD research. New measures may be needed to address lifespan and generational differences in gender factors. Highlights A review of articles identifies 29 measures of gender in biomedical research.Gender is captured using multidimensional, self-reported concepts.One measure was developed with a focus on older adults (65+).
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Affiliation(s)
- Shana D. Stites
- Department of PsychiatryPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Hannah Cao
- School of Social Policy and PracticeUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Richard James
- University of Pennsylvania LibrariesPhiladelphiaPennsylvaniaUSA
| | - Kristin Harkins
- Division of Geriatric MedicineDepartment of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Cameron Coykendall
- Division of Geriatric MedicineDepartment of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jason D. Flatt
- Department of Social and Behavioral HealthSchool of Public HealthUniversity of NevadaLas VegasNevadaUSA
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Nathan J, McIntosh S, Niemiec C, Williams G, Coykendall C, Lin Y, Holub A, Thevenet-Morrison K, Block R. Effects of Music Therapy on Psychological Constructs and Atherogenic Lipoproteins in Patients with Severe Hypercholesterolemia. J Clin Lipidol 2021. [DOI: 10.1016/j.jacl.2021.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lin YS, Coykendall C, McIntosh S, Shannon K, Nathan J, Block R. Patient-Centered Themes in Adults with Very High Levels of LDL Cholesterol Expressed During Therapeutic Songwriting. J Clin Lipidol 2021. [DOI: 10.1016/j.jacl.2021.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wojdak C, Block R, Silvey P, Coykendall C, Lin Y, Bansal A, Niemiec C, Shannon K, Wagner H, McIntosh S. Patient-Centered Themes in Adults with Very High Levels of LDL Cholesterol during Therapeutic Songwriting. J Clin Lipidol 2021. [DOI: 10.1016/j.jacl.2021.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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