Beyond memory: neuropsychologic features in differential diagnosis of dementia

Analysis of the Clock-Reading Ability in Patients with Cognitive Impairment: Comparison of Analog Clocks and Digital Clocks

Background: Time disorientation is one of the main symptoms observed in patients with dementia; however, their clock-reading ability has not been fully reported. Objective: This study aimed to investigate the clock-reading ability of both digital and analog clocks in patients with dementia. We newly devised the clock-reading test (CRT) and the number-reading test (NRT) to assess cognitive factors that may affect clock-reading ability. Furthermore, the discriminating power of the CRT was calculated. Methods: 104 participants were categorized based on their Mini-Mental State Examination (MMSE) scores as follows: subjective cognitive decline ∼ mild cognitive impairment (SCD∼MCI, N = 43), early Alzheimer’s disease (AD) (N = 26), and middle-to-late AD (N = 35). Their cognitive abilities were evaluated using the clock-drawing test (CDT), CRT, and NRT. Results: Cognitive decline leads to impairment of clock-reading ability which is more pronounced in the analog clocks than digital ones. This deficit in clock-reading is attributed to a loss of semantic memory regarding clocks at all stages. Additionally, visuospatial dysfunction and reduced ability of number recognition may lead to deficit in clock-reading in the advanced stage of AD. The discriminating power of the CRT (analog) (AUC = 0.853) was high enough to detect cognitive decline. Conclusion: Digital clocks are more readable by patients with dementia. Since reading clocks is closely associated with daily life, the CRT has proved to be a useful tool. A decline of analog clock-reading may be an early detector for the onset of dementia in elderly patients.

Using cognitive-functional assessment to predict self-care performance of memory care tenants

A challenge in admitting individuals with Alzheimer's disease and related dementias into memory care residential facilities is determining the appropriate level of service based on abilities and care needs. At intake, the incoming tenant's functional performance capacity is obtained through family or proxy report corroborated with screening results of global cognitive function. Based on this information, the agency determines the level of service needs; if misjudged, inadequate placement can be stressful for the individual and family and costly for the facility. This study examined the predictive validity of a clinically administered assessment of cognitive-functional performance, Cognitive Performance Test (CPT), in gauging service needs in 4 activities of daily living (ADL; dressing, eating/feeding, showering, and toothbrushing) with 57 tenants residing in a memory care-assisted living facility. Linear regression results revealed a significant relationship between CPT scores and ADL performance in all areas (P < .001) with CPT scores accounting for 51% to 62% of the variability in performance.

Clinical features and multidisciplinary approaches to dementia care

Dementia is a clinical syndrome of widespread progressive deterioration of cognitive abilities and normal daily functioning. These cognitive and behavioral impairments pose considerable challenges to individuals with dementia, along with their family members and caregivers. Four primary dementia classifications have been defined according to clinical and research criteria: 1) Alzheimer's disease; 2) vascular dementias; 3) frontotemporal dementias; and 4) dementia with Lewy bodies/Parkinson's disease dementia. The cumulative efforts of multidisciplinary healthcare teams have advanced our understanding of dementia beyond basic descriptions, towards a more complete elucidation of risk factors, clinical symptoms, and neuropathological correlates. The characterization of disease subtypes has facilitated targeted management strategies, advanced treatments, and symptomatic care for individuals affected by dementia. This review briefly summarizes the current state of knowledge and directions of dementia research and clinical practice. We provide a description of the risk factors, clinical presentation, and differential diagnosis of dementia. A summary of multidisciplinary team approaches to dementia care is outlined, including management strategies for the treatment of cognitive impairments, functional deficits, and behavioral and psychological symptoms of dementia. The needs of individuals with dementia are extensive, often requiring care beyond traditional bounds of medical practice, including pharmacologic and non-pharmacologic management interventions. Finally, advanced research on the early prodromal phase of dementia is reviewed, with a focus on change-point models, trajectories of cognitive change, and threshold models of pathological burden. Future research goals are outlined, with a call to action for social policy initiatives that promote preventive lifestyle behaviors, and healthcare programs that will support the growing number of individuals affected by dementia.

Error specific restrictions for older drivers: promoting continued independence and public safety

OBJECTIVES

To describe a population of older drivers with driving restrictions, their most common restrictions, and to compare restricted drivers to their safe and unsafe counterparts. Safe drivers are those who do not commit hazardous errors or traffic violations. Unsafe drivers are those who commit hazardous errors and/or traffic violations that place them in hazardous situations. Restricted drivers are those who have committed traffic or rule violations only under certain driving conditions.

DESIGN

A retrospective, cross-sectional study with mixed methodology.

SETTING

A clinical driving evaluation program within an academic geriatrics department.

PARTICIPANTS

Drivers age 60+ (N=108) referred for clinical driving evaluation and who consented to allow their data to be used for research purposes.

INTERVENTION

Drivers performing at an intermediate level driving fitness were issued error specific driving restrictions.

MEASUREMENT

Driving evaluation included clock drawing test (CDT), mini-mental status exam (MMSE), Trailmaking, geriatric depression scale (GDS), and simulated driving.

RESULTS

The three most common restrictions were limited driving distance (N=8), limited driving time (N=8), and daytime only driving (N=8). Safe, restricted, and unsafe drivers significantly differed on MMSE (F[2,104]=10.75, p<0.001), Trailmaking Part B (F[2,76]=9.96, p<0.001), CDT (F[2,98]=29.88, p<0.001), and total number of hazardous errors (F[2,97]=39.06, p<0.001). Tukey's test indicated safe and restricted drivers scored significantly better than unsafe drivers on MMSE (safe: p<0.001; restricted: p=0.008), CDT (p<0.001), and hazardous errors (p<0.001). Restricted and unsafe drivers required significantly more time to complete Trailmaking B than safe drivers (p=0.004).

CONCLUSION

Preliminary data indicate restricted drivers perform more like safe than unsafe drivers. Driving simulation is instrumental in discerning error specific limitations and categorizing patients as conditionally safe. This clinical evaluation pilots an effective alternative to premature driving cessation.