Effects of working memory deficits on the communicative functioning of Alzheimer's dementia patients

Is Old Age Just a Number in Language Skills? Language Performance and Its Relation to Age, Education, Gender, Cognitive Screening, and Dentition in Very Old Finnish Speakers

PURPOSE

This study reports on how very old (VO) Finnish people without dementia perform in the Western Aphasia Battery (WAB) and two verbal fluency tasks and which demographic factors predict the performance.

METHOD

The study included fifty 80- to 100-year-old community-dwelling Finnish speakers with no dementing illnesses or speech-language disabilities, who completed the WAB and two verbal fluency tasks. Multifactorial statistical analyses with recursive partitioning were carried out to determine the significant predictors out of five predictor variables (age, gender, education, dentition, and Mini-Mental State Examination [MMSE]) for four response variables (WAB Aphasia Quotient [AQ], Language Quotient [LQ], semantic, and phonemic word fluencies).

RESULTS

Overall, individual variation was notable in VO speakers. All predictor variables were statistically significantly associated with one or more of the language skills. Age was the most significant predictor; the critical age of 85-86 years was associated with a decline in WAB-AQ and semantic fluency. Poor dentition and the MMSE score both predicted a decline in WAB-LQ and phonemic fluency. A high level of education was positively associated with the skills of the best-performing individuals in WAB-AQ, WAB-LQ, and semantic fluency.

CONCLUSIONS

VO age is a significant factor contributing to language performance. However, a younger age, a good cognitive performance, intact teeth, and a higher educational level also seem to have a preservative power as regards language skills. Gender differences should be interpreted with caution. The results of this study provide culture- and language-specific normative data, which aids in differentiating typical aging from the signs of acute or degenerative neuropathology to ensure appropriate medical and therapeutic interventions.

On the Working Memory of Humans and Great Apes: Strikingly Similar or Remarkably Different?

In this article we review publications relevant to addressing widely reported claims in both the academic and popular press that chimpanzees working memory (WM) is comparable to, if not exceeding, that of humans. WM is a complex multidimensional construct with strong parallels in humans to prefrontal cortex and cognitive development. These parallels occur in chimpanzees, but to a lesser degree. We review empirical evidence and conclude that the size of WM in chimpanzees is 2 ± 1 versus Miller's famous 7 ± 2 in humans. Comparable differences occur in experiments on chimpanzees relating to strategic and attentional WM subsystems. Regardless of the domain, chimpanzee WM performance is comparable to that of humans around the age of 4 or 5. Next, we review evidence showing parallels among the evolution of WM capacity in hominins ancestral to Homo sapiens, the phylogenetic evolution of hominins leading to Homo sapiens, and evolution in the complexity of stone tool technology over this time period.

Moving Toward Accurate Assessment of Working Memory in Adults With Neurogenically Based Communication Disorders

Purpose This article presents a viewpoint highlighting concerns regarding currently available assessments of working memory in adults with neurogenic communication disorders. Additionally, we provide recommendations for improving working memory assessment in this population. Method This viewpoint includes a critique of clinical and experimental working memory tests relevant to speech-language pathologists. We consider the terminology used to describe memory, as well as discuss language demands and test construction. Results Clinical and experimental testing of working memory in adults with neurogenic communication disorders is challenged due to theoretical, methodological, and practical limitations. The major limitations are characterized as linguistic and task demands, presentation and response modality effects, test administration, and scoring parameters. Taking these limitations into consideration, several modifications to working memory testing and their relevance to neurogenic populations are discussed. Conclusions The recommendations provided in this article can better guide clinicians and researchers to advocate for improved tests of working memory in adults with neurogenic communication disorders. Future research should continue to address these concerns and consider our recommendations.

Individuals With Mild Cognitive Impairment and Alzheimer's Disease Benefit From Audiovisual Speech Cues and Supportive Sentence Context

Purpose Speech perception in noise becomes difficult with age but can be facilitated by audiovisual (AV) speech cues and sentence context in healthy older adults. However, individuals with Alzheimer's disease (AD) may present with deficits in AV integration, potentially limiting the extent to which they can benefit from AV cues. This study investigated the benefit of these cues in individuals with mild cognitive impairment (MCI), individuals with AD, and healthy older adult controls. Method This study compared auditory-only and AV speech perception of sentences presented in noise. These sentences had one of two levels of context: high (e.g., "Stir your coffee with a spoon") and low (e.g., "Bob didn't think about the spoon"). Fourteen older controls (M _age = 72.71 years, SD = 9.39), 13 individuals with MCI (M _age = 79.92 years, SD = 5.52), and nine individuals with probable Alzheimer's-type dementia (M _age = 79.38 years, SD = 3.40) completed the speech perception task and were asked to repeat the terminal word of each sentence. Results All three groups benefited (i.e., identified more terminal words) from AV and sentence context. Individuals with MCI showed a smaller AV benefit compared to controls in low-context conditions, suggesting difficulties with AV integration. Individuals with AD showed a smaller benefit in high-context conditions compared to controls, indicating difficulties with AV integration and context use in AD. Conclusions Individuals with MCI and individuals with AD do benefit from AV speech and semantic context during speech perception in noise (albeit to a lower extent than healthy older adults). This suggests that engaging in face-to-face communication and providing ample context will likely foster more effective communication between patients and caregivers, professionals, and loved ones.

Rasch Analysis of the Assessment of Quality of Activities (A-QOA), an Observational Tool for Clients With Dementia

IMPORTANCE

The Assessment of Quality of Activities (A-QOA) is an observation-based tool for assessing the strength of engagement in an activity by the person performing it in a natural context. By quantifying the quality of engagement, the A-QOA can help occupational therapy practitioners be better able to select meaningful activities and more clearly understand the effectiveness of various choices.

OBJECTIVE

To examine use of the A-QOA as a valid unidimensional scale and to clarify preliminary results on its internal scale validity and item reliability using the Rasch model.

PARTICIPANTS

One hundred thirty-one participants with dementia performing 262 activities.

OUTCOMES AND MEASURES

We used the Rasch model to clarify the psychometric properties of A-QOA's measurement quality.

RESULTS

Rasch analysis revealed that 21 of the 25 items reached an acceptable level of fit, and 4 did not. After eliminating the 4 misfitting items, the resulting A-QOA was determined to have both acceptable internal scale validity and item separation reliability, which are fundamental psychometric properties of a clinical observational instrument.

CONCLUSIONS AND RELEVANCE

The A-QOA can be used to quantitatively assess the strength of engagement in an activity by the person performing it by using the observational method.

WHAT THIS ARTICLE ADDS

In clinical settings, the A-QOA can be used both to select activities for clients with dementia and to quantitatively show the effects of occupational therapy interventions.

An Interactional Profile to Assist the Differential Diagnosis of Neurodegenerative and Functional Memory Disorders

OBJECTIVE

Specialist services for dementia are seeing an increasing number of patients. We investigated whether interactional and linguistic features in the communication behavior of patients with memory problems could help distinguish between those with problems secondary to neurological disorders (ND) and those with functional memory disorder (FMD).

METHODS

In part 1 of this study, a diagnostic scoring aid (DSA) was developed encouraging linguists to provide quantitative ratings for 14 interactional features. An optimal cut-off differentiating ND and FMD was established by applying the DSA to 30 initial patient-doctor memory clinic encounters. In part 2, the DSA was tested prospectively in 10 additional cases analyzed independently by 2 conversation analysts blinded to medical information.

RESULTS

In part 1, the median score of the DSA was +5 in ND and -5 in FMD (P<0.001). The optimal numeric DSA cut-off (+1) identified patients with ND with a sensitivity of 86.7% and a specificity of 100%. In part 2, DSA scores of rater 1 correctly predicted 10/10 and those of rater 2 predicted 9/10 diagnoses.

CONCLUSIONS

This study indicates that interactional and linguistic features can help distinguish between patients developing dementia and those with FMD and could aid the stratification of patients with memory problems.

Improving Comprehension in Written Medical Informed Consent Procedures

Abstract. Older adults are frequently required to undergo medical informed consent procedures. This study investigates the influence of four types of written language and visual support (Elaborated Plain Language, Easy-to-Read Language, Standard Version with additional picture, Easy-to-Read-Language with additional picture) on comprehension and affect, compared with the Standard Version alone. In an online survey, n = 87 younger participants aged 26–59 and n = 72 older participants aged 60–81 read a simulation of an informed consent form. Directly after reading it, we used the Understanding dimension of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to ask them about the information presented in the form. The results showed that, by reducing complexity and elaborating the provided information, comprehension of medical information could be improved in the older participant group. In the so-called Elaborated Plain Language groups, the results were the same for younger and older participants. This was not true for the groups that received the Standard Version, on which younger participants performed better. Variations in the language used had no influence on affect. Our conclusion is that Elaborated Plain Language can be recommended for use in medical informed consent procedures with older patients and should be taught to medical professionals.

A Qualitative Study to Explore Ways to Observe Results of Engaging Activities in Clients with Dementia

BACKGROUND

Many occupational therapists face the challenge of helping clients with dementia to select and perform meaningful occupations, which may be difficult due to cognitive impairment. Understanding tacit knowledge of well-experienced occupational therapists could positively affect occupational therapy practice for clients with dementia.

OBJECTIVES OF STUDY

To explore the observations of experienced occupational therapists when evaluating the effects of activities in clients with dementia.

METHODS

Ten occupational therapists with over 10 years of clinical experience participated in this qualitative study. In-depth interviews were conducted to ask the question, "What do you observe in clients with dementia when you assess the effectiveness of activities among these clients?" Findings. From 47 cases, we found five major themes and 18 subthemes. Main themes were "engaging activity," "emotional expression during activity," "verbal expression during activity," "social interaction through activity," and "something obtained as outcome of activity." Relevance to Clinical Practice. The 18 subthemes could be used as viewpoints to observe engagements of activity in clients with dementia.

LIMITATIONS AND RECOMMENDATIONS FOR FURTHER RESEARCH

Future studies could examine which viewpoints were utilized for each type of activity and/or severity of dementia as this was not investigated in the current study.

The Quality of Pain Treatment in Community-Dwelling Persons with Dementia

Purpose

Dementia of Alzheimer's type (DAT) is a major cognitive communication disorder. The present study attempted to analyse communication disorders in DAT in the International Classification of Functions (ICF) framework. The study investigated the impact of the severity of communication disorders in persons with DAT on activity participation and environment components of the ICF.

Method

Thirty bilingual individuals with DAT in the age range of 65-88 years were classified into three groups of mild, moderate and severe degree of dementia. Forty-three items of the American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) were linked to the ICF framework. A few additional items were also added for a complete profiling of DAT. A total of 50 (ASHA FACS + ICF) items were rated and administered for the purpose of the study.

Results

The study revealed a disproportionate impact of the severity of DAT on activity participation and environment components of the ICF.

Conclusion

The present study investigated the utility of the ICF framework for profiling the functionality of persons with DAT. This profiling highlighted the need for ensuring effective communication and quality of life in the DAT population.

Abstract Word Definition in Patients with Amnestic Mild Cognitive Impairment

The aims of this study were to investigate concrete and abstract word definition ability (1) between patients with amnestic mild cognitive impairment (aMCI) and normal adults and (2) between the aMCI subtypes (i.e., amnestic single-domain MCI and amnestic multidomain MCI; asMCI and amMCI) and normal controls. The 68 patients with aMCI (29 asMCI and 39 amMCI) and 93 age- and education-matched normal adults performed word definition tasks composed of five concrete (e.g., train) and five abstract nouns (e.g., jealousy). Task performances were analyzed on total score, number of core meanings, and number of supplementary meanings. The results were as follows. First, the aMCI patients scored significantly poorer than the normal controls in only abstract word definition. Second, both subtypes of aMCI performed worse than the controls in only abstract word definition. In conclusion, a definition task of abstract rather than concrete concepts may provide richer information to show semantic impairment of aMCI.

Increasing stimulus duration improves attention and memory performance in elderly with cognitive impairment

Objectives:

In this study, we investigated whether increasing stimulus duration could improve performance on a test of attention and short-term memory in cognitively impaired individuals.

Methods:

A computer-generated forward digit span test was administered to 65 patients with mild cognitive impairment or dementia (28 intervention and 37 controls). After point of failure, testing in the intervention group was continued at the same rate, but with an average 150% digit lengthening to 800 ms. Testing of controls was continued using the standard digit span test.

Results:

In the intervention group, 13/28 (46.4%) improved their digit span test performance, compared to 2/37 (5.4%) in the control group (p = 0.00005).

Conclusion:

Cognitively impaired elderly participants improved performance on a test of attention and short-term memory, when stimulus duration was increased in proportion to elongation of the finger tap touch-phase previously found in a similar cohort. A possible mechanism for the effect of increased stimulus duration on attention and short-term memory is discussed.

Are There Any Connections between Language Deficits and Cognitive Slowing in Alzheimer's Disease?

Background

Speech disorders already occur in the early phases of Alzheimer's disease (AD). As a possible cause, problems of executive processes are discussed. Cognitive slowing is also repeatedly addressed.

Aims

Are there any connections between cognitive slowing and speech disorders in AD? And is there a relationship between cognitive slowing and executive processes?

Methods

The data of 72 healthy controls and 52 AD patients were examined with regard to their language performance and their response times in a computerized Stroop paradigm.

Results

The AD patients showed significantly worse results in all language tests as well as much longer reaction times in all Stroop conditions, especially in the interference condition (Stroop 3). Speech errors and response times correlated with severity (MMSE), and the speech errors correlated with the reaction times in Stroop 3 (interference condition, which reflects the processing time of executive processes).

Conclusion

The most interesting question now is: How are language processing and executive processing time (Stroop 3) related?

Need for and challenges facing functional communication as outcome parameter in AD clinical trials

This paper (1) highlights the relevance of functional communication as an outcome parameter in Alzheimer disease (AD) clinical trials; (2) identifies studies that have reported functional communication outcome measures in AD clinical trials; (3) critically reviews the scales of functional communication used in recent AD clinical trials by summarizing the sources of information, characteristics, and available psychometric data for these scales; and (4) evaluates whether these measures actually or partially assess functional communication. To provide direction for future research and generate suggestions to assist in the development of a valid and reliable functional communication scale for the needs of AD clinical trials, we have included not only functional communication scales, but also related concepts that give thought-provoking impulses for the development of a functional communication scale. As outcome measures for AD clinical trials, the 6 identified papers use 6 different scales, for functional communication and for related concepts. All of the scales appear to have questionable psychometric properties, but still provide a promising basis for the creation of a functional communication scale. We conclude with concrete suggestions on how to combine the advantages of the existing scales for future research aimed at developing a valid and reliable functional communication scale for the needs of AD clinical trials.

CODEM Instrument

Communication and communication behaviors in situational contexts are essential conditions for well-being and quality of life in people with dementia. Measuring methods, however, are limited. The CODEM instrument, a standardized observational communication behavior assessment tool, was developed and evaluated on the basis of the current state of research in dementia care and social-communicative behavior. Initially, interrater reliability was examined by means of videoratings (N = 10 people with dementia). Thereupon, six caregivers in six German nursing homes observed 69 residents suffering from dementia and used CODEM to rate their communication behavior. The interrater reliability of CODEM was excellent (mean κ = .79; intraclass correlation = .91). Statistical analysis indicated that CODEM had excellent internal consistency (Cronbach’s α = .95). CODEM also showed excellent convergent validity (Pearson’s R = .88) as well as discriminant validity (Pearson’s R = .63). Confirmatory factor analysis verified the two-factor solution of verbal/content aspects and nonverbal/relationship aspects. With regard to the severity of the disease, the content and relational aspects of communication exhibited different trends. CODEM proved to be a reliable, valid, and sensitive assessment tool for examining communication behavior in the field of dementia. CODEM also provides researchers a feasible examination tool for measuring effects of psychosocial intervention studies that strive to improve communication behavior and well-being in dementia.

Prefrontal cortex activation during story encoding/retrieval: a multi-channel functional near-infrared spectroscopy study

Encoding, storage and retrieval constitute three fundamental stages in information processing and memory. They allow for the creation of new memory traces, the maintenance and the consolidation of these traces over time, and the access and recover of the stored information from short or long-term memory. Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique that measures concentration changes of oxygenated-hemoglobin (O₂Hb) and deoxygenated-hemoglobin (HHb) in cortical microcirculation blood vessels by means of the characteristic absorption spectra of hemoglobin in the near-infrared range. In the present study, we monitored, using a 16-channel fNIRS system, the hemodynamic response during the encoding and retrieval processes (EP and RP, respectively) over the prefrontal cortex (PFC) of 13 healthy subjects (27.2 ± 2.6 years) while were performing the “Logical Memory Test” (LMT) of the Wechsler Memory Scale. A LMT-related PFC activation was expected; specifically, it was hypothesized a neural dissociation between EP and RP. The results showed a heterogeneous O₂Hb/HHb response over the mapped area during the EP and the RP, with a O₂Hb progressive and prominent increment in ventrolateral PFC (VLPFC) since the beginning of the EP. During the RP a broader activation, including the VLPFC, the dorsolateral PFC and the frontopolar cortex, was observed. This could be explained by the different contributions of the PFC regions in the EP and the RP. Considering the fNIRS applicability for the hemodynamic monitoring during the LMT performance, this study has demonstrated that fNIRS could be utilized as a valuable clinical diagnostic tool, and that it has the potential to be adopted in patients with cognitive disorders or slight working memory deficits.

Lexical retrieval in discourse: an early indicator of Alzheimer's dementia

We examined the progression of lexical-retrieval deficits in individuals with neuropathologically determined Alzheimer's disease (AD; n = 23) and a comparison group without criteria for AD (n = 24) to determine whether linguistic changes were a significant marker of the disease. Our participants underwent multiple administrations of a neuropsychological battery, with initial administration occurring on average 16 years prior to death. The battery included the Boston Naming Test (BNT), a letter fluency task (FAS) and written description of the Cookie Theft Picture (CTP). Repeated measures analysis revealed that the AD-group showed progressively greater decline in FAS and CTP lexical performance than the comparison group. Cross-sectional time-specific group comparisons indicated that the CTP differentiated performance between the two groups at 7-9 years prior to death and FAS and BNT only at 2-4 years. These results suggest that lexical-retrieval deficits in written discourse serve as an early indicator of AD.

A family living with Alzheimer’s disease: The communicative challenges

Alzheimer’s disease irrevocably challenges a person’s capacity to communicate with others. Earlier research on these challenges focused on the language disorders associated with the condition and situated language deficit solely in the limitations of a person’s cognitive and semantic impairments. This research falls short of gaining insight into the actual interactional experiences of a person with Alzheimer’s and their family. Drawing on a UK data set of 70 telephone calls recorded over a two-and-a-half year period (2006–2008) between one elderly woman with Alzheimer’s disease, and her daughter and son-in-law, this paper explores the role which communication (and its degeneration) plays in family relationships. Investigating these interactions, using a conversation analytic approach, reveals that there are clearly communicative difficulties, but closer inspection suggests that they arise due to the contingencies that are generated by the other’s contributions in the interaction. That being so, this paper marks a departure from the traditional focus on language level analysis and the assumption that deficits are intrinsic to the individual with Alzheimer’s, and instead focuses on the collaborative communicative challenges that arise in the interaction itself and which have a profound impact on people’s lives and relationships.

Working memory is partially preserved during sleep

Although several cognitive processes, including speech processing, have been studied during sleep, working memory (WM) has never been explored up to now. Our study assessed the capacity of WM by testing speech perception when the level of background noise and the sentential semantic length (SSL) (amount of semantic information required to perceive the incongruence of a sentence) were modulated. Speech perception was explored with the N400 component of the event-related potentials recorded to sentence final words (50% semantically congruent with the sentence, 50% semantically incongruent). During sleep stage 2 and paradoxical sleep: (1) without noise, a larger N400 was observed for (short and long SSL) sentences ending with a semantically incongruent word compared to a congruent word (i.e. an N400 effect); (2) with moderate noise, the N400 effect (observed at wake with short and long SSL sentences) was attenuated for long SSL sentences. Our results suggest that WM for linguistic information is partially preserved during sleep with a smaller capacity compared to wake.

Cholinergic degeneration is associated with increased plaque deposition and cognitive impairment in APPswe/PS1dE9 mice

Cholinergic dysfunction and deposition of plaques containing amyloid β-peptides (Aβ) are two of the characteristics of Alzheimer's disease. Here, we combine APPswe/PS1dE9 (APP/PS1) mice with the cholinergic immunotoxin mu p75-saporin (SAP) to integrate partial basal forebrain cholinergic degeneration and the neuropathology of APP/PS1 mice. By 6 months of age, APP/PS1 mice and wild type littermates (Wt) received intracerebroventricular injection of 0.6 μg SAP (lesion) or PBS (sham). Two months following surgery, APP/PS1 mice treated with SAP were significantly impaired compared to sham treated APP/PS1 mice in a behavioural paradigm addressing working memory. Conversely, the performance of Wt mice was unaffected by SAP treatment. Choline acetyltransferase activity was reduced in the hippocampus and frontal cortex following SAP treatment. The selective effect of a mild SAP lesion in APP/PS1 mice was not due to a more extensive cholinergic degeneration since the reduction in choline acetyltransferase activity was similar following SAP treatment in APP/PS1 mice and Wt. Interestingly, plaque load was significantly increased in SAP treated APP/PS1 mice relative to sham lesioned APP/PS1 mice. Additionally, APP/PS1 mice treated with SAP showed a tendency towards an increased level of soluble and insoluble Aβ1-40 and Aβ1-42 measured in brain tissue homogenate. Our results suggest that the combination of cholinergic degeneration and Aβ overexpression in the APP/PS1 mouse model results in cognitive decline and accelerated plaque burden. SAP treated APP/PS1 mice might thus constitute an improved model of Alzheimer's disease-like neuropathology and cognitive deficits compared to the conventional APP/PS1 model without selective removal of basal forebrain cholinergic neurons.

Acoustic markers associated with impairment in language processing in Alzheimer's Disease

This study broaches in a novel way the analysis of cognitive impairment characteristic of the early stages of Alzheimer's Disease (AD). Specifically, we attempt to determine the acoustic speech parameters that are sensitive to the onset of the disease, and their association with the language deficit characteristic of AD. Speech analysis was carried out on 21 elderly patients with AD using Praat software, which analyzes the acoustic components of speech. The data obtained were subjected to stepwise regression, using the overall scores obtained in the test as the criterion variable, and the scores on the frequency, amplitude and periodicity variables as predictors of performance. We found that the percentage of voiceless segments explains a significant portion of the variance in the overall scores obtained in the neuropsychological test. This component seems to be related mainly to the patient's ability in phonological fluency. This finding could permit the creation of a diagnostic test for AD through analysis of the acoustic speech parameters at very low cost in terms of both time and resources.

TANDEM: Communication training for informal caregivers of people with dementia

OBJECTIVES

Dementia increasingly diminishes the ability to communicate. We aimed to develop and evaluate a psychosocial intervention program that focuses on communication in dementia care. This was intended to enhance the quality of life (QoL) of people with dementia and to reduce the burden on their informal caregivers.

METHOD

A training program for informal caregivers of people with dementia was developed. The training combines the expertise of geriatric psychiatry, geriatric care, and educational psychology. Caregivers acquire and deepen competencies required to improve communication in dementia care. The training was evaluated with a pre-post-control group design and time-series analyses. Twenty-four informal caregivers participated in the study.

RESULTS

The results of the study provide evidence that TANDEM training increases caregivers' use of strategies that are relevant for communication in dementia care and the care receivers' QoL.

CONCLUSION

The results of research in this program show the relevance of including caregivers in interventions and the importance of communication for the QoL of people with dementia.

What spouse caregivers know about communication in Alzheimer's disease: development of the AD Communication Knowledge Test

Most individuals with Alzheimer's disease are cared for at home by family members, particularly spouses. As language impairment progresses, communication between spouses becomes difficult and caregivers are likely to be unprepared for this challenge. The purpose of this study is to describe spouse caregivers' knowledge of communication in AD and to determine their learning needs regarding effective communication strategies. A measure of knowledge about declining language skills and appropriate communication strategies was developed and pilot tested. Participants included 16 spouses caring for a partner with AD at home. Care recipients were generally mildly impaired. Caregivers were aware of at least some of the decline in language but were less knowledgeable about communication strategies. They were experiencing numerous communication problems, but reported minimal difficulty in communicating. Nurses in acute and long-term care settings are challenged to assess spouses' knowledge and awareness about communication in AD and provide information about effective communication strategies to decrease misunderstandings and frustration, which often lead to behavior problems. Recommendations for further development of the AD Communication Knowledge Test are offered.

The factorial structure of the Mini-Mental State Examination (MMSE) in Japanese dementia patients

Background

The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments in the evaluation of global cognitive status. Few studies have investigated the relationship among its components in terms of factorial structure in Japanese individuals suffering from dementia. The aims of this study were: 1) to analyze the factorial structure of MMSE in Japanese dementia patients, 2) to clarify the MMSE static structure in identifying different cognitive profiles and understanding how these profiles are related to levels of dysfunction in subsets of dementia patients.

Methods

30,895 consecutive outpatients with dementia were evaluated. The 11 subtests composing the MMSE and the global MMSE score were analyzed. Factor analysis based on principal component analysis with Promax rotation was applied to the data representing the frequency of failures in each subtest as identified by the MMSE.

Results

Factor analysis identified three factors that explained approximately 44.57% of the total variance. The first factor, immediate memory, essentially constituted a simple index of the reading and writing subtests. The second factor, orientation and delayed recall, expressed the ability to handle new information. The third factor, working memory, was most closely related to the severity of dementia at the time of test administration.

Conclusions

Japanese dementia patients appear to develop difficulty handling new information in the early stages of their disease. This finding, and our finding that there is a factor associated with disease severity, suggest that understanding the specific factors related to subtest items, which underlie the total MMSE score may be useful to clinicians in planning interventions for Japanese patients in the early stages of dementia.

How can we get access to the experiences of people with dementia?

This paper suggests and discusses a methodological approach that aims to facilitate the inclusion of people with dementia in research where the ambition is to better understand their experiences. People with dementia have commonly not been included as informants in research as their cognitive deficits have been regarded as a hindrance. Moreover, in the qualitative research tradition, most inquiries rely on data obtained from interviews, thereby requiring communication and verbal skills, which are skills that are affected early in the cause of dementia. Consequently, the considerably under-researched area of how dementia is experienced and managed from the perspective of those afflicted has long been put aside. This paper suggests that a combination of qualitative observations and adapted interviews may make it possible for people with dementia to participate as research informants. Issues concerned with creating a relationship with informants with dementia and helping them to elicit their experiences are elaborated and discussed. Some suggestions are made concerning how the context can be used for this intent, and how the observations and interviews can be adapted to the informants with dementia.

Functional communication ability in frontotemporal lobar degeneration and Alzheimer's disease

Functional communication is crucial for independent and efficient communicative behavior in response to every day activities. In the course of dementia progression, cognitive losses may impair these abilities. For this reason, functional communication assessment should be part of a formal assessment to quantify and qualify the impact of deficiency on patients' lives.

Objective

To compare functional communication abilities in fronto-temporal lobar degeneration (FLTD) and Alzheimer's disease (AD).

Methods

Six AD patients (mean age: 82.50±2.66 years; mean education: 5.67±3.61 years), and eight FTLD patients (mean age: 57.13±9.63 years; mean education: 10.86±6.91 years) had their close relatives answer the Functional Assessment of Communication Skills for Adults (Asha-facs) . Statistical analyses correlated the performance on each of the Asha-facs domains (social communication, communication of basic needs; reading, writing, number concept and daily planning) between both groups.

Results

Analyses showed that functional communication was similar for AD and FTLD patients. Only two items had statistical difference, namely 'Comprehension of inference' (AD 6.7±1.33; FTLD 2.43±2.30, p=0.017) and 'capacity to make basic money transactions' (AD 2.17±2.04; FTLD 4.00±0.90, p=0.044). Comparison among the four domains' mean scores revealed no significant difference.

Conclusion

The Asha-facs is a useful instrument to characterize functional communication abilities in both FTLD and AD. Nevertheless, the analysis presented for this sample showed that the Asha-facs could not discriminate which aspects of the FTLD and AD differed.

People with severe dementia exhibit episodes of lucidity. A population-based study

AIMS AND OBJECTIVES

To describe frequency and characteristics of people with severe dementia who according to care providers, exhibit ELs in a population of those with dementia in institutional care.

BACKGROUND

There are reports in the literature concerning episodes when the resident unexpectedly says or acts in a way that surprises the care provider because the resident seems to be much more aware of her/his situation than usual. This is labelled 'episodes of lucidity' (ELs).

DESIGN

The study is based on data from a point prevalence study from institutions for the older people in northern Sweden in May 2000.

METHODS

Out of 3804 residents, assessed by key care providers, by means of the Multi-Dimensional Dementia Assessment Scale (MDDAS) with questions about ELs added, 92 residents were found to have severe dementia and difficulties with verbal communication. The key care providers' competence in assessing severe dementia was not evaluated. An ethics committee approved the study.

RESULTS

Fifty-two residents (57%) were assessed as exhibiting ELs. Residents who showed ELs had higher orientation scores and expressed more emotions than residents who did not show ELs. More residents who exhibited ELs took outdoor walks with their care providers exhibited ELs than those who did not (P = 0.001).

CONCLUSIONS

Every second resident with severe dementia and difficulties with verbal communication showed ELs.

RELEVANCE FOR CLINICAL PRACTICE

The fact that every second resident with severe dementia and difficulties with verbal communication showed ELs and that this was noticed especially when care providers took outdoor walks with the residents imply that closer contact between care providers and residents with severe dementia could change the care providers' expectations and enhance communication between the parties.

Alpha rhythms in mild dements during visual delayed choice reaction time tasks: A MEG study

Can simple delayed response tasks affect latency and amplitude of magnetoencephalographic midline alpha rhythms (6-12 Hz) in early dementia? We recruited 15 mild Alzheimer's disease (AD) and 10 vascular dementia (VaD) patients (paired mini mental state exam of 17-24). The control groups comprised 18 young and 22 elderly normal subjects. In the first task, a simple "cue" stimulus (one bit) was memorized along a brief delay period (3.5-5.5s) up to a "go" stimulus triggering (right or left) button press. In the second task, the "cue" stimulus remained available along the delay period. Event-related reduction in power of the alpha rhythms indexed the cortical activation (event-related desynchronization, ERD) for the trials associated with correct behavioral responses. Behavioral performances to both tasks were lower in the AD and VaD patients than in the normal subjects. In particular, just four AD and five VaD patients executed a sufficient amount of correct responses for the alpha ERD analysis, so they were included in a unique group. In both tasks, the alpha ERD peak was later in latency in the demented and normal elderly subjects than in the normal young subjects. Furthermore, the alpha ERD peak was stronger in amplitude in the demented patients than in the normal subjects. These results suggest that simple delayed response tasks during physiological recordings are quite difficult for patients even at an early dementia stage. Such difficulty may induce the abnormal amount of the related cortical activation in dementia as revealed by the alpha ERD.

Communicative Responsibility and Semantic Task in the Language of Adults with Dementia

A probe technique requiring convergent and divergent semantic behavior and representing five levels of communicative responsibility served as the research tool. Stimuli were presented to adults identified as having Alzheimer disease or multi-infarct dementia. Within each group differences were observed on the semantic task (convergent and divergent) and on communicative responsibility. Group characteristics are compared with data previously published in 1994 on aphasic and schizophrenic adults responding to the same stimuli.