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Harmon S, Kocum CG, Ranum RM, Hermann G, Farias ST, Kiselica AM. The mobile everyday cognition scale (mECog): development and pilot testing. Clin Neuropsychol 2024:1-20. [PMID: 39060986 DOI: 10.1080/13854046.2024.2383333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Objective: Subjective cognitive decline (SCD) is an important part of the aging process and may be a sign of neurodegenerative disease. Current measures of SCD are subject to the limits of retrospective recall of symptoms over a long span of time, which might be addressed by using ecological momentary assessment (EMA) methods. However, there are no currently available measures of SCD validated for use in EMA. Thus, our goal was to develop and pilot test the mobile Everyday Cognition Scale (mECog). Method: 31 community-dwelling older adults completed in lab measures of cognition and mental health symptoms, followed by daily mECog ratings on a smart phone for 28 days. Results: Most participants completed at least 75% of mECog assessments (n = 27, 87%), and the average number of assessments completed was 22. Further, respondents rated the mobile assessment platform and measures as easy to use and non-interfering with daily life. Test-retest reliability of mECog scores was very strong (RKRN = .99), and within-person reliability was moderate (RCN = .41). mECog scores demonstrated strong positive associations with scores from the original ECog (ρ = .62-69, p < .001) and short form ECog (ρ = .63-.69, p < .001) and non-significant associations with demographics (ρ = -0.25-.04, p = .21-.94) and mental health symptoms (ρ = -0.06-.34, p = .08-.99). mECog scores also exhibited small-to-moderate negative correlations with objective cognitive test scores, though these relationships did not reach statistical significance (ρ = -0.32 to -0.22, p = .10-.27). Conclusions: Results suggest that mobile assessment of SCD via the mECog is feasible and acceptable. Further, mECog scores demonstrated good psychometric properties, including evidence of strong reliability, convergent validity, and divergent validity.
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Affiliation(s)
- Sawyer Harmon
- Department of Educational, School, and Counseling Psychology, University of Missouri, Columbia, MO, USA
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - Courtney G Kocum
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Rylea M Ranum
- Department of Psychology, University of Houston, Houston, TX
| | - Greta Hermann
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | | | - Andrew M Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
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Sasaninezhad M, Moradi A, Farahimanesh S, Choobin MH, Almasi-Dooghaee M. Enhancing cognitive flexibility and working memory in individuals with mild cognitive impairment: Exploring the impact of virtual reality on daily life activities. Geriatr Nurs 2024; 56:32-39. [PMID: 38211369 DOI: 10.1016/j.gerinurse.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
Mild Cognitive Impairment (MCI) serving as a transitional stage between normal aging and dementia. This study aimed to explore the impact of virtual reality (VR) on enhancing cognitive flexibility, working memory, and daily life activities. Forty participants diagnosed with MCI were randomly assigned to either an intervention group (N = 20) or a control group (N = 20). Evaluations were at baseline, post-training, and three months post-training using various cognitive assessment tools. Results showed that the VR-based cognitive rehabilitation significantly improved instrumental activities of daily living performance, visual and verbal working memory, and reduced anxiety and depression symptoms. While cognitive flexibility did not exhibit significant improvement, these findings highlight VR interventions as a potential avenue for improving cognitive and functional aspects, and alleviating psychological symptoms in individuals with MCI. Further research with larger sample sizes and extended follow-up periods is recommended to establish the long-term effectiveness of such interventions.
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Affiliation(s)
| | - Alireza Moradi
- Kharazmi University, Institute for Cognitive Science Studies, Tehran, Iran.
| | - Sharareh Farahimanesh
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Mohammad Hasan Choobin
- Kharazmi University, Institute for Cognitive Science Studies, Tehran, Iran; Institute for Cognitive Science Studies, Tehran, Iran
| | - Mostafa Almasi-Dooghaee
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Plassman BL, Ford CB, Smith VA, DePasquale N, Burke JR, Korthauer L, Ott BR, Belanger E, Shepherd-Banigan ME, Couch E, Jutkowitz E, O’Brien EC, Sorenson C, Wetle TT, Van Houtven CH. Elevated Amyloid-β PET Scan and Cognitive and Functional Decline in Mild Cognitive Impairment and Dementia of Uncertain Etiology. J Alzheimers Dis 2024; 97:1161-1171. [PMID: 38306055 PMCID: PMC11034799 DOI: 10.3233/jad-230950] [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: 02/03/2024]
Abstract
BACKGROUND Elevated amyloid-β (Aβ) on positron emission tomography (PET) scan is used to aid diagnosis of Alzheimer's disease (AD), but many prior studies have focused on patients with a typical AD phenotype such as amnestic mild cognitive impairment (MCI). Little is known about whether elevated Aβ on PET scan predicts rate of cognitive and functional decline among those with MCI or dementia that is clinically less typical of early AD, thus leading to etiologic uncertainty. OBJECTIVE We aimed to investigate whether elevated Aβ on PET scan predicts cognitive and functional decline over an 18-month period in those with MCI or dementia of uncertain etiology. METHODS In 1,028 individuals with MCI or dementia of uncertain etiology, we evaluated the association between elevated Aβ on PET scan and change on a telephone cognitive status measure administered to the participant and change in everyday function as reported by their care partner. RESULTS Individuals with either MCI or dementia and elevated Aβ (66.6% of the sample) showed greater cognitive decline compared to those without elevated Aβ on PET scan, whose cognition was relatively stable over 18 months. Those with either MCI or dementia and elevated Aβ were also reported to have greater functional decline compared to those without elevated Aβ, even though the latter group showed significant care partner-reported functional decline over time. CONCLUSIONS Elevated Aβ on PET scan can be helpful in predicting rates of both cognitive and functional decline, even among cognitively impaired individuals with atypical presentations of AD.
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Affiliation(s)
- Brenda L. Plassman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Department of Neurology, School of Medicine, Duke University, NC, USA
| | - Cassie B. Ford
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Valerie A. Smith
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Nicole DePasquale
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - James R. Burke
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Department of Neurology, School of Medicine, Duke University, NC, USA
| | - Laura Korthauer
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian R. Ott
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Emmanuelle Belanger
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Megan E. Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
| | - Elyse Couch
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Eric Jutkowitz
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Emily C. O’Brien
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Corinna Sorenson
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Terrie T. Wetle
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Courtney H. Van Houtven
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
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Aguilar-Navarro SG, Sánchez BLP, Gutiérrez LAG, Arias-Trejo N, Quiroz YT, Alvarado AJM. Cross-cultural adaptation of the everyday cognition scale (M-ECog) in older Mexican adults with cognitive impairment. Dement Neuropsychol 2023; 17:e20230011. [PMID: 37885966 PMCID: PMC10599302 DOI: 10.1590/1980-5764-dn-2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/22/2023] [Indexed: 10/28/2023] Open
Abstract
The Everyday Cognition (ECog) scale was created to evaluate the functional abilities of older adults across a wide range of abilities between normal aging and dementia. ECog screens cognitive alterations such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). This early recognition is done by the measurement of the ability to perform the activities of daily living (ADLs). Objective To establish the cross-cultural adaptation, validity, and reliability of the ECog Mexican version (M-ECog) in participants with: SCD, MCI, and dementia coming from a memory clinic. Methods There were 200 patients and their respective informants in a memory clinic of a third level hospital in Mexico City. Four groups were studied: 50 cognitively healthy (CH), 50 SCD, 50 MCI, and 50 dementia. The clinical evaluation included: sociodemographic and health characteristics, cognitive status by the Mini-Mental State Evaluation (MMSE) and Montreal Cognitive Evaluation Spanish version (MoCA-E), and caregiver information (informants) about the difficulty in ADLs as well as the ECog Spanish version (M-ECog). Results The M-ECog was significantly correlated with MMSE, MoCA-E, and ADLs. It showed the ability to discriminate the different cognitive declines (Cronbach's alpha 0.881). The intra-class correlation coefficient was 0.877 (95% confidence interval - CI, 0.850-0.902; p<0.001). The patient's group area under curve (AUC) of M-ECog for SCD was 0.70 (95%CI 0.58-0.82, p<0.005), for MCI it was 0.94 (95%CI 0.89-0.99, p<0.001) and for dementia 0.86 (95%CI 0.79-0.92, p<0.001). Conclusion The M-ECog scale proves to be valid and reliable for measuring everyday abilities mediated by cognition. It is self-applicable without requiring extensive prior formation. It is useful to screen for SCD and MCI in older Mexican adults.
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Affiliation(s)
- Sara Gloria Aguilar-Navarro
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Geriatrics Department, Mexico City, Mexico
| | | | | | - Natalia Arias-Trejo
- Universidad Nacional Autónoma de México, Faculty of Psychology, Mexico City, Mexico
| | - Yakeel T. Quiroz
- Harvard Medical School, Massachusetts General Hospital, Department of Neurology and Psychiatry, Boston, MA, USA
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Rakutt MJ, Mace RA, Conley CEW, Stone AV, Duncan ST, Greenberg J, Landy DC, Vranceanu AM, Jacobs CA. Association of Osteoarthritis and Functional Limitations With Cognitive Impairment Among Older Adults in the United States. J Aging Health 2023; 35:643-650. [PMID: 36680455 PMCID: PMC10940858 DOI: 10.1177/08982643231153459] [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: 01/22/2023]
Abstract
Objective: Given overlapping pathophysiology, this study sought to assess the association between osteoarthritis (OA), functional impairment, and cognitive impairment in the aging population. Methods: The National Health and Nutrition Examination Survey was used to identify participants >60 years of age. We analyzed multivariable associations of grouped participants that underwent cognitive function testing using linear and logistic regression, adjusting for sex, age, race, and ethnicity. Results: Of 2776 identified participants representing a population of 50,242,917, 40% did not report OA or functional limitations; 21% had OA but not functional limitations; 15% did not have OA but had functional limitations; 17% had OA and related functional limitations; and 7% had OA and non-arthritic functional limitations. OA was not independently associated with cognitive impairment. Contrarily, functional limitations were associated with cognitive impairment regardless of OA diagnosis. Discussion: Cognitive impairment is not associated with OA, but rather functional limitations, potentially guiding future intervention.
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Affiliation(s)
| | - Ryan A. Mace
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Caitlin E. W. Conley
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, USA
| | - Austin V. Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, USA
| | - Stephen T. Duncan
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, USA
| | | | - David C. Landy
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, USA
| | | | - Cale A. Jacobs
- Massachusetts General Brigham Sports Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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Chilton RL, Schmitter-Edgecombe M. Assessing functional ability of healthy adults with the Night Out Task. Clin Neuropsychol 2023; 37:1302-1320. [PMID: 35848169 PMCID: PMC9845424 DOI: 10.1080/13854046.2022.2096485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/27/2022] [Indexed: 01/21/2023]
Abstract
Objective: Given the negative health outcomes associated with functional loss, there is need to better understand the trajectory of functional change and compensation use with age. Many older adults successfully age in place, and there is not a one-to-one relationship between cognitive changes and ability to live independently. This study compared healthy age cohorts' performance and approach on a functional measure, particularly examining compensatory strategy use to support task performance. Methods: 57 young adults (YAs; ages 18-39), 42 young-old adults (YOAs; ages 60-69) and 47 old-old (OOAs; ages 70+) completed the Night Out Task (NOT); an open-ended functional assessment in which participants complete eight subtasks in preparation for a night out with a friend (e.g. prepare tea and gather items for a recipe). The NOT measures both primary outcome variables (e.g. time and accuracy), error types and 'compensation variables', which are process-approach variables intended to map on to the types of compensatory strategies individuals use in their everyday lives (e.g. planning and checking). Results: Results revealed that YAs performed better than the oldest group on the NOT in accuracy, execution time and number of both inefficient and inaccurate/incomplete errors. YAs additionally used fewer compensatory strategies than both older groups. Only one compensation variable had a positive relationship to outcome; double-checking was related to improved accuracy and fewer inaccurate/incomplete errors within the oldest cohort. Conclusion: Together these findings support a spectrum of functional change with age. While compensation use increased with age, the relationship between compensation use and outcome was unclear. Future work is needed to understand under what conditions older adults' self-initiate compensation use and to understand the relationship between compensation use and outcome.
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Hausman HK, Alexander GE, Cohen R, Marsiske M, DeKosky ST, Hishaw GA, O'Shea A, Kraft JN, Dai Y, Wu S, Woods AJ. Primary outcome from the augmenting cognitive training in older adults study (ACT): A tDCS and cognitive training randomized clinical trial. Brain Stimul 2023; 16:904-917. [PMID: 37245842 PMCID: PMC10436327 DOI: 10.1016/j.brs.2023.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND There is a need for effective interventions to stave off cognitive decline in older adults. Cognitive training has variably produced gains in untrained tasks and daily functioning. Combining cognitive training with transcranial direct current stimulation (tDCS) may augment cognitive training effects; however, this approach has yet to be tested on a large-scale. OBJECTIVE This paper will present the primary findings of the Augmenting Cognitive Training in Older Adults (ACT) clinical trial. We hypothesize that receiving active stimulation with cognitive training will result in greater improvements on an untrained fluid cognition composite compared to sham following intervention. METHODS 379 older adults were randomized, and 334 were included in intent-to-treat analyses for a 12-week multidomain cognitive training and tDCS intervention. Active or sham tDCS was administered at F3/F4 during cognitive training daily for two weeks then weekly for 10 weeks. To assess the tDCS effect, we fitted regression models for changes in NIH Toolbox Fluid Cognition Composite scores immediately following intervention and one year from baseline controlling for covariates and baseline scores. RESULTS Across the entire sample, there were improvements in NIH Toolbox Fluid Cognition Composite scores immediately post-intervention and one year following baseline; however, there were no significant tDCS group effects at either timepoint. CONCLUSIONS The ACT study models rigorous, safe administration of a combined tDCS and cognitive training intervention in a large sample of older adults. Despite potential evidence of near-transfer effects, we failed to demonstrate an additive benefit of active stimulation. Future analyses will continue to assess the intervention's efficacy by examining additional measures of cognition, functioning, mood, and neural markers.
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Affiliation(s)
- Hanna K Hausman
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Gene E Alexander
- Department of Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, and BIO5 Institute, University of Arizona and Arizona Alzheimer's Disease Consortium, Tucson, AZ, USA; Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Michael Marsiske
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Steven T DeKosky
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Georg A Hishaw
- Department of Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, and BIO5 Institute, University of Arizona and Arizona Alzheimer's Disease Consortium, Tucson, AZ, USA
| | - Andrew O'Shea
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Jessica N Kraft
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yunfeng Dai
- Department of Biostatistics, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Samuel Wu
- Department of Biostatistics, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
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Cognitive and behavioral abnormalities in individuals with Alzheimer’s disease, mild cognitive impairment, and subjective memory complaints. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
AbstractIn this study, we investigated the ability of commonly used neuropsychological tests to detect cognitive and functional decline across the Alzheimer’s disease (AD) continuum. Moreover, as preclinical AD is a key area of investigation, we focused on the ability of neuropsychological tests to distinguish the early stages of the disease, such as individuals with Subjective Memory Complaints (SMC). This study included 595 participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset who were cognitively normal (CN), SMC, mild cognitive impairment (MCI; early or late stage), or AD. Our cognitive measures included the Rey Auditory Verbal Learning Test (RAVLT), the Everyday Cognition Questionnaire (ECog), the Functional Abilities Questionnaire (FAQ), the Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog), the Montreal Cognitive Assessment scale (MoCA), and the Trail Making test (TMT-B). Overall, our results indicated that the ADAS-13, RAVLT (learning), FAQ, ECog, and MoCA were all predictive of the AD progression continuum. However, TMT-B and the RAVLT (immediate and forgetting) were not significant predictors of the AD continuum. Indeed, contrary to our expectations ECog self-report (partner and patient) were the two strongest predictors in the model to detect the progression from CN to AD. Accordingly, we suggest using the ECog (both versions), RAVLT (learning), ADAS-13, and the MoCA to screen all stages of the AD continuum. In conclusion, we infer that these tests could help clinicians effectively detect the early stages of the disease (e.g., SMC) and distinguish the different stages of AD.
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Stringer G, Couth S, Heuvelman H, Bull C, Gledson A, Keane J, Rayson P, Sutcliffe A, Sawyer PH, Zeng XJ, Montaldi D, Brown LJE, Leroi I. Assessment of non-directed computer-use behaviours in the home can indicate early cognitive impairment: A proof of principle longitudinal study. Aging Ment Health 2023; 27:193-202. [PMID: 35352597 DOI: 10.1080/13607863.2022.2036946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Computer-use behaviours can provide useful information about an individual's cognitive and functional abilities. However, little research has evaluated unaided and non-directed home computer-use. In this proof of principle study, we explored whether computer-use behaviours recorded during routine home computer-use i) could discriminate between individuals with subjective cognitive decline (SCD) and individuals with mild cognitive impairment (MCI); ii) were associated with cognitive and functional scores; and iii) changed over time. METHODS Thirty-two participants with SCD (n = 18) or MCI (n = 14) (mean age = 72.53 years; female n = 19) participated in a longitudinal study in which their in-home computer-use behaviour was passively recorded over 7-9 months. Cognitive and functional assessments were completed at three time points: baseline; mid-point (4.5 months); and end point (month 7 to 9). RESULTS Individuals with MCI had significantly slower keystroke speed and spent less time on the computer than individuals with SCD. More time spent on the computer was associated with better task switching abilities. Faster keystroke speed was associated with better visual attention, recall, recognition, task inhibition, and task switching. No significant change in computer-use behaviour was detected over the study period. CONCLUSION Passive monitoring of computer-use behaviour shows potential as an indicator of cognitive abilities, and can differentiate between people with SCD and MCI. Future studies should attempt to monitor computer-use behaviours over a longer time period to capture the onset of cognitive decline, and thus could inform timely therapeutic interventions. UNLABELLED Supplemental data for this article can be accessed online at http://dx.doi.org/10.1080/13607863.2022.2036946.
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Affiliation(s)
- Gemma Stringer
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Samuel Couth
- Division of Human Communication, Development & Hearing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Hein Heuvelman
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Christopher Bull
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Gledson
- Research IT, The University of Manchester, Manchester, UK
| | - John Keane
- Department of Computer Science, The University of Manchester, Manchester, UK
| | - Paul Rayson
- Computing and Communications, Lancaster University, Bailrigg, Lancaster, UK
| | - Alistair Sutcliffe
- Computing and Communications, Lancaster University, Bailrigg, Lancaster, UK
| | - Peter Harvey Sawyer
- Computer Science, School of Engineering and Applied Science, Aston University, Birmingham, UK
| | - Xiao-Jun Zeng
- Research IT, The University of Manchester, Manchester, UK
| | - Daniela Montaldi
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Laura J E Brown
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Iracema Leroi
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Psychiatry, School of Medicine, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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Divers R, Robinson A, Miller L, De Vito AN, Pugh E, Calamia M. Beyond depression: examining the role of anxiety and anxiety sensitivity on subjective cognition and functioning in older adults. Aging Ment Health 2022; 26:2300-2306. [PMID: 34424804 DOI: 10.1080/13607863.2021.1966747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Subjective cognitive difficulties in the elderly may serve as potential risk-factors for future, objective decline and conversion to neurodegenerative disorders (e.g., mild cognitive impairment [MCI] and dementia). Though these subjective declines have been associated with depression, and to a lesser extent, anxiety, it is unknown if related constructs (e.g. anxiety sensitivity) and specific kinds of worries (e.g. worry about developing dementia, health anxiety) are related to subjective declines. The current study sought to examine if cognitive concerns related to anxiety sensitivity, dementia worry, and health anxiety added incremental validity beyond general symptoms of anxiety and depression in predicting subjective cognition and functioning in a sample of older adults. METHODS Participants were 429 older adults who were at least 60 years old. Participants completed questionnaires on subjective cognition, subjective everyday function, anxiety, depression, anxiety sensitivity, dementia worry, and health anxiety via Qualtrics Panels. Hierarchical multiple regressions were conducted. RESULTS Our variables of interest (anxiety sensitivity, dementia worry, and health anxiety) added significant variance in predicting subjective cognition and everyday function. Specifically, anxiety sensitivity was related to subjective cognition and functioning, while dementia worry and health anxiety were variably associated. CONCLUSION Our results suggest that constructs related to anxiety and worry have a significant relationship with subjective cognition and function in older adults beyond general symptoms of depression and anxiety. Future work should examine if interventions and education may help to decrease anxiety sensitivity and worry about dementia respectively in older adults, which may in tern protect against future subjective declines.
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Affiliation(s)
- Ross Divers
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Anthony Robinson
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Luke Miller
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Alyssa N De Vito
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Erika Pugh
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
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Wei X, Liu H, Yang L, Gao Z, Kuang J, Zhou K, Xu M. Joint developmental trajectories and temporal precedence of physical function decline and cognitive deterioration: A longitudinal population-based study. Front Psychol 2022; 13:933886. [PMID: 36312122 PMCID: PMC9597508 DOI: 10.3389/fpsyg.2022.933886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesPrevious studies primarily explored the unidirectional impact of cognition on physical function. However, the interplay between physical function and cognition and the temporal precedence in their predictive relationships have not been elucidated. We explored the bidirectional mechanism between physical function and cognition in a longitudinal dataset.Materials and methodsA total of 1,365 participants in the Chinese Longitudinal Healthy Longevity Survey assessed physical function and cognition in 2011 (T1), 2014 (T2), and 2018 (T3) by the Katz scale and the Chinese version of the Mini-Mental State Examination scale, respectively. Changes in the trajectories of physical function and cognition were examined using the latent growth model. The correlational and reciprocal relationships between physical function and cognition were examined using the parallel process latent growth model and autoregressive cross-lagged (ARCL) models.ResultsCognition and physical function decreased by an average of 0.096 and 0.017 points per year, respectively. Higher physical function was associated with better cognition at baseline (r = 0.237, p < 0.05), and longitudinal changes in physical function and cognition were positively correlated (r = 0.756, p < 0.05). ARCL analysis indicated that physical function at T1 positively predicted T2 cognitive function. However, this predictive relationship reversed between T2 and T3, whereby cognitive function at T2 predicted physical function at T3.ConclusionBoth physical function and cognition declined over time. Early identification and intervention in physical dysfunction among older adults could be critical to prevent further cognitive impairment and maintain functional independence. Hence, regular functional assessment and individualized care plans are required to achieve healthy aging.
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Martin P, Poon LW, Lee G, Obhi HK, Kallianpur KJ, Willcox B, Masaki K. A 13-Year Time-Lagged Description of General Cognitive and Functional Abilities in Older Men: A Cross-Lagged Panel Model. J Aging Health 2022; 35:335-344. [PMID: 36194185 DOI: 10.1177/08982643221130381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The purpose of this study was to evaluate a cross-lagged panel model of general cognition and functional abilities over 13 years. The goal was to determine whether general cognitive abilities predict or precede functional decline versus functional abilities predicting cognitive decline. Methods: The sample included 3508 men (71-93 years of age at baseline) of the Kuakini Honolulu-Asia Aging Study who were tested repeatedly using a global cognitive test and an assessment of functional capacity. Education and age served as covariates. Cross-lagged models were tested, assessing stationarity of stability and cross-lags. Results: The overall model fit the data well. Cognitive scores had better stability than functional abilities and predicted functional abilities more strongly than functional abilities predicted cognitive scores over time. The strength of all cross-lags increased over time. Discussion: These longitudinal data show that cognitive scores predicted functional decline in a population-based study of older men.
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Affiliation(s)
| | | | - Gina Lee
- 1177Iowa State University, Ames, USA
| | | | - Kalpana J Kallianpur
- 3950Kuakini Medical Center, Honolulu, HI, USA.,University of Hawaii, Honolulu, USA
| | - Bradley Willcox
- 3950Kuakini Medical Center, Honolulu, HI, USA.,University of Hawaii, Honolulu, USA
| | - Kamal Masaki
- 3950Kuakini Medical Center, Honolulu, HI, USA.,University of Hawaii, Honolulu, USA
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13
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Divers R, Robinson A, Miller L, Davis K, Reed C, Calamia M. Examining heterogeneity in depression symptoms and associations with cognition and everyday function in MCI. J Clin Exp Neuropsychol 2022; 44:185-194. [PMID: 35862574 PMCID: PMC9665159 DOI: 10.1080/13803395.2022.2102154] [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] [Received: 03/15/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Although there is some evidence that different symptoms of depression have differential effects on cognition in older adults, these relationships remain understudied in older adults with mild cognitive impairment (MCI). METHOD Older adults (>50 years old) were classified as having MCI by Alzheimer's Disease Research Centers (ADRCs). Exploratory factor analyses and factor mixture modeling were used to determine depression symptom classes. Classes were then compared across different domains of cognition (i.e., memory, attention, language, and executive function) and informant-rated everyday function. RESULTS Analyses revealed six, distinct symptom classes (i.e., somatic symptoms, severely depressed, anhedonic symptoms, cognitive symptoms, minimally depressed, and low life satisfaction symptoms). Classes significantly varied on all measures of cognition and everyday function. In particular, the anhedonic class often showed the most substantial decline (on par with the severely depressed class), while the low life satisfaction class often showed the least (on par with the minimally depressed class). CONCLUSIONS To our knowledge, this is the first study to examine the relationship between depression symptom profiles and cognitive and everyday function in those with MCI. Our findings show that depression symptoms greatly differ in their associations with cognitive and everyday function. It may be beneficial for clinicians to specifically note if patients with MCI are reporting anhedonic and somatic symptoms of depression specifically.
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Affiliation(s)
- Ross Divers
- Department of Psychology, Louisiana State University, Baton Rouge, United States of America
| | - Anthony Robinson
- Department of Psychology, Louisiana State University, Baton Rouge, United States of America
| | - Luke Miller
- Department of Psychology, Louisiana State University, Baton Rouge, United States of America
| | - Katrail Davis
- Department of Psychology, Louisiana State University, Baton Rouge, United States of America
| | - Christopher Reed
- Department of Psychology, Louisiana State University, Baton Rouge, United States of America
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, United States of America
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14
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Choudhury S, Ghodasara S, Stiffel M, Fischer CE, Tang-Wai DF, Smith EE, Massoud F, Robin Hsiung GY, Lee L, Bruneau MA, Laforce RJ, Ismail Z, Burhan AM, Kumar S. Informant-based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders: Systematic review and report from a CCCDTD5 Working Group. Int J Geriatr Psychiatry 2022; 37. [PMID: 35043452 DOI: 10.1002/gps.5678] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 01/02/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE As part of the fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, we assessed the literature on informant-based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders (NCDs) to provide evidence-based recommendations for clinicians and researchers. METHODS A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards guidelines. Publications that validated the informant-based tools or described their key properties were reviewed. Quality of the studies was assessed using the modified Quality Assessment tool for Diagnostic Accuracy Studies. RESULTS Out of 386 publications identified through systematic search, 34 that described 19 informant-based tools were included in the final review. Most of these tools are backed by good-quality studies and are appropriate to use in clinical care or research. The tools vary in their psychometric properties, domains covered, comprehensiveness, completion time, and ability to detect longitudinal change. Based on these properties, we identify different tools that may be appropriate for primary care, specialized memory clinic, or research settings. We also identify barriers to use of these tools in routine clinical practice. CONCLUSION There are several good-quality tools available to collect informant-report for assessment and monitoring of cognition, behavior, or function in patients with NCDs. Clinicians and researchers may choose a particular tool based on their specific needs such as domains of interest, desired psychometric properties, and feasibility. Further work is needed to make the tools more user-friendly and to adopt them into routine clinical care.
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Affiliation(s)
- Samira Choudhury
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Sheena Ghodasara
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Michael Stiffel
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Corinne E Fischer
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - David F Tang-Wai
- Department of Medicine (Neurology & Geriatric Medicine), University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, University Health Network Memory Clinic, Toronto, Ontario, Canada
| | - Eric Edward Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Fadi Massoud
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Ging-Yuek Robin Hsiung
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marie-Andrée Bruneau
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Quebec, Canada.,Geriatric Institute of Montreal Research Center, Montreal, Quebec, Canada
| | - Robert Jr Laforce
- Département des Sciences Neurologiques, Clinique Interdisciplinaire de Mémoire du CHU de Québec, Université Laval, Quebec, Quebec, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Amer M Burhan
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Sanjeev Kumar
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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15
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Sapkota S, Ramirez J, Yhap V, Masellis M, Black SE. Brain atrophy trajectories predict differential functional performance in Alzheimer's disease: Moderations with apolipoprotein E and sex. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12244. [PMID: 34692981 PMCID: PMC8515221 DOI: 10.1002/dad2.12244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/09/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION We examine whether distinct brain atrophy patterns (using brain parenchymal fraction [BPF]) differentially predict functional performance and decline in Alzheimer's disease (AD), and are independently moderated by (1) a key AD genetic risk marker (apolipoprotein E [APOE]), (2) sex, and (3) high-risk group (women APOE ɛ4 carriers). METHODS We used a 2-year longitudinal sample of AD patients (baseline N = 170; mean age = 71.3 [9.1] years) from the Sunnybrook Dementia Study. We applied latent class analysis, latent growth modeling, and path analysis. We aimed to replicate our findings (N = 184) in the Alzheimer's Disease Neuroimaging Initiative. RESULTS We observed that high brain atrophy class predicted lower functional performance and steeper decline. This association was moderated by APOE, sex, and high-risk group. Baseline findings as moderated by APOE and high-risk group were replicated. DISCUSSION Women APOE ɛ4 carriers may selectively be at a greater risk of functional impairment with higher brain atrophy.
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Affiliation(s)
- Shraddha Sapkota
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Joel Ramirez
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Vanessa Yhap
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Mario Masellis
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of Medicine (Neurology)University of TorontoTorontoOntarioCanada
| | - Sandra E. Black
- Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of Medicine (Neurology)University of TorontoTorontoOntarioCanada
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Compensatory and Lifestyle-Based Brain Health Program for Subjective Cognitive Decline: Self-Implementation versus Coaching. Brain Sci 2021; 11:brainsci11101306. [PMID: 34679371 PMCID: PMC8534077 DOI: 10.3390/brainsci11101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Although recent studies have explored the potential of multidomain brain health programs, there is a dearth of literature on operationalizing this research to create a clinical treatment program specifically for subjective cognitive decline (SCD). Patients seen by geriatricians in primary care and by behavioral neurology services at our institution presenting with SCD were recruited via a patient-appropriate flyer. After all participants had a 1-h brain health consultation with a neuropsychologist and were provided with program materials, they were randomized to attend a 10-week intervention designed to support program implementation (N = 10) or the control group of implementing the program on their own (N = 11). The program included (1) a calendar-based executive and memory support system for compensatory training and (2) training in healthy lifestyle. There were no significant differences between groups for any outcomes. Participants across both groups showed significant improvements with moderate effect sizes in compensatory strategy use, anxiety symptoms, and daily functioning, which were sustained through 6-month follow-up. They also increased physical activity by the end of the intervention period but did not sustain this through 6-month follow-up. Our pilot study demonstrates preliminary feasibility of a cognitive compensatory and lifestyle-based brain health program. Additional research is recommended to further develop two potentially scalable implementation strategies—coaching and self-implementation after brief consultation.
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17
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Read S, Hu B, Wittenberg R, Brimblecombe N, Robinson L, Banerjee S. A Longitudinal Study of Functional Unmet Need Among People with Dementia. J Alzheimers Dis 2021; 84:705-716. [PMID: 34569960 DOI: 10.3233/jad-210724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding the changes of unmet need in dementia may enable effective targeting of help and allow people to stay in their homes longer. OBJECTIVE We investigated changes in unmet need and functioning over a 4-year period and the role of socio-demographic factors in these changes among people with dementia. METHODS 234 community-dwelling people with dementia at baseline were studied in three consecutive waves (four years) of the English Longitudinal Study of Ageing (ELSA). Unmet needs (self/informant-reported limitations for which no help was received) and functional limitations (self/informant-reported difficulties in activities/instrumental activities of daily living and mobility) were modelled with latent growth curves. Sex, age, partnership, and socioeconomic status at baseline were used as predictors. Admission to a care home was an additional outcome. RESULTS Unmet needs increased over time, especially among those who initially had more functional limitations. Unmet needs contributed to faster decline in functional capability, except among those with many limitations initially. The major driver of increased unmet needs was not having a partner (direct effect). Age, sex, and wealth contributed indirectly via the initial level of functional limitations and/or unmet need. Those with several functional limitations but few unmet needs were most likely to move to a care home. CONCLUSION Unmet need increases over time in those with dementia with mitigating effects of having a partner and initial levels of functioning. Meeting needs at early stages of dementia, especially for those living alone and when functional limitations are low may help slow functional decline.
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Affiliation(s)
- Sanna Read
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Bo Hu
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Raphael Wittenberg
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Nicola Brimblecombe
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
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18
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Garland SN, Savard J, Eisel SL, Wassersug RJ, Rockwood NJ, Thoms J, Jim HSL, Gonzalez BD. A 2-year prospective analysis of insomnia as a mediator of the relationship between androgen deprivation therapy and perceived cognitive function in men with prostate cancer. Cancer 2021; 127:4656-4664. [PMID: 34411294 DOI: 10.1002/cncr.33850] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) may affect cognitive function in men with prostate cancer (PCa). This study examined whether insomnia symptoms mediate the relationship between ADT and perceived cognitive function and whether depressive symptoms, fatigue severity, and physical activity moderate the strength of this relationship. METHODS This was a prospective study of ADT recipients (n = 83) who were matched with control patients with PCa who were not on ADT (n = 92) and with controls with no history of cancer (n = 112) over a 2-year follow-up period. Perceived cognitive function and satisfaction were assessed with the Everyday Cognition Scale. Insomnia was assessed with the Insomnia Severity Index. Multilevel mediation analyses were conducted to estimate the indirect effect of ADT on perceived cognitive function through insomnia symptoms. Exploratory moderated mediation analyses assessed whether the indirect effect of ADT on perceived cognitive function through insomnia symptoms was dependent on levels of fatigue, depression, or physical activity. RESULTS Insomnia symptoms significantly mediated the relationship between receipt of ADT and perceived cognitive function (P < .001) and satisfaction with cognition (P < .001) after controlling for comorbidities. Men with greater fatigue had a more pronounced association of ADT with insomnia severity. Men with greater depressive symptoms had a stronger association between insomnia severity and worse perceived cognitive function. Physical activity was not a significant moderator of the relationship between ADT and perceived cognitive function. CONCLUSIONS Insomnia influenced the relationship between ADT and perceived cognitive abilities. Interventions to address insomnia, fatigue, and depression may improve perceived cognitive function.
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Affiliation(s)
- Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Josée Savard
- School of Psychology, Université Laval, Quebec City, Quebec, Canada.,Laval University Cancer Research Center, Quebec City, Quebec, Canada
| | - Sarah L Eisel
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Richard J Wassersug
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John Thoms
- Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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19
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Lobo E, Gracia-García P, Lobo A, Saz P, De-la-Cámara C. Differences in Trajectories and Predictive Factors of Cognition over Time in a Sample of Cognitively Healthy Adults, in Zaragoza, Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7092. [PMID: 34281039 PMCID: PMC8297330 DOI: 10.3390/ijerph18137092] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022]
Abstract
Great inter-individual variability has been reported in the maintenance of cognitive function in aging. We examined this heterogeneity by modeling cognitive trajectories in a population-based longitudinal study of adults aged 55+ years. We hypothesized that (1) distinct classes of cognitive trajectories would be found, and (2) between-class differences in associated factors would be observed. The sample comprised 2403 cognitively healthy individuals from the Zaragoza Dementia and Depression (ZARADEMP) project, who had at least three measurements of the Mini-Mental State Examination (MMSE) in a 12-year follow-up. Longitudinal changes in cognitive functioning were modeled using growth mixture models (GMM) in the data. The best-fitting age-adjusted model showed 3 distinct trajectories, with 1-high-to-moderate (21.2% of participants), 2-moderate-stable (67.5%) and, 3-low-and-declining (9.9%) cognitive function over time, respectively. Compared with the reference 2-trajectory, the association of education and depression was significantly different in trajectories 1 and 3. Instrumental activities of daily living (iADLs) were only associated with the declining trajectory. This suggests that intervention strategies should be tailored specifically to individuals with different trajectories of cognitive aging, and intervention strategies designed to maintain cognitive function might be different from those to prevent decline. A stable cognitive performance ('successful cognitive aging') rather than a mild decline, might be more 'normal' than generally expected.
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Affiliation(s)
- Elena Lobo
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain
| | - Patricia Gracia-García
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain
- Psychiatry Service, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Antonio Lobo
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Pedro Saz
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Concepción De-la-Cámara
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, 28029 Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, 50009 Zaragoza, Spain
- Psychiatry Service, Hospital Clínico Universitario, 50009 Zaragoza, Spain
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Farias ST, Weakley A, Harvey D, Chandler J, Huss O, Mungas D. The Measurement of Everyday Cognition (ECog): Revisions and Updates. Alzheimer Dis Assoc Disord 2021; 35:258-264. [PMID: 33901047 PMCID: PMC8387334 DOI: 10.1097/wad.0000000000000450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Everyday Cognition scale (ECog), a measure of everyday functioning developed in 2008, is sensitive to early detection and progression of neurodegenerative disease. The goal was to update ECog item content to ensure relevancy to contemporary older adults from diverse backgrounds. METHODS Participants included 44 culturally diverse older adults (18 with normal cognition, 11 with mild cognitive impairment) and their study partners. Item understandability and relevance was evaluated using iterative interviewing methods that were analyzed using standard qualitative methods. On the basis of this information, items were modified, deleted, or developed as needed. RESULTS Of the 39 original items, 19 were revised, 3 new items were added (primarily to cover contemporary activities such as the use of technology), and 1 was deleted. The revised version (ECog-II) includes 41 items. DISCUSSION To ensure strong psychometric properties, and to facilitate harmonization of previously collected data, we preserved well over half of the items. Future work will validate the revised ECog by measuring associations with neuropsychological performance, external measures of disease, and other functional measures. Overall, the revised ECog will continue to be a useful tool for measuring cognitively relevant everyday abilities in clinical settings and intervention clinical trials.
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Affiliation(s)
| | - Alyssa Weakley
- University of California, Davis Departments of Neurology
| | - Danielle Harvey
- University of California, Davis Departments of Public Health
| | - Julie Chandler
- University of California, Davis Departments of Eli Lilly Pharmaceuticals
| | - Olivia Huss
- University of California, Davis Departments of Neurology
| | - Dan Mungas
- University of California, Davis Departments of Neurology
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21
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Barthold D, Marcum ZA, Chen S, White L, Ailabouni N, Basu A, Coe NB, Gray SL. Difficulty with Taking Medications Is Associated with Future Diagnosis of Alzheimer's Disease and Related Dementias. J Gen Intern Med 2021; 36:863-868. [PMID: 33037589 PMCID: PMC8041972 DOI: 10.1007/s11606-020-06279-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medication management requires complex cognitive functioning, and therefore, difficulty taking medications might be an early sign of cognitive impairment and could be a risk factor for Alzheimer's disease and related dementias (ADRD). Accordingly, people with difficulty taking medications may benefit from more detailed cognitive screening, potentially aiding in the diagnosis of ADRD, which is underdiagnosed. We are unaware of evidence on medication management difficulties that precede a real-world ADRD diagnosis in the USA. OBJECTIVE Examine the association between difficulty taking medications and subsequent real-world ADRD diagnoses. DESIGN Case-control study, using Health and Retirement Study (HRS) survey data linked to Medicare claims. PARTICIPANTS A total of 1461 HRS respondents with an ADRD diagnosis observed from 1993 to 2012 (cases), matched by year of birth, wave of HRS entry, and sex to 3771 controls with no ADRD diagnosis. MAIN MEASURES We examined the association between diagnosis of ADRD and self-reported difficulty taking medications in the preceding years (1-2 and 3-4 years prior to case definition). Control individuals were assigned the index date from their matched case. Conditional logistic regressions adjusted for age, sex, race, education, and comorbidities. KEY RESULTS Compared with matched controls, cases had higher prevalence of difficulty taking medications 1-2 years prior to diagnosis (11.0% versus 2.3%), and 3-4 years prior to diagnosis (5.8% versus 2.3%). Adjusted analyses showed that compared with individuals without ADRD, those with an ADRD diagnosis had more than four times higher odds of difficulty taking medications 1-2 years prior (OR = 4.56 (CI 3.30-6.31)), and more than two times higher odds of difficulty taking medications 3-4 years prior (OR = 2.41 (CI 1.61-3.59)). CONCLUSIONS Odds of medication difficulty 1-2 years prior were more than four times greater for individuals with ADRD diagnoses compared with those without ADRD. Medication management difficulties may prompt further cognitive screening, potentially aiding in earlier recognition of ADRD.
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Affiliation(s)
- Douglas Barthold
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA.
- The Plein Center for Geriatric Pharmacy Research, Education, and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA.
| | - Zachary A Marcum
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
- The Plein Center for Geriatric Pharmacy Research, Education, and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Shuxian Chen
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | | | - Nagham Ailabouni
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
- The Plein Center for Geriatric Pharmacy Research, Education, and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA
- Quality Use of Medicine and Pharmacy Practice Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Norma B Coe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shelly L Gray
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
- The Plein Center for Geriatric Pharmacy Research, Education, and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA
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22
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Lowe DA, Linck JF. Item Response Theory Analysis of the Texas Functional Living Scale. Arch Clin Neuropsychol 2021; 36:135-144. [PMID: 32722804 DOI: 10.1093/arclin/acaa051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/05/2020] [Accepted: 06/23/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The Texas Functional Living Scale (TFLS) is a performance-based measure of functional abilities assessing the domains of time, money and calculation, communication, and memory. It is likely that certain items are more sensitive at different levels of functional impairment, with some signaling milder degrees of functional difficulty. This study analyzed psychometric characteristics of individual TFLS items using item response theory (IRT) in an outpatient clinical sample. METHOD In total, 270 adult outpatients completed the TFLS during clinical neuropsychological evaluation. IRT analysis using 2PL and graded response model was applied to the TFLS. RESULTS Item parameters, item characteristic curves, and information curves were produced. Item difficulty (a) parameters ranged from 1.05 to 2.23, and item discrimination (b) parameters ranged from -4.11 to 0.51. CONCLUSIONS TFLS items were differentially sensitive along the continuum of functional impairment. Items that were most sensitive to milder degrees of functional impairment involved clock drawing, microwave programming, financial calculation, and prospective memory. Other items that were optimally precise in more severe degrees of functional impairment involved interacting with a calendar and a relatively simple financial calculation task. These findings suggest that the ability to pass at least some of the items on the TFLS may not necessarily reflect fully intact functional abilities. Certain TFLS items may be able to detect the presence of subtle functional difficulties.
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Affiliation(s)
- Deborah A Lowe
- University of Oklahoma Health Sciences Center, Department of Psychiatry & Behavioral Sciences, Oklahoma City, OK, USA
| | - John F Linck
- University of Oklahoma Health Sciences Center, Department of Psychiatry & Behavioral Sciences, Oklahoma City, OK, USA
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23
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Dubbelman MA, Jutten RJ, Tomaszewski Farias SE, Amariglio RE, Buckley RF, Visser PJ, Rentz DM, Johnson KA, Properzi MJ, Schultz A, Donovan N, Gatchell JR, Teunissen CE, Van Berckel BNM, Van der Flier WM, Sperling RA, Papp KV, Scheltens P, Marshall GA, Sikkes SAM. Decline in cognitively complex everyday activities accelerates along the Alzheimer's disease continuum. Alzheimers Res Ther 2020; 12:138. [PMID: 33121534 PMCID: PMC7597034 DOI: 10.1186/s13195-020-00706-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Impairment in daily functioning is a clinical hallmark of dementia. Difficulties with "instrumental activities of daily living" (IADL) seem to increase gradually over the course of Alzheimer's disease (AD), before dementia onset. However, it is currently not well established how difficulties develop along the preclinical and prodromal stages of AD. We aimed to investigate the trajectories of decline in IADL performance, as reported by a study partner, along the early stages of AD. METHODS In a longitudinal multicenter study, combining data from community-based and memory clinic cohorts, we included 1555 individuals (mean age 72.5 ± 7.8 years; 50% female) based on availability of amyloid biomarkers, longitudinal IADL data, and clinical information at baseline. Median follow-up duration was 2.1 years. All amyloid-positive participants (n = 982) were classified into the National Institute on Aging-Alzheimer's Association (NIA-AA) clinical stages ranging from preclinical AD (1) to overt dementia (4+). Cognitively normal amyloid-negative individuals (n = 573) served as a comparison group. The total scores of three study-partner reported IADL questionnaires were standardized. RESULTS The rate of decline in cognitively normal (stage 1) individuals with and without abnormal amyloid did not differ (p = .453). However, from stage 2 onwards, decline was significantly faster in individuals on the AD continuum (B [95%CI] = - 0.32 [- 0.55, - 0.09], p = .007). The rate of decline increased with each successive stage: one standard deviation (SD) unit per year in stage 3 (- 1.06 [- 1.27, - 0.85], p < .001) and nearly two SD units per year in stage 4+ (1.93 [- 2.19, - 1.67], p < .001). Overall, results were similar between community-based and memory clinic study cohorts. CONCLUSIONS Our results suggest that the rate of functional decline accelerates along the AD continuum, as shown by steeper rates of decline in each successive NIA-AA clinical stage. These results imply that incremental changes in function are a meaningful measure for early disease monitoring. Combined with the low-cost assessment, this advocates the use of these functional questionnaires for capturing the effects of early AD-related cognitive decline on daily life.
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Affiliation(s)
- Mark A Dubbelman
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Roos J Jutten
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | | | - Rebecca E Amariglio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel F Buckley
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Pieter Jelle Visser
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Dorene M Rentz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Properzi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Schultz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy Donovan
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer R Gatchell
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bart N M Van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wiesje M Van der Flier
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathryn V Papp
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philip Scheltens
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Gad A Marshall
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sietske A M Sikkes
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Clinical, Neuro- & Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Abstract
OBJECTIVES Instrumental activities of daily living (IADL) have been operationalized as exhibiting a greater level of complexity than basic ADL. In the same way, incorporating more advanced ADLs may increase the sensitivity of functional measures to identify cognitive changes that may precede IADL impairment. Towards this direction, the IADL-extended scale (IADL-x) consists of four IADL tasks and five advanced ADLs (leisure time activities). DESIGN Retrospective, cross-sectional study. SETTING Athens and Larissa, Greece. PARTICIPANTS 1,864 community-dwelling men and women aged over 64. MEASUREMENTS We employed both the IADL-x and IADL scales to assess functional status among all the participants. Diagnoses were assigned dividing the population of our study into three groups: cognitively normal (CN), mild cognitive impairment (MCI) and dementia patients. Neuropsychological evaluation was stratified in five cognitive domains: memory, language, attention-speed, executive functioning and visuospatial perception. Z scores for each cognitive domain as well as a composite z score were constructed. Models were controlled for age, sex, education and depression. RESULTS In both IADL-x and IADL scales dementia patients reported the most functional difficulties and CN participants the fewest, with MCI placed in between. When we restricted the analyses to the CN population, lower IADL-x score was associated with worse cognitive performance. This association was not observed when using the original IADL scale. CONCLUSION There is strong evidence that the endorsement of more advanced IADLs in functional scales may be useful in detecting cognitive differences within the normal spectrum.
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25
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Sanchez DL, Thomas KR, Edmonds EC, Bondi MW, Bangen KJ. Regional Hypoperfusion Predicts Decline in Everyday Functioning at Three-Year Follow-Up in Older Adults without Dementia. J Alzheimers Dis 2020; 77:1291-1304. [PMID: 32831202 DOI: 10.3233/jad-200490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Increasing evidence indicates that cerebrovascular dysfunction may precede cognitive decline in aging and Alzheimer's disease (AD). Reduced cerebral blood flow (CBF) is associated with cognitive impairment in older adults. However, less is known regarding the association between CBF and functional decline, and whether CBF predicts functional decline beyond cerebrovascular and metabolic risk factors. OBJECTIVE To examine the association between regional CBF and functional decline in nondemented older adults. METHOD One hundred sixty-six (N = 166) participants without dementia from the Alzheimer's Disease Neuroimaging Initiative underwent neuropsychological testing and neuroimaging. Pulsed arterial spin labeling magnetic resonance imaging was acquired to quantify resting CBF. Everyday functioning was measured using the Functional Assessment Questionnaire at baseline and annual follow-up visit across three years. RESULTS Adjusting for age, education, sex, cognitive status, depression, white matter hyperintensity volume, cerebral metabolism, and reference (precentral) CBF, linear mixed effects models showed that lower resting CBF at baseline in the medial temporal, inferior temporal, and inferior parietal lobe was significantly associated with accelerated decline in everyday functioning. Results were similar after adjusting for conventional AD biomarkers, including cerebrospinal fluid (CSF) amyloid-β (Aβ) and hyperphosphorylated tau (p-tau) and apolipoprotein E (APOE) ɛ4 positivity. Individuals who later converted to dementia had lower resting CBF in the inferior temporal and parietal regions compared to those who did not. CONCLUSION Lower resting CBF in AD vulnerable regions including medial temporal, inferior temporal, and inferior parietal lobes predicted faster rates of decline in everyday functioning. CBF has utility as a biomarker in predicting functional declines in everyday life and conversion to dementia.
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Affiliation(s)
- Danielle L Sanchez
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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26
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Corlier FW, Shaw C, Hayes-Larson E, Mungas D, Tomaszewski Farias S, Glymour MM, Whitmer RA, Mayeda ER. Association Between Cognitive Test Performance and Subjective Cognitive Decline in a Diverse Cohort of Older Adults: Findings From the KHANDLE Study. Alzheimer Dis Assoc Disord 2020; 34:198-205. [PMID: 32427599 PMCID: PMC7528733 DOI: 10.1097/wad.0000000000000383] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Subjective cognitive decline (SCD) may represent a low-burden indicator of dementia risk. The value of SCD as a proxy marker, however, depends on the consistency of associations between subjective and objective cognitive measures across sociodemographic and psychological factors. METHODS We evaluated baseline data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study (n=1615). SCD was measured using the 12-item Everyday Cognition (ECog) scale. Using linear regression models with interaction terms, we evaluated 6 potential modifiers (age, sex, race/ethnicity, educational attainment, family history of dementia, and depressive symptoms) of the association between cognitive performance (episodic memory, executive function) and SCD. RESULTS Lower episodic memory and executive function scores were associated with higher log(ECog scores) (more SCD). Older age and elevated depressive symptoms were associated with higher log(ECog scores). Age (interaction P=0.002) and education (interaction P=0.01) modified the association between executive function and log(ECog scores). Specifically, associations between executive function and log(ECog scores) were stronger among participants with more education and less pronounced among older participants. CONCLUSIONS The association between cognitive performance and log(ECog scores) differed little across sociodemographic and psychological factors. SCD as measured by the ECog may be a valuable proxy for cognitive performance in diverse older adults.
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Affiliation(s)
- Fabian W. Corlier
- University of California, Los Angeles Fielding School of
Public Health, Department of Epidemiology
| | - Crystal Shaw
- University of California, Los Angeles Fielding School of
Public Health, Department of Epidemiology
| | - Eleanor Hayes-Larson
- University of California, Los Angeles Fielding School of
Public Health, Department of Epidemiology
| | - Dan Mungas
- University of California, Davis Alzheimer’s Disease
Research Center
- University of California, Davis Department of
Neurology
| | - Sarah Tomaszewski Farias
- University of California, Davis Alzheimer’s Disease
Research Center
- University of California, Davis Department of
Neurology
| | - M. Maria Glymour
- University of California, San Francisco Department of
Epidemiology and Biostatistics
| | - Rachel A. Whitmer
- University of California, Davis Alzheimer’s Disease
Research Center
- University of California, Davis Department of Public
Health Sciences, Division of Epidemiology
- Kaiser Permanente Division of Research, Oakland, CA
| | - Elizabeth Rose Mayeda
- University of California, Los Angeles Fielding School of
Public Health, Department of Epidemiology
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27
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The Everyday Compensation (EComp) Questionnaire: Construct Validity and Associations with Diagnosis and Longitudinal Change in Cognition and Everyday Function in Older Adults. J Int Neuropsychol Soc 2020; 26:303-313. [PMID: 31668159 DOI: 10.1017/s135561771900119x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The Everyday Compensation scale (EComp) is an informant-rated questionnaire designed to measure cognitively based compensatory strategies that support both everyday memory and executive function in the context of completing instrumental activities of daily living (IADLs). Although previous findings provided early support for the usefulness of the initial version of EComp, the current paper further describes the development, refinement, and validation of EComp as a new assessment tool of compensation for IADLs. METHOD Confirmatory factor analysis (CFA) was used to examine its factor structure. Convergent and predictive validity was evaluated by examining the relationship between EComp and markers of disease, including diagnosis, cognitive change, and trajectories of functional abilities. RESULTS CFA supported a general compensation factor after accounting for variance attributable to IADL domain-specific engagement. The clinical groups differed in compensatory strategy use, with those with dementia using significantly fewer compensatory strategies as compared to individuals with normal cognition or mild cognitive impairment. Greater levels of compensation were related to better cognitive functions (memory and executive function) and functional abilities, as well as slower rates of cognitive and functional decline over time. Importantly, higher levels of compensation were associated with less functional difficulties and subsequently slower rate of functional decline independent of the level of cognitive impairment. CONCLUSIONS Engagement in compensatory strategies among older adults has important implications for prolonging functional independence, even in those with declining cognitive functioning. Results suggest that the revised EComp is likely to be useful in measuring cognitively based compensation in older adults.
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28
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Cheng CH, Wang PN, Mao HF, Hsiao FJ. Subjective cognitive decline detected by the oscillatory connectivity in the default mode network: a magnetoencephalographic study. Aging (Albany NY) 2020; 12:3911-3925. [PMID: 32100722 PMCID: PMC7066903 DOI: 10.18632/aging.102859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/08/2020] [Indexed: 12/29/2022]
Abstract
Discriminating between those with and without subjective cognitive decline (SCD) in cross-sectional investigations using neuropsychological tests is challenging. The available magnetoencephalographic (MEG) studies have demonstrated altered alpha-band spectral power and functional connectivity in those with SCD. However, whether the functional connectivity in other frequencies and brain networks, particularly the default mode network (DMN), exhibits abnormalities in SCD remains poorly understood. We recruited 26 healthy controls (HC) without SCD and 27 individuals with SCD to perform resting-state MEG recordings. The power of each frequency band and functional connectivity within the DMN were compared between these two groups. Posterior cingulate cortex (PCC)-based connectivity was also used to test its diagnostic accuracy as a predictor of SCD. There were no significant between-group differences of spectral power in the regional nodes. However, compared with HC, those with SCD demonstrated increased delta-band and gamma-band functional connectivity within the DMN. Moreover, node strength in the PCC exhibited a good discrimination ability at both delta and gamma frequencies. Our data suggest that the node strength of delta and gamma frequencies in the PCC may be a good neurophysiological marker in the discrimination of individuals with SCD from those without SCD.
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Affiliation(s)
- Chia-Hsiung Cheng
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan.,Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan
| | - Pei-Ning Wang
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of General Neurology, Department of Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurology, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Fen Mao
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Fu-Jung Hsiao
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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29
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Ord AS, Phillips JI, Wolterstorff T, Kintzing R, Slogar SM, Sautter SW. Can deficits in functional capacity and practical judgment indicate cognitive impairment in older adults? APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:737-744. [PMID: 31835920 DOI: 10.1080/23279095.2019.1698582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Neuropsychological literature has demonstrated a significant relationship between cognitive decline and functional capacity, but the directionality of this relationship is still not well understood. Further, the construct of practical judgment has been linked to both cognitive impairment and functional capacity, but these associations are still under-researched. Moreover, few studies to date have examined the relationships among all three constructs utilizing performance-based, ecologically valid and psychometrically sound measures. The present study aimed to address this gap in published literature and investigated whether a practical judgment and functional capacity can help differentiate individuals with cognitive dysfunction from those without. Participants were 270 community-dwelling individuals aged 56-95 years referred for neuropsychological evaluation in an outpatient setting. Bivariate correlations revealed moderate to strong relationships among the three studied variables. Additionally, logistic regression analysis indicated that ability to make sound practical judgments and ability to perform instrumental activities of daily living (IADL) can be used as indicators of cognitive impairment. The clinical implications of these findings are discussed.
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Affiliation(s)
- Anna S Ord
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA.,W. G. Hefner VA Medical Center, Salisbury, NC, USA.,Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC, USA
| | - Jacob I Phillips
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA
| | - Trevor Wolterstorff
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA
| | - Rebekah Kintzing
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA
| | - Sue-Mei Slogar
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA
| | - Scott W Sautter
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA
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30
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Wang J, Zhu WH, Li YF, Zhu WW. Temporal precedence of cognitive function and functional abilities: A latent difference score model of the Chinese community-dwelling elders. Int J Geriatr Psychiatry 2019; 34:1892-1899. [PMID: 31469190 DOI: 10.1002/gps.5206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/24/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Little research has explored how cognitive function and activities of daily living (ADL) affect each other over time. In addition, no current finding provides a clear hint to the temporal precedence between them. The present study tries to address these limitations of prior studies by utilizing a longitudinal data and advanced statistical modeling. METHODS This study analyzed the data from the China Health and Retirement Longitudinal Study (CHARLS), a prospective observational study performed every 2 years for a total of three waves between 2011 and 2015 using a multistage probability sampling. Cognitive function was measured on the basis of three aspects of cognitive performance. Functional abilities were assessed using six types of activities of ADL and five types of instrumental ADL (IADL). Latent difference score modeling was employed to investigate the temporal precedence between cognitive function and ADL. RESULTS The best fitting model indicates poor cognitive function precede worsening in ADL function, whereas the current findings did not support that poor ADL predate the cognition decline or reciprocal influence hypotheses. CONCLUSIONS The elderly with poor cognitive function may be more vulnerable to deterioration in ADL. Findings underscore the importance of early screening for cognitive function among the elderly as the key strategy to prevent further ADL impairment and keep independence.
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Affiliation(s)
- Juan Wang
- School of Public Health, Guangzhou Medical University, Guangzhou, China.,Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei-Heng Zhu
- College of information science and technology, Jinan University, Guangzhou, China
| | - You-Fu Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei-Wen Zhu
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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31
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Shaked D, Sunderaraman P, Piscitello J, Cines S, Hale C, Devanand D, Karlawish J, Cosentino S. Modification of everyday activities and its association with self-awareness in cognitively diverse older adults. PLoS One 2019; 14:e0222769. [PMID: 31697690 PMCID: PMC6837494 DOI: 10.1371/journal.pone.0222769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/06/2019] [Indexed: 01/05/2023] Open
Abstract
Cognitive impairment (CI) in older adults is frequently accompanied by difficulty performing complex everyday activities (e.g., managing finances). However, it is unclear if and how older adults with CI modify their activities (i.e., Do individuals continue, monitor, seek help with, change their approach to, or stop different activities?). In the current study, we examined if older adults with CI are concerned about their ability to carry out complex activities, if and how they modify activities based on their concern, and the factors associated with activity modification. We hypothesized that older adults with CI will more frequently be concerned about, and modify, everyday activities than cognitively healthy (HE) older adults, and that higher awareness of memory loss in the CI group would relate to more frequent modification. The sample included 81 older adults (51 HEs; mean age 70.02 (7.34) and 30 CI; mean age 75.97 (8.12)). Compared to HEs, the CI group reported having more concern about, F(3,77) = 5.50, p = 0.02, and modifying a greater number of activities, F(3,77) = 5.02, p = 0.03. Medication management (30%) and completing taxes (33.3%) were among the most frequently modified activities for the CI and HE groups, respectively. In the CI group, higher memory awareness was associated with more concern (r = .53, p = .005) and activity modification (r = 0.55, p = .003). Findings provide novel information about how cognitively diverse older adults navigate complex activities in daily life. We propose a preliminary theoretical model by which self-awareness may influence navigation of everyday activities in the context of CI.
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Affiliation(s)
- Danielle Shaked
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States of America
| | - Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
| | - Jennifer Piscitello
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
| | - Sarah Cines
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
| | - Christiane Hale
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
| | - Davangere Devanand
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
- Division of Geriatric Psychiatry, Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States of America
| | - Jason Karlawish
- Healthy Brain Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
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32
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Villeneuve SC, Houot M, Cacciamani F, Verrijp M, Dubois B, Sikkes S, Epelbaum S. Latent class analysis identifies functional decline with Amsterdam IADL in preclinical Alzheimer's disease. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:553-562. [PMID: 31650012 PMCID: PMC6804616 DOI: 10.1016/j.trci.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Trials in Alzheimer's disease (AD) now include participants at the earliest stages to prevent further decline. However, the lack of tools sensitive to subtle functional changes in early-stage AD hinders the development of new therapies as it is difficult to prove their clinical relevance. Methods We assessed functional changes over three years in 289 elderly memory complainers from the Investigation of Alzheimer's Predictors in subjective memory complainers cohort using the Amsterdam Instrumental-Activities-of-Daily-Living questionnaire (A-IADL-Q). Results No overall functional decline related to AD imaging markers was evidenced. However, five distinct classes of A-IADL-Q trajectories were identified. The largest class (212 [73.4%]) had stable A-IADL-Q scores over 3 years. A second group (23 [8.0%]) showed a persistent functional decline, higher amyloid load (P = .0005), and lower education (P = .0392). Discussion The A-IADL-Q identified a subtle functional decline in asymptomatic at-risk AD individuals. This could have important implications in the field of early intervention in AD.
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Affiliation(s)
- Sarah-Christine Villeneuve
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Center of excellence of neurodegenerative disease (CoEN) and National Reference Center for Rare or Early Dementias Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, Paris, France.,Department of Geriatry, Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Marion Houot
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Center of excellence of neurodegenerative disease (CoEN) and National Reference Center for Rare or Early Dementias Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, Paris, France
| | - Federica Cacciamani
- Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Inserm, U 1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Sorbonne Université, Paris, France.,Inria, Aramis project-team, Paris, France
| | - Merike Verrijp
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bruno Dubois
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Center of excellence of neurodegenerative disease (CoEN) and National Reference Center for Rare or Early Dementias Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, Paris, France.,Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Inserm, U 1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Sorbonne Université, Paris, France
| | - Sietske Sikkes
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stéphane Epelbaum
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Center of excellence of neurodegenerative disease (CoEN) and National Reference Center for Rare or Early Dementias Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, Paris, France.,Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Inserm, U 1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Sorbonne Université, Paris, France.,Inria, Aramis project-team, Paris, France
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Mis R, Devlin K, Drabick D, Giovannetti T. Heterogeneity of Informant-Reported Functional Performance in Mild Cognitive Impairment: A Latent Profile Analysis of the Functional Activities Questionnaire. J Alzheimers Dis 2019; 68:1611-1624. [PMID: 30909219 PMCID: PMC8359776 DOI: 10.3233/jad-180975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Heterogeneity of subtle functional difficulties in mild cognitive impairment (MCI) remains poorly understood. We characterized patterns of informant reports of functional abilities among participants with MCI and the relation between functional ability pattern and cognitive abilities and subsequent decline. Data from 4,273 MCI participants from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) were included in latent profile analyses (LPA) of informant responses on the Functional Activities Questionnaire (FAQ). Profiles from the best fitting model were compared on demographic, clinical, and cognitive variables. The best fitting model supported three profiles varying by level and type of difficulty: intact function (n = 3,299), intermediate (n = 769), and high ratings of difficulty (n = 205). For the Intermediate profile, items related to finances, remembering dates, and travel were rated as most difficult. The High Ratings profile also had elevated ratings on the meal preparation item. Participants with either the Intermediate or High Ratings profile demonstrated a three-fold increase in conversion to dementia as compared to participants with the Intact profile. Demographically, the Intact profile was younger and consisted of a higher proportion of minorities. On cognitive tests, the Intact profile showed the best performance, and the Intermediate profile performed comparably to or better than the High Ratings profile. There is meaningful heterogeneity in informant ratings of function in MCI, though individuals with MCI whose informants report even intermediate-level functional difficulties are more likely to progress to dementia, suggesting that even subtle functional difficulties place individuals at higher risk for future decline.
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Affiliation(s)
- Rachel Mis
- Temple University, Department of Psychology, Philadelphia, PA, USA
| | - Kathryn Devlin
- Thomas Jefferson University, Department of Neurology, Philadelphia, PA, USA
| | - Deborah Drabick
- Temple University, Department of Psychology, Philadelphia, PA, USA
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Differential Contributions of Selective Attention and Sensory Integration to Driving Performance in Healthy Aging and Alzheimer's Disease. J Int Neuropsychol Soc 2018; 24:486-497. [PMID: 29283079 PMCID: PMC5910249 DOI: 10.1017/s1355617717001291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Patients with Alzheimer's disease (AD) demonstrate deficits in cross-cortical feature binding distinct from age-related changes in selective attention. This may have consequences for driving performance given its demands on multisensory integration. We examined the relationship of visuospatial search and binding to driving in patients with early AD and elderly controls (EC). METHODS Participants (42 AD; 37 EC) completed search tasks requiring either luminance-motion (L-M) or color-motion (C-M) binding, analogs of within and across visual processing stream binding, respectively. Standardized road test (RIRT) and naturalistic driving data (CDAS) were collected alongside clinical screening measures. RESULTS Patients performed worse than controls on most cognitive and driving indices. Visual search and clinical measures were differentially related to driving behavior across groups. L-M search and Trail Making Test (TMT-B) were associated with RIRT performance in controls, while C-M binding, TMT-B errors, and Clock Drawing correlated with CDAS performance in patients. After controlling for demographic and clinical predictors, L-M reaction time significantly predicted RIRT performance in controls. In patients, C-M binding made significant contributions to CDAS above and beyond demographic and clinical predictors. RIRT and C-M binding measures accounted for 51% of variance in CDAS performance in patients. CONCLUSIONS Whereas selective attention is associated with driving behavior in EC, cross-cortical binding appears most sensitive to driving in AD. This latter relationship may emerge only in naturalistic settings, which better reflect patients' driving behavior. Visual integration may offer distinct insights into driving behavior, and thus has important implications for assessing driving competency in early AD. (JINS, 2018, 24, 486-497).
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Tomaszewski Farias S, Schmitter-Edgecombe M, Weakley A, Harvey D, Denny KG, Barba C, Gravano JT, Giovannetti T, Willis S. Compensation Strategies in Older Adults: Association With Cognition and Everyday Function. Am J Alzheimers Dis Other Demen 2018; 33:184-191. [PMID: 29357670 PMCID: PMC10852491 DOI: 10.1177/1533317517753361] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/RATIONALE Compensation strategies may contribute to greater resilience among older adults, even in the face of cognitive decline. This study sought to better understand how compensation strategy use among older adults with varying degrees of cognitive impairment impacts everyday functioning. METHODS In all, 125 older adults (normal cognition, mild cognitive impairment, dementia) underwent neuropsychological testing, and their informants completed questionnaires regarding everyday compensation and cognitive and functional abilities. RESULTS Cognitively normal and mild cognitive impairment older adults had greater levels of compensation use than those with dementia. Higher levels of neuropsychological functioning were associated with more frequent compensation use. Most importantly, greater frequency of compensation strategy use was associated with higher levels of independence in everyday function, even after accounting for cognition. CONCLUSION Use of compensation strategies is associated with higher levels of functioning in daily life among older adults. Findings provide strong rational for development of interventions that directly target such strategies.
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Affiliation(s)
| | | | - Alyssa Weakley
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
| | - Katherine G. Denny
- Department of Neurology, School of Medicine, University of California, Davis, CA, USA
| | - Cheyanne Barba
- Department of Neurology, School of Medicine, University of California, Davis, CA, USA
| | - Jason T. Gravano
- Department of Neurology, School of Medicine, University of California, Davis, CA, USA
| | | | - Sherry Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Radiology, Integrated Brain Imaging Center (IBIC), University of Washington, Seattle, WA
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Weintraub S, Carrillo MC, Farias ST, Goldberg TE, Hendrix JA, Jaeger J, Knopman DS, Langbaum JB, Park DC, Ropacki MT, Sikkes SAM, Welsh-Bohmer KA, Bain LJ, Brashear R, Budur K, Graf A, Martenyi F, Storck MS, Randolph C. Measuring cognition and function in the preclinical stage of Alzheimer's disease. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:64-75. [PMID: 29955653 PMCID: PMC6021264 DOI: 10.1016/j.trci.2018.01.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Alzheimer's Association's Research Roundtable met in November 2016 to explore how best to measure changes in cognition and function in the preclinical stage of Alzheimer's disease. This review will cover the tools and instruments currently available to identify populations for prevention trials, and measure subtle disease progression in the earliest stages of Alzheimer's disease, and will include discussions of suitable cognitive, behavioral, functional, composite, and biological endpoints for prevention trials. Current prevention trials are reviewed including TOMMOROW, Alzheimer's Prevention Initiative Autosomal Dominant Alzheimer's Disease Trial, the Alzheimer's Prevention Initiative Generation Study, and the Anti-Amyloid Treatment in Asymptomatic Alzheimer's to compare current approaches and tools that are being developed.
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Affiliation(s)
- Sandra Weintraub
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Judith Jaeger
- Cognition Metrics, LLC, Wilmington, DE, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | | | - Sietske A M Sikkes
- Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands.,Amsterdam Neuroscience, Amsterdam, Netherlands
| | | | - Lisa J Bain
- Independent Science Writer, Elverson, PA, USA
| | - Robert Brashear
- Janssen Research and Development, Titusville, New Jersey, USA
| | | | - Ana Graf
- Novartis Pharma AG, Basel, Switzerland
| | | | | | - Christopher Randolph
- MedAvante-Prophase, Hamilton, NJ, USA.,Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
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Self-perceived Difficulties in Everyday Function Precede Cognitive Decline among Older Adults in the ACTIVE Study. J Int Neuropsychol Soc 2018; 24:104-112. [PMID: 28797312 PMCID: PMC5750129 DOI: 10.1017/s1355617717000546] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Careful characterization of how functional decline co-evolves with cognitive decline in older adults has yet to be well described. Most models of neurodegenerative disease postulate that cognitive decline predates and potentially leads to declines in everyday functional abilities; however, there is mounting evidence that subtle decline in instrumental activities of daily living (IADLs) may be detectable in older individuals who are still cognitively normal. METHODS The present study examines how the relationship between change in cognition and change in IADLs are best characterized among older adults who participated in the ACTIVE trial. Neuropsychological and IADL data were analyzed for 2802 older adults who were cognitively normal at study baseline and followed for up to 10 years. RESULTS Findings demonstrate that subtle, self-perceived difficulties in performing IADLs preceded and predicted subsequent declines on cognitive tests of memory, reasoning, and speed of processing. CONCLUSIONS Findings are consistent with a growing body of literature suggesting that subjective changes in everyday abilities can be associated with more precipitous decline on objective cognitive measures and the development of mild cognitive impairment and dementia. (JINS, 2018, 24, 104-112).
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Cooper RA, Benge J, Lantrip C, Soileau MJ. The Everyday Cognition Scale in Parkinson's disease. Proc (Bayl Univ Med Cent) 2017; 30:265-267. [PMID: 28670053 DOI: 10.1080/08998280.2017.11929611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
This brief report describes caregiver ratings on the Everyday Cognition (ECog) scale, a psychometrically robust measure of cognitively driven daily activities that was initially designed for other neurodegenerative conditions, in individuals with Parkinson's disease (PD). In 49 individuals with PD, those with suspected PD dementia had more difficulties across ECog domains than those with normal cognition or mild cognitive impairment. Results from multiple regression analyses revealed that activities captured by the ECog were related to measured cognitive ability, over and above disease duration and demographic factors. The lack of floor and ceiling effects speaks to the potential utility of the instrument in practice and research regarding this population. Preliminary data support the utility of the ECog as a marker of functional impact of cognitive problems in PD, though further research will be required to validate the instrument in this population.
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Affiliation(s)
- Rachel A Cooper
- Division of Neuropsychology, Department of Neurology, Scott & White Medical Center, Temple, Texas (Cooper, Benge, Lantrip); Plummer Movement Disorders Center, Scott & White Medical Center, Temple, Texas (Benge, Soileau); and Department of Internal Medicine, Texas A&M Health Sciences Center, Temple, Texas (Cooper, Benge, Lantrip, Soileau)
| | - Jared Benge
- Division of Neuropsychology, Department of Neurology, Scott & White Medical Center, Temple, Texas (Cooper, Benge, Lantrip); Plummer Movement Disorders Center, Scott & White Medical Center, Temple, Texas (Benge, Soileau); and Department of Internal Medicine, Texas A&M Health Sciences Center, Temple, Texas (Cooper, Benge, Lantrip, Soileau)
| | - Crystal Lantrip
- Division of Neuropsychology, Department of Neurology, Scott & White Medical Center, Temple, Texas (Cooper, Benge, Lantrip); Plummer Movement Disorders Center, Scott & White Medical Center, Temple, Texas (Benge, Soileau); and Department of Internal Medicine, Texas A&M Health Sciences Center, Temple, Texas (Cooper, Benge, Lantrip, Soileau)
| | - Michael J Soileau
- Division of Neuropsychology, Department of Neurology, Scott & White Medical Center, Temple, Texas (Cooper, Benge, Lantrip); Plummer Movement Disorders Center, Scott & White Medical Center, Temple, Texas (Benge, Soileau); and Department of Internal Medicine, Texas A&M Health Sciences Center, Temple, Texas (Cooper, Benge, Lantrip, Soileau)
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Burton RL, O’Connell ME, Morgan DG. Cognitive and Neuropsychiatric Correlates of Functional Impairment Across the Continuum of No Cognitive Impairment to Dementia. Arch Clin Neuropsychol 2017; 33:795-807. [DOI: 10.1093/arclin/acx112] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 11/07/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Rachel L Burton
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Megan E O’Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
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Farias ST, Lau K, Harvey D, Denny KG, Barba C, Mefford AN. Early Functional Limitations in Cognitively Normal Older Adults Predict Diagnostic Conversion to Mild Cognitive Impairment. J Am Geriatr Soc 2017; 65:1152-1158. [PMID: 28306147 DOI: 10.1111/jgs.14835] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine whether specific types of early functional limitations in cognitively normal older adults are associated with subsequent development of mild cognitive impairment (MCI), as well as the relative predictive value of self versus informant report in predicting diagnostic conversion to MCI. DESIGN As a part of a longitudinal study design, participants underwent baseline and annual multidisciplinary clinical evaluations, including a physical and neurological examination, imaging, laboratory work, and neuropsychological testing. SETTING Data used in this study were collected as part of longitudinal research at the University of California, Davis Alzheimer's Disease Center. PARTICIPANTS Individuals diagnosed as having normal cognition at study baseline who had an informant who could complete informant-based ratings and at least one follow-up visit (N = 324). MEASUREMENTS Participants and informants each completed the Everyday Cognition Scale (ECog), an instrument designed to measure everyday function in six cognitively relevant domains. RESULTS Self- and informant-reported functional limitations on the ECog were associated with significantly greater risk of diagnostic conversion to MCI (informant: hazard ratio (HR) = 2.0, 95% confidence interval (CI) = 1.3-3.2, P = .002), with self-report having a slightly higher hazard (HR = 2.3, 95% CI = 1.4-3.6, P < .001). When controlling for baseline cognitive abilities, the effect remained significant for self- and informant-reported functional limitations. CONCLUSION Deficits in everyday memory and executive function domains were the strongest predictors of diagnostic conversion to MCI. Detection of early functional limitations may be clinically useful in assessing the future risk of developing cognitive impairment in cognitively normal older adults.
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Affiliation(s)
- Sarah Tomaszewski Farias
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, California
| | - Karen Lau
- Department of Psychiatry, Marin/Sonoma Service Area, Kaiser Permanente Northern California, The Permanente Medical Group, San Rafael, California
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, California
| | - Katherine G Denny
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, California
| | - Cheyanne Barba
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, California
| | - Anthony N Mefford
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, California
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Harvey PD, Cosentino S, Curiel R, Goldberg TE, Kaye J, Loewenstein D, Marson D, Salmon D, Wesnes K, Posner H. Performance-based and Observational Assessments in Clinical Trials Across the Alzheimer's Disease Spectrum. INNOVATIONS IN CLINICAL NEUROSCIENCE 2017; 14:30-39. [PMID: 28386519 PMCID: PMC5373793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Assessment of the earlier stages of Alzheimer's disease requires different strategies than those previously developed for fully syndromal Alzheimer's disease . This challenge is further magnified in very early stages, where symptomatology may be minimal and functional deficits very subtle to absent. This paper reviews strategies for performance-based assessment of the early stages of Alzheimer's disease, including assessments of cognition, functional capacity, and social cognition. Meetings with an International Society for CNS Clinical Trials and Methodology working group served as the basis for this paper and its companion. The current state of the art of detection and staging-oriented assessments is presented, and information is provided regarding the practicality and validity of these approaches, with a special focus on their usefulness in clinical trials for new medication development.
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Affiliation(s)
- Philip D Harvey
- Drs. Harvey, Curiel, and Loewenstein are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Cosentino is with Columbia University College of Physicians and Surgeons, New York, New York; Dr. Goldberg is with North Shore Hofstra School of Medicine, Hempstead, New York; Dr. Kaye is with University of Alabama, Birmingham, Alabama; Dr. Marson is with University of Oregon, Portland, Oregon; Dr. Salmon is with USCD Medical Center, La Jolla, California; Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames, United Kingdom, and Department of Psychology, Northumbria University, Newcastle, United Kingdom; and Dr. Posner is with Global Product Development, Neuroscience & Pain, Pfizer, Inc., New York, New York
| | - Stephanie Cosentino
- Drs. Harvey, Curiel, and Loewenstein are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Cosentino is with Columbia University College of Physicians and Surgeons, New York, New York; Dr. Goldberg is with North Shore Hofstra School of Medicine, Hempstead, New York; Dr. Kaye is with University of Alabama, Birmingham, Alabama; Dr. Marson is with University of Oregon, Portland, Oregon; Dr. Salmon is with USCD Medical Center, La Jolla, California; Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames, United Kingdom, and Department of Psychology, Northumbria University, Newcastle, United Kingdom; and Dr. Posner is with Global Product Development, Neuroscience & Pain, Pfizer, Inc., New York, New York
| | - Rosie Curiel
- Drs. Harvey, Curiel, and Loewenstein are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Cosentino is with Columbia University College of Physicians and Surgeons, New York, New York; Dr. Goldberg is with North Shore Hofstra School of Medicine, Hempstead, New York; Dr. Kaye is with University of Alabama, Birmingham, Alabama; Dr. Marson is with University of Oregon, Portland, Oregon; Dr. Salmon is with USCD Medical Center, La Jolla, California; Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames, United Kingdom, and Department of Psychology, Northumbria University, Newcastle, United Kingdom; and Dr. Posner is with Global Product Development, Neuroscience & Pain, Pfizer, Inc., New York, New York
| | - Terry E Goldberg
- Drs. Harvey, Curiel, and Loewenstein are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Cosentino is with Columbia University College of Physicians and Surgeons, New York, New York; Dr. Goldberg is with North Shore Hofstra School of Medicine, Hempstead, New York; Dr. Kaye is with University of Alabama, Birmingham, Alabama; Dr. Marson is with University of Oregon, Portland, Oregon; Dr. Salmon is with USCD Medical Center, La Jolla, California; Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames, United Kingdom, and Department of Psychology, Northumbria University, Newcastle, United Kingdom; and Dr. Posner is with Global Product Development, Neuroscience & Pain, Pfizer, Inc., New York, New York
| | - Jeffrey Kaye
- Drs. Harvey, Curiel, and Loewenstein are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Cosentino is with Columbia University College of Physicians and Surgeons, New York, New York; Dr. Goldberg is with North Shore Hofstra School of Medicine, Hempstead, New York; Dr. Kaye is with University of Alabama, Birmingham, Alabama; Dr. Marson is with University of Oregon, Portland, Oregon; Dr. Salmon is with USCD Medical Center, La Jolla, California; Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames, United Kingdom, and Department of Psychology, Northumbria University, Newcastle, United Kingdom; and Dr. Posner is with Global Product Development, Neuroscience & Pain, Pfizer, Inc., New York, New York
| | - David Loewenstein
- Drs. Harvey, Curiel, and Loewenstein are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Cosentino is with Columbia University College of Physicians and Surgeons, New York, New York; Dr. Goldberg is with North Shore Hofstra School of Medicine, Hempstead, New York; Dr. Kaye is with University of Alabama, Birmingham, Alabama; Dr. Marson is with University of Oregon, Portland, Oregon; Dr. Salmon is with USCD Medical Center, La Jolla, California; Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames, United Kingdom, and Department of Psychology, Northumbria University, Newcastle, United Kingdom; and Dr. Posner is with Global Product Development, Neuroscience & Pain, Pfizer, Inc., New York, New York
| | - Daniel Marson
- Drs. Harvey, Curiel, and Loewenstein are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Cosentino is with Columbia University College of Physicians and Surgeons, New York, New York; Dr. Goldberg is with North Shore Hofstra School of Medicine, Hempstead, New York; Dr. Kaye is with University of Alabama, Birmingham, Alabama; Dr. Marson is with University of Oregon, Portland, Oregon; Dr. Salmon is with USCD Medical Center, La Jolla, California; Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames, United Kingdom, and Department of Psychology, Northumbria University, Newcastle, United Kingdom; and Dr. Posner is with Global Product Development, Neuroscience & Pain, Pfizer, Inc., New York, New York
| | - David Salmon
- Drs. Harvey, Curiel, and Loewenstein are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Cosentino is with Columbia University College of Physicians and Surgeons, New York, New York; Dr. Goldberg is with North Shore Hofstra School of Medicine, Hempstead, New York; Dr. Kaye is with University of Alabama, Birmingham, Alabama; Dr. Marson is with University of Oregon, Portland, Oregon; Dr. Salmon is with USCD Medical Center, La Jolla, California; Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames, United Kingdom, and Department of Psychology, Northumbria University, Newcastle, United Kingdom; and Dr. Posner is with Global Product Development, Neuroscience & Pain, Pfizer, Inc., New York, New York
| | - Keith Wesnes
- Drs. Harvey, Curiel, and Loewenstein are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Cosentino is with Columbia University College of Physicians and Surgeons, New York, New York; Dr. Goldberg is with North Shore Hofstra School of Medicine, Hempstead, New York; Dr. Kaye is with University of Alabama, Birmingham, Alabama; Dr. Marson is with University of Oregon, Portland, Oregon; Dr. Salmon is with USCD Medical Center, La Jolla, California; Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames, United Kingdom, and Department of Psychology, Northumbria University, Newcastle, United Kingdom; and Dr. Posner is with Global Product Development, Neuroscience & Pain, Pfizer, Inc., New York, New York
| | - Holly Posner
- Drs. Harvey, Curiel, and Loewenstein are with the University of Miami Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, Florida; Dr. Cosentino is with Columbia University College of Physicians and Surgeons, New York, New York; Dr. Goldberg is with North Shore Hofstra School of Medicine, Hempstead, New York; Dr. Kaye is with University of Alabama, Birmingham, Alabama; Dr. Marson is with University of Oregon, Portland, Oregon; Dr. Salmon is with USCD Medical Center, La Jolla, California; Dr. Wesnes is with Wesnes Cognition Ltd., Streatley on Thames, United Kingdom, and Department of Psychology, Northumbria University, Newcastle, United Kingdom; and Dr. Posner is with Global Product Development, Neuroscience & Pain, Pfizer, Inc., New York, New York
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Chen Y, Denny KG, Harvey D, Farias ST, Mungas D, DeCarli C, Beckett L. Progression from normal cognition to mild cognitive impairment in a diverse clinic-based and community-based elderly cohort. Alzheimers Dement 2016; 13:399-405. [PMID: 27590706 DOI: 10.1016/j.jalz.2016.07.151] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/20/2016] [Accepted: 07/28/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Investigation of the conversion rates from normal cognition (NC) to mild cognitive impairment (MCI) is important, as effective early intervention could potentially prevent or substantially delay the onset of dementia. However, reported conversion rates differ across studies and recruitment source. Our study examined predictors of conversion from NC to MCI in a racially and ethnically diverse sample drawn both from community and clinic recruitment sources. METHODS Rates and predictors of conversion were assessed in an ongoing prospective longitudinal study at University of California, Davis, Alzheimer's Disease Center from 2000 to 2015. Participants (n = 254) were recruited through a clinic (5%) and community sample (95%). They were clinically confirmed as cognitively normal at baseline and followed up to seven years. Recruitment source, demographic factors (age, gender, race/ethnicity, year of education, APOE ε4 positive), cognitive measures (SENAS test scores), functional assessments (CDR sum of boxes), and neuroimaging measures (total brain volume, total hippocampal volume, white hyperintensity volume) were assessed as predictors of conversion from cognitively normal to mild cognitive impairment using proportional hazards models. RESULTS Of 254 participants, 62 (11 clinic, 51 community) progressed to MCI. The clinic-based sample showed an annual conversion rate of 30% (95% CI 17%-54%) per person-year, whereas the community-based sample showed a conversion rate of 5% (95% CI 3%-6%) per person-year. Risk factors for conversion include clinic-based recruitment, being older, lower executive function and worse functional assessment at baseline, and smaller total brain volume. DISCUSSION Older adults who sought out a clinical evaluation, even when they are found to have normal cognition, have increased risk of subsequent development of MCI. Results are consistent with other studies showing subjective cognitive complaints are a risk for future cognitive impairment, but extend such findings to show that those who seek evaluation for their complaints are at particularly high risk. Moreover, these individuals have subtle, but significant differences in functional and cognitive abilities that, in the presence of concerns and evidence of atrophy on by brain imaging, warrant continued clinical follow-up. These risk factors could also be used as stratification variables for dementia prevention clinical trial design.
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Affiliation(s)
- Yingjia Chen
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Katherine G Denny
- Department of Neurology, University of California, Davis, Davis, CA, USA
| | - Danielle Harvey
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | | | - Dan Mungas
- Department of Neurology, University of California, Davis, Davis, CA, USA
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, Davis, CA, USA
| | - Laurel Beckett
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA.
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McAlister C, Schmitter-Edgecombe M. Everyday functioning and cognitive correlates in healthy older adults with subjective cognitive concerns. Clin Neuropsychol 2016; 30:1087-103. [PMID: 27240886 DOI: 10.1080/13854046.2016.1190404] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Few studies have examined functional abilities and complaints in healthy older adults (HOAs) with subjective cognitive concerns (SCC). The aims of this study were to assess everyday functioning in HOAs reporting high and low amounts of SCC and examine cognitive correlates of functional abilities. METHOD Twenty-six HOAs with high SCC and 25 HOAs with low SCC, as well as their knowledgeable informants, completed the Instrumental Activities of Daily Living-Compensation (IADL-C), a questionnaire measure of everyday functioning. RESULTS After controlling for depression, the high-SCC group self-reported significantly more everyday difficulties on the IADL-C, including all subdomains. Compared to the low-SCC group, informants for the high-SCC group endorsed more difficulties on the IADL-C and specifically the social skills subdomain. For the high-SCC group, poorer self-report of everyday functioning was related to poorer executive functioning and temporal order memory. CONCLUSIONS These findings indicate that there may be subtle functional changes that occur early in the spectrum of cognitive decline in individuals with high SCC, and these functional changes are evident to informants. Further work is needed to investigate whether individuals with both SCC and functional difficulties are at an even higher risk for progression to mild cognitive impairment.
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Affiliation(s)
- Courtney McAlister
- a Department of Psychology , Washington State University , Pullman , WA , USA
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Mcalister C, Schmitter-Edgecombe M, Lamb R. Examination of Variables That May Affect the Relationship Between Cognition and Functional Status in Individuals with Mild Cognitive Impairment: A Meta-Analysis. Arch Clin Neuropsychol 2016; 31:123-47. [PMID: 26743326 DOI: 10.1093/arclin/acv089] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 12/13/2022] Open
Abstract
The objective of this meta-analysis was to improve understanding of the heterogeneity in the relationship between cognition and functional status in individuals with mild cognitive impairment (MCI). Demographic, clinical, and methodological moderators were examined. Cognition explained an average of 23% of the variance in functional outcomes. Executive function measures explained the largest amount of variance (37%), whereas global cognitive status and processing speed measures explained the least (20%). Short- and long-delayed memory measures accounted for more variance (35% and 31%) than immediate memory measures (18%), and the relationship between cognition and functional outcomes was stronger when assessed with informant-report (28%) compared with self-report (21%). Demographics, sample characteristics, and type of everyday functioning measures (i.e., questionnaire, performance-based) explained relatively little variance compared with cognition. Executive functioning, particularly measured by Trails B, was a strong predictor of everyday functioning in individuals with MCI. A large proportion of variance remained unexplained by cognition.
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Affiliation(s)
| | | | - Richard Lamb
- Department of Teaching and Learning, Washington State University, Pullman, WA, USA
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Abstract
Alzheimer disease (AD) and frontotemporal dementia (FTD) are 2 neurodegenerative diseases with differing cognitive and neuropathologic profiles. Although both diseases ultimately result in functional disability, differences in the profiles of everyday functioning between the 2 groups have not been well characterized. The present study examines potential differences in the types of everyday functional limitations present in these 2 dementias. The present study compared individuals with AD (N=240) or FTD (N=13). The Everyday Cognition (ECog) scale was used to measure distinct domains of everyday cognition: everyday memory, everyday language, everyday visuospatial ability, and a variety of everyday executive abilities. A total ECog score was used to represent global disability level. The groups showed equivalent levels of global disability. However, AD group exhibited worse Everyday Memory and Everyday Visuospatial abilities than the FTD group. Contrary to expectation, FTD was not more impaired in everyday executive abilities. Results remained similar when accounting for severity of cognitive impairment or disease duration. Findings suggest that a somewhat different pattern of everyday functional difficulties can be seen across dementia types.
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Affiliation(s)
- Lovingly Quitania Park
- Department of Neurology, University of California, Davis, CA
- California Clinical Trials Medical Group/PAREXEL International, Glendale, CA
- Department of Graduate Psychology, Azusa Pacific University, Azusa, CA
| | - Danielle Harvey
- Department of Public Health Sciences, University of California, Davis, CA
| | - Julene Johnson
- Institute for Health & Aging; Department of Social and Behavioral Sciences
- Department of Neurology, University of California, San Francisco, San Francisco, CA
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Early Cognitively Based Functional Limitations Predict Loss of Independence in Instrumental Activities of Daily Living in Older Adults. J Int Neuropsychol Soc 2015; 21:688-98. [PMID: 26391766 PMCID: PMC5540650 DOI: 10.1017/s1355617715000818] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Older adults with early forms of neurodegenerative disease are at risk for functional disability, which is often defined by the loss of independence in instrumental activities of daily living (IADLs). The current study investigated the influence of mild changes in everyday functional abilities (referred to as functional limitations) on risk for development of incident functional disability. A total of 407 participants, who were considered cognitively normal or diagnosed with mild cognitive impairment (MCI) at baseline, were followed longitudinally over an average 4.1 years (range=0.8-9.2 years). Informant-based ratings from the Everyday Cognition (ECog; Farias et al., 2008) and the Instrumental Activities of Daily Living (Lawton & Brody, 1969) scales assessed the degree of functional limitations and incident IADL disability, respectively. Cox proportional hazards models revealed that more severe functional limitations (as measured by the Total ECog score) at baseline were associated with approximately a four-fold increased risk of developing IADL disability a few years later. Among the ECog domains, functional limitations in Everyday Planning, Everyday Memory, and Everyday Visuospatial domains were associated with the greatest risk of incident functional disability. These results remained robust even after controlling for participants' neuropsychological functioning on tests of executive functions and episodic memory. Current findings indicate that early functional limitations have prognostic value in identifying older adults at risk for developing functional disability. Findings highlight the importance of developing interventions to support everyday abilities related to memory, executive function, and visuospatial skills in an effort to delay loss of independence in IADLs.
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Vellas B, Bateman R, Blennow K, Frisoni G, Johnson K, Katz R, Langbaum J, Marson D, Sperling R, Wessels A, Salloway S, Doody R, Aisen P. Endpoints for Pre-Dementia AD Trials: A Report from the EU/US/CTAD Task Force. J Prev Alzheimers Dis 2015; 2:128-135. [PMID: 26247004 PMCID: PMC4523051 DOI: 10.14283/jpad.2015.55] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
For Alzheimer's disease treatment trials that focus on the pre-dementia stage of disease, outcome measures are needed that will enable assessment of disease progression in patients who are clinically normal. The EU/US CTAD Task Force, an international collaboration of investigators from industry, academia, non-profit foundations, and regulatory agencies, met in Philadelphia, Pennsylvania, USA, on November 19, 2014 to discuss existing and novel outcome assessments that may be useful in pre-dementia trials. Composite measures that assess changes in episodic memory, executive function, global cognition, and global function have recently been developed by a number of groups and appear to be sensitive at this stage. Functional measures that involve real-life complex tasks also appear to capture early subtle changes in pre-dementia subjects and have the advantage of representing clinically meaningful change. Patient reported outcomes and novel CSF and imaging biomarkers have also shown promise. More studies are needed to validate all of these tests in the pre-dementia population. Many of them have been incorporated as exploratory measures in ongoing or planned trials.
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Affiliation(s)
- B Vellas
- UMR1027 Inserm, F-31073, Toulouse, France ; University of Toulouse III, F-31073, France ; Gerontopole Toulouse, Toulouse University Hospital, F-31000, Toulouse, France
| | - R Bateman
- Washington University School of Medicine, St. Louis, MO, USA
| | - K Blennow
- University of Gothenburg, MöIndal Hospital, Sahlgrenska University Hospital, 43180 MöIndal, Sweden
| | - G Frisoni
- University Hospitals and University of Geneva, Geneva, Switzerland ; IRCCS Fatebenefratelli, Brescia, Italy
| | - K Johnson
- Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - R Katz
- Division of Neuropharmacological Drug Products, U.S. Food and Drug Administration, USA
| | - J Langbaum
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - D Marson
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - R Sperling
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Wessels
- Eli Lilly and Company, Indianapolis, IN, USA
| | - S Salloway
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - R Doody
- Baylor College of Medicine, Houston, TX, USA
| | - P Aisen
- Department of Neurosciences, University of California, San Diego, San Diego, CA USA
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Rueda AD, Lau KM, Saito N, Harvey D, Risacher SL, Aisen PS, Petersen RC, Saykin AJ, Farias ST. Self-rated and informant-rated everyday function in comparison to objective markers of Alzheimer's disease. Alzheimers Dement 2014; 11:1080-9. [PMID: 25449531 DOI: 10.1016/j.jalz.2014.09.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/12/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
It is recognized that individuals with mild cognitive impairment (MCI) already demonstrate difficulty in aspects of daily functioning, which predicts disease progression. This study examined the relationship between self- versus informant-report of functional ability, and how those reports relate to objective disease measures across the disease spectrum (i.e. cognitively normal, MCI, Alzheimer's disease). A total of 1080 subjects with self- and/or informant-rated Everyday Cognition questionnaires were included. Objective measures included cognitive functioning, structural brain atrophy, cerebrospinal fluid abnormalities, and a marker of amyloid deposition using positron emission tomography with [18F]AV45 (florbetapir). Overall, informant-report was consistently more associated with objective markers of disease than self-report although self-reported functional status may still have some utility in early disease.
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Affiliation(s)
- Alicia D Rueda
- Veterans Affairs, Northern California Health Care System, Sacramento, CA, USA
| | - Karen M Lau
- Department of Neurology, University of California, Davis, Sacramento, CA
| | - Naomi Saito
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Danielle Harvey
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | | | - Paul S Aisen
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Ronald C Petersen
- Department of Neurology and the Mayo Alzheimer Disease Research Center, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Andrew J Saykin
- Indiana University School of Medicine, Indianapolis, IN, USA
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Rog LA, Park LQ, Harvey DJ, Huang CJ, Mackin S, Farias ST. The independent contributions of cognitive impairment and neuropsychiatric symptoms to everyday function in older adults. Clin Neuropsychol 2014; 28:215-36. [PMID: 24502686 DOI: 10.1080/13854046.2013.876101] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The everyday functional capacities of older adults are determined by multiple factors. The primary goal of the present study was to evaluate whether apathy and depression have unique influences on degree of functional impairment, independent of the effects of specific cognitive impairments. Participants included 344 older adults (199 normal, 87 with MCI, 58 with dementia). The Everyday Cognition (ECog) scales were used to measure both global and domain-specific functional abilities. Neuropsychiatric symptoms of depression and apathy were measured by the Neuropsychiatric Inventory (NPI), and specific neuropsychological domains measured included episodic memory and executive functioning. Results indicated that worse memory and executive function, as well as greater depression and apathy, were all independent and additive determinants of poorer functional abilities. Apathy had a slightly more restricted effect than the other variables across the specific functional domains assessed. Secondary analysis suggested that neuropsychiatric symptoms may be more strongly associated with everyday function within cognitively normal and MCI groups, while cognitive impairment is more strongly associated with everyday function in dementia. Thus, a somewhat different set of factors may be associated with functional status across various clinical groups.
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Affiliation(s)
- Lauren A Rog
- a VeteransAffairs Northern California Health Care System , Martinez , CA , USA
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