Urban-rural differences in a memory disorders clinical population

Factors influencing discrepancies in self-reported memory and performance on memory recall in the Canadian Community Health Survey-Healthy Aging, 2008-09

OBJECTIVE

the objectives of this study were: (i) to estimate the rate of discrepancy between participant single-item self-reports of good memory and poor performance on a list-learning task and (ii) to identify the factors including age, gender and health status that influence these discrepant classifications.

STUDY DESIGN AND SETTINGS

in total, 14,172 individuals, aged 45-85, were selected from the 2008-09 Canadian Community Health Survey on Healthy Aging. We examined the individual characteristics of participants with and without discrepancies between memory self-reports and performance with a generalised linear model, adjusting for potential covariates.

RESULTS

the mean age of respondents was 62.9 years with 56.7% being female, 53.8% having post-secondary graduation and 83% being born in Canada. Higher discrepant classification rates we observed for younger people (6.77 versus 3.65 for lowest and highest group), female (5.90 versus 3.68) and with higher education (6.17 versus 3.52). Discrepant classification rates adjusted with all covariates were higher for those without chronic diseases (5.37 [95% Confidence Interval (CI): 4.16, 6.90] versus 4.05 95% CI: 3.38, 4.86; P = 0.0127), those who did not drink alcohol (5.87 95% CI: 4.69, 7.32 versus 3.70 95% CI: 3.00, 4.55; P < 0.0001), lonely participants (5.45 95% CI: 4.20, 7.04 versus 3.99 95% CI: 3.36, 4.77; P = 0.0081) and bilingual participants (5.67 95% CI: 4.18, 7.64 versus 3.83 95% CI: 3.27, 4.50; P = 0.0102).

CONCLUSION

the findings of this study suggest that the self-reported memory and memory performance differ in a substantial proportion of the population. Therefore, relying on a self-reported memory status may not accurately capture those experiencing memory difficulties.

A Review of Diagnostic Process and Postdiagnostic Support for People With Dementia in Rural Areas

Purpose: Early diagnosis of dementia allows the affected individuals to make plans, and helps services to identify and act on need. Previous work has suggested that obtaining an early diagnosis in rural areas can be difficult. This paper discusses diagnosis and postdiagnostic support for people with dementia, with a focus on service delivery in rural areas. Methods: A review of published English language literature 1999 to 2011 identified in Medline, PsycINFO, PubMed, Cochrane Library, and ScienceDirect. Results: Primary care services play a key role in accessing services in many health care systems. The role of primary care staff, and in particular general practitioners, is greatest in rural communities where specialist service access is often reduced. Despite this, rural staff often report limited training on supporting people with dementia. Postdiagnostic services can be more difficult to access in rural areas, and informal caregivers in rural areas can be more reluctant to seek such services. Transport difficulties and distance from specialist services can act as a barrier to service use. Memory services have been offered in both rural and urban areas. Conclusions: Addressing stigma, supporting staff, and signposting access are important in all areas, but seem to be particularly important in rural areas. Training and support for general staff in rural areas can be improved. Memory services provide one way of delivering services in rural areas. Service planners should take negative perceptions of dementia, barriers to access, and training of generalist service providers into account when designing dementia services in rural areas.

Exploring the reasons urban and rural-dwelling older adults participate in memory research

This study examines how underrepresented older urban and rural-dwelling individuals conceptualize participation in cognitive impairment studies. Nine focus groups were held with urban and rural-dwelling older adults who had participated in a community-based memory screening study. Expected and experienced benefits of research participation were motivators for study participation in all focus groups. Results indicate that participation in memory research was believed to lead to an understanding of memory function. Focus group participants expressed an active interest in research on dementia, and viewed research participation as a way to address memory concerns and provide a benefit to society.

Improving access to dementia care: development and evaluation of a rural and remote memory clinic

The availability, accessibility and acceptability of services are critical factors in rural health service delivery. In Canada, the aging population and the consequent increase in prevalence of dementia challenge the ability of many rural communities to provide specialized dementia care. This paper describes the development, operation and evaluation of an interdisciplinary memory clinic designed to improve access to diagnosis and management of early stage dementia for older persons living in rural and remote areas in the Canadian province of Saskatchewan. We describe the clinic structure, processes and clinical assessment, as well as the evaluation research design and instruments. Finally, we report the demographic characteristics and geographic distribution of individuals referred during the first three years.

Memory clinics

Memory clinics were first described in the 1980s. They have become accepted worldwide as useful vehicles for improving practice in the identification, investigation, and treatment of memory disorders, including dementia. They are provided in various settings, the setting determining clientele and practice. All aim to facilitate referral from GPs, other specialists, or by self referral, in the early stages of impairment, and to avoid the stigma associated with psychiatric services. They bring together professionals with a range of skills for the benefit of patients, carers, and colleagues, and contribute to health promotion, health education, audit, and research, as well as service to patients.

Validation of the Spanish version of the Addenbrooke's Cognitive Examination in a rural community in Spain

BACKGROUND

The Addenbrooke's Cognitive Examination (ACE) is a brief cognitive test battery designed to detect and differentiate Alzheimer's disease (AD) and frontotemporal dementia (FTD). Translations of this instrument into French and Malayalam have been recently published

OBJECTIVE

To adapt and validate the ACE into Spanish in a rural population of low-educational level.

SUBJECTS

A clinical group, composed of 70 patients affected by dementia and 25 patients with memory complaints without dementia, was compared with 72 controls matched for gender, age and educational level

METHOD

The clinical group was studied with standard neuropsychological instruments, all patients underwent neuroimaging [Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI), and Single Photon Emission Tomography (SPECT) in all cases of suspected FTD], as well as routine neurological examination. Both groups were studied with the ACE and Clinical Dementia Rating scale (CDR). Sensitivity, specificity, area under curve, reliability and Verbal-Language/ Orientation-Memory (VLOM) ratio were calculated. Subsequently, the sample was stratified regarding educational level in two groups. Receiver Operating Characteristics (ROC) curves were calculated for these conditions. Different cut-off points were calculated addressing educational level.

RESULTS

ROC curves demonstrated the superiority of the ACE in the sub sample of patients that finished school at over 14 years old. VLOM ratio confirmed its usefulness for differential diagnosis between AD and FTD CONCLUSIONS: The Spanish version of the ACE is a useful instrument for dementia diagnosis. In our sample VLOM ratio results were useful for differential diagnosis between AD and FTD. Different cut-off points must be used for different educational levels.

Comparative validity of seven scoring systems for the instrumental activities of daily living scale in rural elders

Lawton and Brody's eight-item Instrumental Activities of Daily Living (IADL) scale is used often with elderly patients but scored in several different ways. We scored the IADL with seven popular procedures ranging from relatively simple to complex (Guttman scores, summed and Rasch scores from dichotomous, trichotomous, and polytomous items) in a sample of rural elders (N = 231). We compared the IADL scales' prediction of concurrent cognitive functioning, depressive symptoms, psychosocial functioning, and health care use (medications, outpatient visits, inpatient days). Validity coefficients ranged from small to large among outcome variables but were highly consistent across IADL scoring procedures. Consequently, researchers and clinicians may prefer to use simpler IADL scoring procedures with this population.