1
|
OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1185-1198. [DOI: 10.1093/arclin/acac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
|
2
|
Ryu HJ, Moon Y, Kim M, Kim HJ, Galvin JE, Han SH. Validation of the Korean Quick Dementia Rating System (K-QDRS). J Alzheimers Dis 2021; 84:1645-1656. [PMID: 34719493 DOI: 10.3233/jad-210584] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Quick Dementia Rating System (QDRS) is a brief and rapid dementia staging tool that does not require a trained rater. OBJECTIVE The purpose of this study is to demonstrate the validity, reliability, and diagnostic usefulness of the Korean version of the QDRS (K-QDRS). METHODS We collected a total of 411 subject-informant dyads including cognitively unimpaired (CU, n = 22), mild cognitive impairment (MCI, n = 198), and dementia (n = 191). The Clinical Dementia Rating (CDR) scale, Korean version of the Mini-Mental State Examination (K-MMSE), Korean version of instrumental activity of daily living (K-IADL), Short Form of the Geriatric Depression Scale, Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI), and detailed neuropsychological tests were administered as gold standards of dementia staging, cognition, function, mood, and behavior. RESULTS Internal consistency of the K-QDRS was excellent with Cronbach's alpha of 0.933. Concurrent validity was also satisfactory, with the K-QDRS correlating highly with the CDR Sum of Boxes (Pearson's r = 0.791), K-MMSE (Pearson's r = -0.518), K-IADL (Pearson's r = 0.727), and CGA-NPI (Pearson's r = 0.700). The K-QDRS was highly correlated with the global CDR, K-IADL, and CGA-NPI. We suggested two types of comparisons (for initial diagnosis and for follow-up evaluation). The cutoff scores for follow-up were 1.0 for MCI, 3.5 for very mild dementia, 6.5 for mild dementia, and 11.0 for moderate dementia. CONCLUSION The K-QDRS is a valid and reliable dementia rating questionnaire and can be used, briefly and rapidly, in various settings like clinical practices, longitudinal cohort studies, and community primary care.
Collapse
Affiliation(s)
- Hui Jin Ryu
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Yeonsil Moon
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Minyoung Kim
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hee-Jin Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Seol-Heui Han
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| |
Collapse
|
3
|
Fearn S, Bartolomeu Pires S, Agarwal V, Roberts HC, Spreadbury J, Kipps C. The Causes and Impact of Crisis for People with Parkinson's Disease: A Patient and Carer Perspective. JOURNAL OF PARKINSONS DISEASE 2021; 11:1935-1945. [PMID: 34250952 DOI: 10.3233/jpd-212641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The reasons for acute hospital admissions among people with Parkinson's disease are well documented. However, understanding of crises that are managed in the community is comparatively lacking. Most existing literature on the causes of crisis for people with Parkinson's disease (PwP) uses hospital data and excludes the individual's own perspective on the crisis trigger and the impact of the crisis on their care needs. OBJECTIVE To identify the causes and impact of crises in both community and hospital settings, from a patient and carer perspective. METHODS A total of 550 UK-based PwP and carers completed a survey on (a) their own personal experiences of crisis, and (b) their general awareness of potential crisis triggers for PwP. RESULTS In addition to well-recognised causes of crisis such as falls, events less widely associated with crisis were identified, including difficulties with activities of daily living and carer absence. The less-recognised crisis triggers tended to be managed more frequently in the community. Many of these community-based crises had a greater impact on care needs than the better-known causes of crisis that more frequently required hospital care. PwP and carer responses indicated a good general knowledge of potential crisis triggers. PwP were more aware of mental health issues and carers were more aware of cognitive impairment and issues with medications. CONCLUSION These findings could improve care of Parkinson's by increasing understanding of crisis events from the patient and carer perspective, identifying under-recognised crisis triggers, and informing strategies for best recording symptoms from PwP and carers.
Collapse
Affiliation(s)
- Sarah Fearn
- Human Development and Health, Faculty of Medicine, University of Southampton, UK.,NIHR Applied Research Collaboration Wessex, University of Southampton, UK
| | - Sandra Bartolomeu Pires
- NIHR Applied Research Collaboration Wessex, University of Southampton, UK.,Neurodegenerative Research, R&D, University Hospital Southampton NHS Trust, UK
| | - Veena Agarwal
- Neurodegenerative Research, R&D, University Hospital Southampton NHS Trust, UK.,School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, UK
| | - Helen C Roberts
- Human Development and Health, Faculty of Medicine, University of Southampton, UK.,NIHR Applied Research Collaboration Wessex, University of Southampton, UK.,Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, UK
| | - John Spreadbury
- Human Development and Health, Faculty of Medicine, University of Southampton, UK.,NIHR Applied Research Collaboration Wessex, University of Southampton, UK
| | - Christopher Kipps
- NIHR Applied Research Collaboration Wessex, University of Southampton, UK.,Wessex Neurological Centre, University Hospital Southampton, Southampton, UK.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
| |
Collapse
|
4
|
Ala TA, Simpson G, Holland MT, Tabassum V, Deshpande M, Fifer A. Many caregivers of persons with memory loss or Alzheimer's disease are unaware of the abilities of their persons with AD to recall their drugs and medical histories. DEMENTIA 2018; 19:2354-2367. [PMID: 30590957 DOI: 10.1177/1471301218820969] [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: 11/17/2022]
Abstract
BACKGROUND Caregiver awareness of the abilities of those they care for has much practical importance, especially from the safety standpoint. OBJECTIVES To determine whether the caregivers of persons with memory impairment or Alzheimer's disease know if their persons are able to recall their own drugs and medical histories. METHOD Persons with prodromal or probable AD (persons with AD) and their caregivers who were visiting our medical school's neurology and internal medicine clinics for routine follow-up care were recruited on the days of their appointments. Sixty-four caregiver-person with AD dyads were recruited. We first asked the caregivers to predict the ability of their persons with AD to answer questions about their drugs and medical histories. We then asked the persons with AD the questions to determine the accuracy of their caregivers' predictions. RESULTS Considering the caregivers of those with Mini-Mental State Exam scores ≥24, 41% incorrectly predicted whether their persons with AD could recall the number of drugs they were taking, 24% incorrectly predicted whether they could recall the names of the drugs, and 34% incorrectly predicted whether they could recall why they were taking the drugs. Most of the caregivers' errors were overestimations. As expected, the persons with AD themselves had much difficulty in answering the questions; only 30% could recall the number of drugs they were taking, only 14% could recall the names of the drugs, and only 16% could recall why they were taking the drugs. CONCLUSIONS Many caregivers of persons with memory impairment or AD are unaware of their persons' inability to recall their drugs and medical histories. Particularly concerning is the relatively high frequency of caregiver overestimations of the abilities of their persons with AD, which highlights a safety concern and presents an opportunity for caregiver education.
Collapse
Affiliation(s)
- Thomas A Ala
- Center for Alzheimer's Disease and Related Disorders, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - GaToya Simpson
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, USA
| | | | - Vajeeha Tabassum
- University of California, San Francisco, Fresno Medical Education Program, Fresno, CA, USA
| | - Maithili Deshpande
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Amber Fifer
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
| |
Collapse
|
5
|
Patient- and Caregiver-Related Factors Associated with Caregiver Assessed Global Deterioration Scale Scoring in Demented Patients. Curr Gerontol Geriatr Res 2018; 2018:9396160. [PMID: 29971098 PMCID: PMC6008841 DOI: 10.1155/2018/9396160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/07/2018] [Indexed: 12/02/2022] Open
Abstract
Background Informant-based rating scales are widely used in dementia but patients' and caregivers' features influence the final scoring. We aimed to evaluate the role of patient- and caregiver-related factors in a caregiver rated Global Deterioration Scale (GDS) score in a sample of Greek patients with dementia. Methods We included 194 patients with dementia and 194 caregivers/family relatives; Mini-Mental State Examination (MMSE); Neuropsychiatric Inventory (NPI); Katz Index of Activities of Daily Living (K-IADL) were administered to (a) patients and Center for Epidemiologic Studies-Depression (CES-D) Scale; Zarit Burden Interview (ZBI) to (b) caregivers. Participants' demographics and patients' and caregivers' characteristics were entered into a 3-block regression analysis. Results The final model explained 55% of the total variance of the caregiver assessed GDS score. The following variables significantly contributed to the final model: MMSE (β=-0.524); K-IADL (β=-0.264); ZBI (β=0.145). Conclusion We herein confirm the contribution of patients' cognitive and functional status and caregivers' burden in caregiver rated GDS scoring irrespective of demographic-related characteristics.
Collapse
|
6
|
Morrell L, Camic PM, Genis M. Factors associated with informant-reported cognitive decline in older adults: A systemised literature review. DEMENTIA 2018; 18:2760-2784. [DOI: 10.1177/1471301218759836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Dementia diagnoses are typically made where there is a significant, progressive decline in cognitive functioning. Evidence of such decline is increasingly established through information provided by informants. However, some studies demonstrate that informant reports may not always be accurate and may be biased by extraneous factors. This review aimed to elucidate factors that have been identified as potentially having some influence on informant reports of cognitive decline. Method A search of PsychInfo, ASSIA, PubMed and Web of Science databases identified 13 peer-reviewed studies that met criteria for inclusion in the review. Results Reviewed studies provide some evidence for associations between informant-reported cognitive decline and demographic characteristics (patient age, education, ethnicity and informant gender), clinical factors (dementia severity, diagnosis, behavioural disturbance, everyday functioning) and psychological factors (patient depressive symptoms and neuroticism, informant psychological distress and burden). Several methodological limitations of the evidence base were identified. Conclusion Findings suggest that informant-reported cognitive decline may not always be wholly reliable in that information holds potential to be influenced by both patient and informant characteristics. Clinical and empirical implications are discussed.
Collapse
Affiliation(s)
| | | | - Michelle Genis
- Kent and Medway NHS and Social Care Partnership Trust, UK
| |
Collapse
|
7
|
Azar M, Zhu C, DeFeis B, Gu Y, Ornstein K, Lawless S, Cosentino S. Increased Reporting Accuracy of Alzheimer Disease Symptoms in Caribbean Hispanic Informants. Alzheimer Dis Assoc Disord 2017; 31:328-334. [PMID: 28557843 PMCID: PMC5699953 DOI: 10.1097/wad.0000000000000199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Informant report of symptoms is essential for diagnosing and characterizing Alzheimer disease (AD). Differences in the perception and experience of dementia across ethnicities may influence informant report. Understanding such differences is critical given that among those with AD, Hispanics are disproportionately affected. METHODS Cross-sectional analyses examined informant report of cognitive and functional symptoms in mild AD across white (n=107) and Caribbean Hispanic (n=71) informants. To explore its accuracy, informant report of symptoms was compared against objective measures of patient performance. RESULTS Adjusted analyses revealed Hispanics reported more symptoms than white informants. Informant report of symptoms was inversely correlated with patients' global cognition in both ethnic groups. Only Hispanic report of symptoms was significantly associated with memory and language performance. DISCUSSION Informant report of symptoms was associated with patients' global cognition, reflecting relatively accurate informant reports in both ethnic groups, and was stronger in Hispanics when examining memory and language. Such differences may reflect cultural caregiving practices and perceptions of dementia, having implications for diagnosis and treatment.
Collapse
Affiliation(s)
- Martina Azar
- Cognitive Neuroscience Division, Department of Neurology, G.H. Sergievsky Center, and Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center
| | - Carolyn Zhu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Brittany DeFeis
- Cognitive Neuroscience Division, Department of Neurology, G.H. Sergievsky Center, and Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology, G.H. Sergievsky Center, and Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center
| | - Katherine Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Siobhan Lawless
- Cognitive Neuroscience Division, Department of Neurology, G.H. Sergievsky Center, and Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, G.H. Sergievsky Center, and Taub Institute for Research on Alzheimer’s Disease and The Aging Brain, Columbia University Medical Center
| |
Collapse
|
8
|
Oldham MA, Piddoubny W, Peterson R, Lee HB. Detection and Management of Preexisting Cognitive Impairment in the Critical Care Unit. Crit Care Clin 2017; 33:441-459. [PMID: 28601131 DOI: 10.1016/j.ccc.2017.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Older adults account for half of intensive care unit (ICU) admissions and ICU days, and approximately 2 in 5 older adults in the ICU have preexisting cognitive impairment (PCI). PCI identification is important for risk stratification and may influence ICU utilization and decision-making surrogacy. PCI is overlooked in more than half of patients without screening; however, screening instruments can identify PCI in less than 5 minutes. Management of PCI in the ICU involves addressing associated neuropsychiatric symptoms. Nonpharmacological interventions should be considered the mainstay of treatment; psychotropics may be considered, although available data on their efficacy is limited.
Collapse
Affiliation(s)
- Mark A Oldham
- Department of Psychiatry, Yale School of Medicine, 20 York Street, Fitkin 615, New Haven, CT 06510, USA.
| | - Walter Piddoubny
- Department of Psychiatry, Yale School of Medicine, 20 York Street, Fitkin 615, New Haven, CT 06510, USA
| | - Ryan Peterson
- Department of Psychiatry, Yale School of Medicine, 20 York Street, Fitkin 615, New Haven, CT 06510, USA
| | - Hochang B Lee
- Department of Psychiatry, Yale School of Medicine, 20 York Street, Fitkin 615, New Haven, CT 06510, USA
| |
Collapse
|
9
|
Howland M, Allan KC, Carlton CE, Tatsuoka C, Smyth KA, Sajatovic M. Patient-rated versus proxy-rated cognitive and functional measures in older adults. Patient Relat Outcome Meas 2017; 8:33-42. [PMID: 28352208 PMCID: PMC5358991 DOI: 10.2147/prom.s126919] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Patients with cognitive impairment may have difficulty reporting their functional and cognitive abilities, which are important clinical outcomes. Health care proxies may be able to corroborate patient self-reports. Several studies reported discrepancy between patient and proxy ratings, though the literature is sparse on changes over time of these ratings. Our goals in this 12-month study were to compare patient and proxy reports on functioning, cognition, and everyday executive function, and to further elucidate correlates of patient-proxy discrepancy. METHODS This was a prospective cohort study of individuals older than 70 years who ranged from having no cognitive impairment to having moderate dementia who had a proxy available to complete instruments at baseline (N=76). Measurements included Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory (ADCS-ADLI), Neuro-QOL Executive Function, PROMIS Applied Cognition (PROMIS-Cog), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale. RESULTS Patient- and proxy-rated ADCS-ADLI were correlated at baseline and at 1-year follow-up. Patient and proxy ratings were discrepant on Neuro-QOL Executive Function and PROMIS-Cog. Greater patient-proxy discrepancy on PROMIS-Cog was associated with younger age and less depression, and greater patient-proxy discrepancy on Neuro-QOL Executive Function was associated with less depression and worse cognitive impairment. Patient-proxy discrepancy increased over time for everyday executive function. Changes in proxy-rated but not patient-rated ADCS-ADLI correlated with MMSE changes. CONCLUSION Patients and proxies generally agree in reporting on activities of daily living. Patient and proxy reports differ in their respective evaluation of cognitive functioning and everyday executive function. Ratings from both sources may be preferred for these two domains, though studies using gold standard measures are necessary. It is important that clinicians are aware of the differences between patient and proxy perspective to create an accurate clinical picture and guide treatment.
Collapse
Affiliation(s)
| | | | | | - Curtis Tatsuoka
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center
- Department of Epidemiology and Biostatistics
- Department of Neurology
| | | | - Martha Sajatovic
- Case Western Reserve University School of Medicine
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center
- Department of Neurology
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
10
|
Abstract
Informants serve an essential role in Alzheimer disease research. Were an informant to be replaced during a longitudinal study, this could have negative implications. We used data from the National Alzheimer's Coordinating Center Uniform Data Set to examine the frequency of informant replacement among Alzheimer disease dementia participants, whether patient and informant characteristics were associated with replacement, and how replacement affected research outcome measures. Informant replacement was common (15.5%) and typically occurred after the first or the second research visit. Adult child (24%) and other (38%) informants were more frequently replaced than spouse informants (10%). Older spouse informant age and younger adult child informant age were associated with replacement. The between-visit change in Functional Assessment Questionnaire scores was greater in patients who replaced informants than in those with stable informants. Clinical Dementia Rating-Sum of Boxes, Functional Assessment Questionnaire, and Neuropsychiatric Inventory scores showed greater variability in between-visit change in patients who replaced informants compared with those with stable informants. These findings suggest that informant replacement is relatively common, may have implications to study analyses, and warrant further examination in the setting of clinical trials.
Collapse
|
11
|
Abstract
Epistemological challenges that attend the study of the degree to which people with Alzheimer’s disease (AD) manifest insight into their deficits are explored in terms of (1) the social dynamics of the situations that those afflicted confront in the process; (2) issues surrounding the use of discrepancy scores and interviews with those afflicted and their caregivers; and (3) problems surrounding the sorts of inferences that are made through the use of statistics in group studies. It is recommended that an understanding of and sensitivity to the personhood of the afflicted individual is of paramount import in interpreting his or her behavior in such situations, and that ignoring the individuality of those afflicted and their scores on assessment instruments in favor of statistical analysis of group data can result in grievous errors of interpretation of that data. Case examples are provided to underscore these points.
Collapse
|
12
|
Persson K, Brækhus A, Selbæk G, Kirkevold Ø, Engedal K. Burden of Care and Patient's Neuropsychiatric Symptoms Influence Carer's Evaluation of Cognitive Impairment. Dement Geriatr Cogn Disord 2016; 40:256-67. [PMID: 26304633 DOI: 10.1159/000437298] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore what effects the carer's burden and patient's neuropsychiatric symptoms have on carer's report on patient's cognitive functioning and instrumental activities of daily living (IADL). METHODS We included 1,832 patients, 742 with mild cognitive impairment and 1,090 with dementia [mean age 75.2 years (SD 9.5), 56% women]. The following scales were used: Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Lawton and Brody IADL Scale, Neuropsychiatric Inventory Questionnaire (NPI-Q), Relatives' Stress Scale (RSS), Mini-Mental State Examination (MMSE), and Clock Drawing Test (CDT). Correlation analyses and multiple linear regression analyses were carried out to explore which factors were associated with IQCODE and IADL. RESULTS Spouses scored lower on the IQCODE compared with non-spouses in spite of equivalent MMSE and CDT scores. In a multiple linear regression analysis using IQCODE as a dependent variable, beta for MMSE was -0.368 (p < 0.001) adjusted for demographic factors. After adjusting also for RSS and NPI-Q, MMSE beta was -0.279 (p < 0.001), RSS beta 0.294 (p < 0.001), and NPI beta 0.237 (p < 0.001). Similar results were found using IADL as the dependent variable. CONCLUSION Carer's burden and neuropsychiatric symptoms of the patient are important biasing factors when carers report on cognitive function and IADL.
Collapse
Affiliation(s)
- Karin Persson
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tx00F8;nsberg, Norway
| | | | | | | | | |
Collapse
|
13
|
Abstract
Executive functioning is frequently impaired among people with Parkinson's disease (PD). Little is known about awareness of executive functioning, in the sense of being able to accurately appraise functioning or performance, in people with PD, or about whether awareness is particularly affected in those who have impaired executive functioning. This study explored awareness of executive functioning at the levels of evaluative judgment (comparison of self- and informant ratings of executive functioning), and performance monitoring (comparison of performance on cognitive tests and self-ratings of that performance). Awareness levels were assessed in people with PD with and without executive deficits, and in healthy controls. When the level of agreement between self- and informant ratings was considered, people with PD in both groups appeared as accurate in evaluating their overall executive functioning as healthy controls. When appraising their performance as the specific tasks were completed, people with PD who had impairments in executive functioning appeared less accurate than controls and people with PD without executive impairments. People with PD who have executive deficits may lack the ability to recognize their limitations while performing specific tasks, which may have implications for their functional abilities.
Collapse
|
14
|
Shardell M, Alley DE, Miller RR, Hicks GE, Magaziner J. Comparing reports from hip-fracture patients and their proxies: implications on evaluating sex differences in disability and depressive symptoms. J Aging Health 2011; 24:367-83. [PMID: 22210805 DOI: 10.1177/0898264311424208] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study compared sex differences in disability and depressive symptoms using reports from hip fracture patients and their proxies. METHOD Hip fracture patients (49 men, 183 women) aged ≥65 years and proxies were interviewed 1 year postfracture. Outcomes were Center for Epidemiological Studies Depression (CES-D) and number of dependencies in performing activities of daily living and instrumental activities of daily living. RESULTS Mean ADL sex differences (men minus women) were 0.40 (p = .37) using proxy reports and 0.70 (p = .08) using patient self-reports. Mean CES-D sex differences were -3.60 (p = .02) using proxy reports and -1.26 (p = .38) using patient self-reports. Discrepancies between patients and proxies were smallest for proxies who have lived with the patient ≥ 1 year. DISCUSSION Patients and proxies produced conflicting conclusions about sex differences. Results suggest that ideal proxies to recruit are those who have been cohabitating with the patients for an extended length of time.
Collapse
|
15
|
Viscogliosi C, Desrosiers J, Belleville S, Caron CD, Ska B, BRAD Group. Differences in Participation According to Specific Cognitive Deficits Following a Stroke. ACTA ACUST UNITED AC 2011; 18:117-26. [DOI: 10.1080/09084282.2010.547779] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
Pisani MA, Kong SYJ, Kasl SV, Murphy TE, Araujo KLB, Van Ness PH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 2009; 180:1092-7. [PMID: 19745202 DOI: 10.1164/rccm.200904-0537oc] [Citation(s) in RCA: 539] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Delirium is a frequent occurrence in older intensive care unit (ICU) patients, but the importance of the duration of delirium in contributing to adverse long-term outcomes is unclear. OBJECTIVES To examine the association of the number of days of ICU delirium with mortality in an older patient population. METHODS We performed a prospective cohort study in a 14-bed ICU in an urban acute care hospital. The patient population comprised 304 consecutive admissions 60 years of age and older. MEASUREMENTS AND MAIN RESULTS The main outcome was 1-year mortality after ICU admission. Patients were assessed daily for delirium with the Confusion Assessment Method for the ICU and a validated chart review method. The median duration of ICU delirium was 3 days (range, 1-46 d). During the follow-up period, 153 (50%) patients died. After adjusting for relevant covariates, including age, severity of illness, comorbid conditions, psychoactive medication use, and baseline cognitive and functional status, the number of days of ICU delirium was significantly associated with time to death within 1 year post-ICU admission (hazard ratio, 1.10; 95% confidence interval, 1.02-1.18). CONCLUSIONS Number of days of ICU delirium was associated with higher 1-year mortality after adjustment for relevant covariates in an older ICU population. Investigations should be undertaken to reduce the number of days of ICU delirium and to study the impact of this reduction on important health outcomes, including mortality and functional and cognitive status.
Collapse
Affiliation(s)
- Margaret A Pisani
- Department of Internal Medicine, Pulmonary & Critical Care Section, and the Program on Aging, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208057, New Haven, CT 06520-8057, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Pisani MA, Murphy TE, Araujo KLB, Slattum P, Van Ness PH, Inouye SK. Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population. Crit Care Med 2009; 37:177-83. [PMID: 19050611 PMCID: PMC2700732 DOI: 10.1097/ccm.0b013e318192fcf9] [Citation(s) in RCA: 241] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There is a high prevalence of delirium in older medical intensive care unit (ICU) patients and delirium is associated with adverse outcomes. We need to identify modifiable risk factors for delirium, such as medication use, in the ICU. The objective of this study was to examine the impact of benzodiazepine or opioid use on the duration of ICU delirium in an older medical population. DESIGN Prospective cohort study. SETTING Fourteen-bed medical intensive care unit in an urban university teaching hospital. PATIENTS 304 consecutive admissions age 60 and older. INTERVENTIONS None. MAIN OUTCOME MEASUREMENTS The main outcome measure was duration of ICU delirium, specifically the first episode of ICU delirium. Patients were assessed daily for delirium with the Confusion Assessment Method for the ICU and a validated chart review method. Our main predictor was receiving benzodiazepines or opioids during ICU stay. A multivariable model was developed using Poisson rate regression. RESULTS Delirium occurred in 239 of 304 patients (79%). The median duration of ICU delirium was 3 days with a range of 1-33 days. In a multivariable regression model, receipt of a benzodiazepine or opioid (rate ratio [RR] 1.64, 95% confidence interval [CI] 1.27-2.10) was associated with increased delirium duration. Other variables associated with delirium duration in this analysis include preexisting dementia (RR 1.19, 95% CI 1.07-1.33), receipt of haloperidol (RR 1.35, 95% CI 1.21-1.50), and severity of illness (RR 1.01, 95% CI 1.00-1.02). CONCLUSIONS The use of benzodiazepines or opioids in the ICU is associated with longer duration of a first episode of delirium. Receipt of these medications may represent modifiable risk factors for delirium. Clinicians caring for ICU patients should carefully evaluate the need for benzodiazepines, opioids, and haloperidol.
Collapse
Affiliation(s)
- Margaret A Pisani
- Department of Internal Medicine, Pulmonary and Critical Care Section, and the Program on Aging, Yale University School of Medicine, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Jayasinghe S, Young L, Santiano N, Bauman A, Dickson HG, Rowland J, Anderson T. Hospital care of people living in residential care facilities: Profile, utilization patterns and factors impacting on quality and safety of care. Geriatr Gerontol Int 2007. [DOI: 10.1111/j.1447-0594.2007.00415.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
19
|
Abstract
Recent interest in the empirical exploration of patients' awareness in relation to their clinical states has resulted in a range of approaches taken to evaluate such awareness. These approaches vary in terms of the bases on which awareness is determined and rated, the contents of the measures used, the level of detail and complexity of judgements required, etc. The approaches use different definitions and objects of awareness and hence give rise to different (and on occasions divergent) awareness phenomena. Such differences help to explain both the contradictory nature of published results and the difficulties involved in generalising from them. In practical terms, these differences should encourage the development of management and rehabilitation strategies that are individual to specific phenomena of awareness.
Collapse
|
20
|
Shen J, Gao S, Unverzagt FW, Ogunniyi A, Baiyewu O, Gureje O, Hendrie HC, Hall KS. Validation analysis of informant's ratings of cognitive function in African Americans and Nigerians. Int J Geriatr Psychiatry 2006; 21:618-25. [PMID: 16802282 PMCID: PMC3202708 DOI: 10.1002/gps.1536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To examine informant validity using the Community Screening Interview for Dementia (CSI 'D') both cross-sectionally and longitudinally in two very different cultures and to explore the effects of informants and study participants' characteristics on the validity of informants' reports. METHODS Elderly African Americans age 65 years and older residing in Indianapolis, USA and elderly Yoruba Nigerians age 65 years and older residing in Ibadan, Nigeria were assessed on cognitive functioning using the CSI 'D' at baseline (1992-1993) and five-year follow-up (1997-1998). At baseline, the informant validity in both samples was evaluated against participants' cognitive tests using Pearson correlation and regular regression models. At follow-up, informants ratings on cognitive decline were assessed against participants' cognitive decline scores from baseline to follow-up using biserial correlation and logistic regressions. RESULTS At baseline, informants' reports on cognitive functioning significantly correlated with cognitive scores in both samples (Indianapolis:r = -0.43, p < 0.001; Ibadan:r = -0.47, p < 0.001). The participant-informant relationships significantly affected the informants' reports in the two samples with different patterns (p = 0.005 for Indianapolis and p < 0.001 for Ibadan) at a given level of cognitive functioning. African Americans spouses reported more cognitive problems, while siblings reported more problems for the Yoruba Nigerians. At follow-up, informants' ratings on cognitive decline significantly correlated with the cognitive decline scores (Indianapolis r = 0.38, p < 0.001; Ibadan r = 0.32, p < 0.001). The characteristics of study participants and informants had little impact on the informants' ratings on cognitive decline. CONCLUSIONS Informant reports are valid in assessing the cognitive functioning of study participants both cross-sectionally and longitudinally in two very different cultures, languages and environments.
Collapse
Affiliation(s)
- Jianzhao Shen
- Department of Medicine, Indiana University School of Medicine, Indianapolis, 46202, USA.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
A comprehensive range of literature on awareness in dementia published in peer-reviewed journals during the last 15 years was reviewed with the aim of extracting details of the methods and measurement instruments adopted for the purposes of assessing awareness. Assessment approaches fell into five categories: clinician rating methods, questionnaire-based methods, performance-based methods, phenomenological methods, and multidimensional or combined methods. Ranges of objects of awareness assessment were identified both within and across domains. Strengths and limitations of methods in each category were identified. Reasons for the inconclusive findings from research using the methods described here were considered, and suggestions for future directions were made.
Collapse
Affiliation(s)
- Linda Clare
- School of Psychology, University of Wales Bangor, UK.
| | | | | | | |
Collapse
|
22
|
Pisani MA, Redlich CA, McNicoll L, Ely EW, Friedkin RJ, Inouye SK. Short-term outcomes in older intensive care unit patients with dementia*. Crit Care Med 2005; 33:1371-6. [PMID: 15942358 DOI: 10.1097/01.ccm.0000165558.83676.48] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the impact of dementia on the outcomes of intensive care unit (ICU) care and use of ICU interventions among older patients. DESIGN Prospective observational cohort study. SETTING Urban university teaching hospital. PATIENTS Patients were 395 patients age >/=65 consecutively admitted to a medical ICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Dementia was determined by a previously validated proxy measure, the Modified Blessed Dementia Rating Scale. We chose cut points to focus on patients with moderate-severe dementia at baseline. Our primary outcomes included length of mechanical ventilation and ICU and hospital length of stay. Secondary outcomes included ICU readmission, changes in code status, discharge location, mortality, and use of ICU interventions. Medical record abstraction was performed to determine the rates of ICU outcomes, use of ICU interventions, and potential confounders. Our study documented a prevalence of moderate-severe dementia of 17% in patients age >/=65 admitted to the ICU. Patients with dementia were significantly older (80 vs. 76), more likely to be female (65% vs. 52%), and more likely to be admitted from a nursing home (46% vs. 11%). Patients with dementia had significantly higher Acute Physiology and Chronic Health Evaluation II scores on admission to the ICU (25 vs. 23). Patients with dementia were more likely to have their code status changed to less aggressive in the ICU (24% vs. 14%). There was no significant difference in readmission to the ICU, discharge location, ICU or hospital mortality rate, or use of ICU interventions between patients with and without dementia. CONCLUSIONS Our study documents no difference in outcomes from ICU care in older patients with and without dementia. There was no increased short-term mortality rate in older patients with dementia compared with those without dementia after admission to the ICU. Presumptions that outcomes from critical care are less favorable in patients with dementia should not drive treatment decisions in the ICU.
Collapse
Affiliation(s)
- Margaret A Pisani
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8057, USA.
| | | | | | | | | | | |
Collapse
|
23
|
Ala TA, Berck LG, Popovich AM. Using the Telephone to Call for Help and Caregiver Awareness in Alzheimer Disease. Alzheimer Dis Assoc Disord 2005; 19:79-84. [PMID: 15942325 DOI: 10.1097/01.wad.0000165509.45123.57] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We assessed the ability of 73 patients with Alzheimer disease (AD) and mild cognitive impairment (MCI) from our outpatient clinic to demonstrate how they would use the telephone to call for help in case of an emergency. We also assessed their caregivers' awareness of their abilities. Overall, 44% of the patients did not demonstrate how to call for help correctly if they had no written telephone number to call, and 18% did not when they had a written number. There was an association between the abilities of the patients and their Mini-Mental State Examination (MMSE) scores, with the patients with the lowest scores having the most difficulty (P < 0.0001). Surprisingly, 21% of those with MMSE scores 26-30 did not use the telephone correctly when they had no written number. Of the caregivers, 31% were incorrect in predicting their patients' abilities for the first task, and 11% were incorrect in predicting the second task. We conclude that AD patients lose their ability to use the telephone to call for help as their illness progresses. Furthermore, many caregivers are unaware of their patients' impairment. These findings highlight safety concerns in AD and suggest that caregivers could benefit from education about potential patient losses.
Collapse
Affiliation(s)
- Thomas A Ala
- Center for Alzheimer Disease and Related Disorders, Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9643, USA.
| | | | | |
Collapse
|
24
|
Ala TA, Berck LG, Popovich AM. Knowledge of personal information and caregiver awareness in Alzheimer's disease. Am J Alzheimers Dis Other Demen 2005; 20:119-25. [PMID: 15844758 PMCID: PMC10833337 DOI: 10.1177/153331750502000202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We assessed the ability of 73 patients with Alzheimer's disease (AD) to recall important personal information like their names, their caregivers 'names, their addresses, and their telephone numbers. We also assessed their caregivers' awareness of their abilities. There was an association between the abilities of the patients and their Mini-Mental Status Examination (MMSE) scores, with the patients with the lowest MMSE scores making the most errors. Five to 10 percent of the mildest patients were unable to state their addresses and telephone numbers correctly. The caregivers of the patients with intermediate MMSE scores made the most errors in their predictions, with up to 50 percent being incorrect and up to 37 percent overestimating their patients' abilities. We concluded that AD patients lose their ability to provide personal information as their illness progresses. Caregivers of patients with MMSE ranging from 10 to 25 are the most likely to be unaware of their patients' impairment. These findings highlight safety concerns in AD.
Collapse
Affiliation(s)
- Thomas A Ala
- Center for Alzheimer Disease and Related Disorders, Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | | | | |
Collapse
|
25
|
Abstract
Delirium is a frequent complication in older patients in the ICU and often persists beyond their ICU stay. Delirium in older persons in the ICU is a dynamic and complex process. There is a high prevalence of pre-existing cognitive impairment in patients who are admitted to the medical ICU. This pre-existing cognitive impairment is an important predisposing risk factor for the development of delirium during and after the ICU stay. Given the high rates of delirium in the ICU that range from 50% to 80% (see references [27, 28, 34]), future studies are urgently needed to examine risk factors for delirium in the ICU setting, such as examining the impact of psychoactive medication use on delirium rates and persistence in the ICU setting. Moreover, studies that examine the impact of delirium prevention in the ICU on rates of delirium, duration and persistence of delirium, and long-term cognitive and functional outcomes post-ICU stay are greatly needed.
Collapse
Affiliation(s)
- Margaret A Pisani
- Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8057, USA.
| | | | | |
Collapse
|
26
|
Pisani MA, Redlich C, McNicoll L, Ely EW, Inouye SK. Underrecognition of preexisting cognitive impairment by physicians in older ICU patients. Chest 2004; 124:2267-74. [PMID: 14665510 DOI: 10.1378/chest.124.6.2267] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES Cognitive impairment increases with age, as do many serious illnesses requiring intensive care. Little is known, however, about physician recognition of preexisting cognitive impairment in the ICU and which patient factors may play a role in physician recognition. DESIGN Cross-sectional comparative study. SETTING Urban university teaching hospital. PARTICIPANTS A total of 165 patients aged > or =65 years who were admitted to the medical ICU. MEASUREMENTS Two previously validated proxy measures of cognitive impairment, the modified Blessed dementia rating scale and the informant questionnaire on cognitive decline in the elderly. Physician interviews and medical record abstraction were used to evaluate the recognition of cognitive impairment. RESULTS The prevalence of preexisting cognitive impairment in the ICU was 37%. Attending physicians were unaware of the preexisting cognitive impairment in 53% of cases, and intern physicians were unaware in 59% of cases. The recognition of preexisting cognitive impairment increased as the severity of the cognitive impairment increased. Two independent risk factors were identified that were significantly associated with the increased recognition of preexisting cognitive impairment (ie, impairment in activities of daily living or being admitted to the ICU from a nursing home). If both were present, preexisting cognitive impairment was 13 times more likely to be recognized. CONCLUSIONS A substantial number of older ICU patients have preexisting cognitive impairment on admission to the ICU, and ICU physicians caring for these patients are unaware of this cognitive impairment in the majority of cases. Future research is needed to identify outcomes related to preexisting cognitive impairment and to improve its recognition.
Collapse
Affiliation(s)
- Margaret A Pisani
- Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
| | | | | | | | | |
Collapse
|
27
|
Pisani MA, Inouye SK, McNicoll L, Redlich CA. Screening for preexisting cognitive impairment in older intensive care unit patients: use of proxy assessment. J Am Geriatr Soc 2003; 51:689-93. [PMID: 12752846 DOI: 10.1034/j.1600-0579.2003.00215.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the prevalence of preexisting cognitive impairment (CI) in patients admitted to the medical intensive care unit (ICU) and compare two different proxy measures of preexisting CI in ICU patients. DESIGN Cross-sectional comparative study. SETTING Urban university teaching hospital. PARTICIPANTS One hundred thirty patients aged 65 and older admitted to the medical ICU. MEASUREMENTS Two previously validated proxy measures of CI: the Modified Blessed Dementia Rating Scale (MBDRS) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). RESULTS The prevalence of preexisting CI in the ICU, determined using a combination of the measures, was 42%. Agreement between the two CI measures was 86%, with a kappa of 0.69, with discrepancies being related to the different domains measured by each instrument. CONCLUSION There is a high prevalence of preexisting CI in patients admitted to the medical ICU. Both the MBDRS and IQCODE can be used to screen for preexisting CI in situations where direct patient assessment is not feasible. Future studies are needed to address physician recognition of CI and its effect on patient care decisions and outcomes.
Collapse
Affiliation(s)
- Margaret A Pisani
- Department of Internal Medicine, Yale University School ofMedicine, New Haven, Connecticut 06520, USA.
| | | | | | | |
Collapse
|
28
|
Thompsell A, Lovestone S. Out of sight out of mind? Support and information given to distant and near relatives of those with dementia. Int J Geriatr Psychiatry 2002; 17:804-7. [PMID: 12221652 DOI: 10.1002/gps.692] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Increasing attention has been paid to the needs of family members caring for a person with dementia but little has been written about the impact on the wider family. This paper was intended to see whether the need for information would stretch to those relatives living far from the patient. METHOD A case-control study comparing two sets of relatives of community-dwelling probands in contact with secondary services and having a clinical diagnosis of dementia: one set of relatives living less than an hour away and another set living further away.The reported need for and source of information obtained by relatives was questioned using a specially designed questionnaire. Mini Mental State Examination (MMSE) and Clinical Dementia Ratings Scale were used with probands. RESULTS Relatives living distantly from the person with dementia reported similar rates of subjective distress but were more often dissatisfied with information received. Distant relatives were also less likely to access information from books or lay societies. CONCLUSION The impact of having a relative with dementia does not lessen with distance. The wider family need support and information as well as 'primary carers'. If the whole family is to be supported in their caring role, then clinicians and the lay societies need to widen their supportive net.
Collapse
Affiliation(s)
- Amanda Thompsell
- Old Age Psychiatry, South London and Maudsley NHS Trust, Croydon, UK.
| | | |
Collapse
|
29
|
Kemp NM, Brodaty H, Pond D, Luscombe G. Diagnosing dementia in primary care: the accuracy of informant reports. Alzheimer Dis Assoc Disord 2002; 16:171-6. [PMID: 12218648 DOI: 10.1097/00002093-200207000-00007] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the diagnosis of dementia, information obtained from informants or proxies is important; however, little is known about the circumstances under which informants' reports lack accuracy. This study compares informant reports of cognitive status against psychometric tests to identify the degree of, and factors associated with, discrepant reporting. Four areas of patient cognitive ability were examined: memory of recent events, ability to remember a short list of items after a delay, language/naming abilities, and working memory. Primary care practitioners recruited 248 community-dwelling patients aged 75 years or more or aged 50-74 years with suspected memory complaints; 248 friends or relatives acted as informants. More than half of the informants (60%) gave responses consistent with psychometric testing. Informants who underreported patient difficulties tended to report on patients who were diagnosed as having subclinical dementia, were less educated, and had poorer remote memory. Informants who overreported difficulties were more likely to report on those diagnosed with dementia. While informant accounts are critical for the assessment of dementia, we found that in 40% of cases these reports may be inaccurate, particularly when the patient has low education and poor remote memory or when overall cognitive difficulties are mild.
Collapse
Affiliation(s)
- Nicola M Kemp
- Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia
| | | | | | | |
Collapse
|
30
|
Neri M, Roth M, Rubichi S, DeVreese LP, Bolzani R, Cipolli C. The validity of informant report for grading the severity of Alzheimer's dementia. AGING (MILAN, ITALY) 2001; 13:22-9. [PMID: 11292148 DOI: 10.1007/bf03351490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The validity of informant-based techniques has been established for the detection of dementia cases by non-pathological individuals, but is still controversial for the assessment of the severity of dementia. This study aimed at ascertaining whether informant-based evaluation (the so-called informant report) of the cognitive and behavioral impairment of a patient is valid for grading the severity of dementia, and consistent with objective assessment of the patient's cognitive and behavioral functioning. We enrolled 96 community-dwelling outpatients and 56 controls assessed at the Geriatric Evaluation Unit of the University of Modena, Italy. All patients scored lower than 27 on the MMSE, and met DSM-IV inclusion criteria for Alzheimer's dementia. Patients and controls were administered the CAMDEX interview, containing a section which collects participant (patient or control) and informant evaluations on dementia-related cognitive and behavioral deficits. The informant report resulted effective at MANOVA for grading the severity of dementia in 4 of its 5 measures (namely, memory, everyday activities, general mental functioning and depressed mood), and was correlated with the scores of several scales of the CAMDEX cognitive section (i.e., CAMCOG). Instead, the participant's (patient or control) report showed a lower capacity for grading dementia, and was poorly correlated with the psychometric outcomes of cognitive functioning. On the whole, the results corroborated the validity of the informant report in the diagnostic work-up for grading dementia, given its sensitivity to the severity of dementia, and its consistency with cognitive psychometric outcomes.
Collapse
Affiliation(s)
- M Neri
- Department of Internal Medicine-Geriatric Unit, University of Modena and Reggio Emilia, Italy.
| | | | | | | | | | | |
Collapse
|
31
|
Neumann PJ, Araki SS, Gutterman EM. The use of proxy respondents in studies of older adults: lessons, challenges, and opportunities. J Am Geriatr Soc 2000; 48:1646-54. [PMID: 11129756 DOI: 10.1111/j.1532-5415.2000.tb03877.x] [Citation(s) in RCA: 179] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Proxies play a critical role as sources of health information for older persons with cognitive impairment and other chronic debilitating conditions. This paper reviews the validity of proxy responses for people older than age 60 in the following areas: functioning, physical and mental health, cognition, medical care utilization, and preferences for types of care and health states. DESIGN A Medline review identified 24 clinical studies from 1990 to 1999 that use proxy data as a source of information about older adults. RESULTS In general, studies report fairly good agreement between subjects and proxies in assessments of functioning, physical health, and cognitive status, and fair-to-poor agreement in assessments of psychological well-being. Proxies tend to describe more impairment in functioning and emotional well-being, relative to subjects, a pattern that is particularly marked among persons with cognitive impairment. In addition, proxies who report more caregiver responsibilities and subjective stress from caregiver duties provide more negative assessments of subjects' health and well-being. CONCLUSIONS Findings tend to support the use of proxy ratings among older adults in many areas but not all when self-reports are not feasible. There is a need for more evaluation of proxy data in relation to other measures, such as performance assessments, medical records, and claims data, which may be less subject to respondent biases.
Collapse
Affiliation(s)
- P J Neumann
- Program on the Economic Evaluation of Medical Technology, Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | | | | |
Collapse
|