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Pinaka O, Gioulekas F, Routa E, Delliou A, Stamatiadis E, Dratsiou I, Romanopoulou E, Billinis C. Introducing New Paths towards Public Primary Healthcare Services in Greece: Efforts for Scaling-Up Mental Healthcare Services Addressed to Older Adults. Healthcare (Basel) 2022; 10:healthcare10071230. [PMID: 35885757 PMCID: PMC9320876 DOI: 10.3390/healthcare10071230] [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: 05/09/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
The exponential growth in the aging population challenges the Primary Care Providers (PCPs) who provide health care services to older adults who are considered highly vulnerable and are in need of specialized healthcare services. The development of new policies and the adoption of appropriate health strategies by PCPs may improve the early detection and prevention of mental disorders in older adults. This reduces both queuing and costs in outpatient clinics while preventing stigma for patients and families. To this end, specialized training for PCPs at the Local Primary Health Care Unit (LPHCU) was provided in order to conduct efficient assessments of older adults (65 and above years old, without previously diagnosed depression or dementia, and willing to participate). The assessment is based on the Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS). Older adults identified with MMSE <20 and GDS >5 were referred to the psychiatric outpatient clinic. The aim of this study is to discuss evidence-informed policymaking in Greece with a focus on advancing mental health practices and scaling up quality primary healthcare services for older adults.
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Affiliation(s)
- Ourania Pinaka
- 4th Local Primary Healthcare Unit of Ampelokipi Larissa, 5th Regional Health Authority of Thessaly & Sterea, 5–7 Myron, 41447 Larissa, Greece; (E.R.); (A.D.)
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, 43100 Karditsa, Greece;
- Correspondence: ; Tel.: +30-241-0534-235
| | - Fotios Gioulekas
- 5th Regional Health Authority of Thessaly & Sterea, Mezourlo Area, 41110 Larissa, Greece; (F.G.); (E.S.)
| | - Evlampia Routa
- 4th Local Primary Healthcare Unit of Ampelokipi Larissa, 5th Regional Health Authority of Thessaly & Sterea, 5–7 Myron, 41447 Larissa, Greece; (E.R.); (A.D.)
| | - Aikaterini Delliou
- 4th Local Primary Healthcare Unit of Ampelokipi Larissa, 5th Regional Health Authority of Thessaly & Sterea, 5–7 Myron, 41447 Larissa, Greece; (E.R.); (A.D.)
| | - Evangelos Stamatiadis
- 5th Regional Health Authority of Thessaly & Sterea, Mezourlo Area, 41110 Larissa, Greece; (F.G.); (E.S.)
| | - Ioanna Dratsiou
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (I.D.); (E.R.)
| | - Evangelia Romanopoulou
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (I.D.); (E.R.)
| | - Charalambos Billinis
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, 43100 Karditsa, Greece;
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Creavin ST, Noel-Storr AH, Langdon RJ, Richard E, Creavin AL, Cullum S, Purdy S, Ben-Shlomo Y. Clinical judgement by primary care physicians for the diagnosis of all-cause dementia or cognitive impairment in symptomatic people. Cochrane Database Syst Rev 2022; 6:CD012558. [PMID: 35709018 PMCID: PMC9202995 DOI: 10.1002/14651858.cd012558.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In primary care, general practitioners (GPs) unavoidably reach a clinical judgement about a patient as part of their encounter with patients, and so clinical judgement can be an important part of the diagnostic evaluation. Typically clinical decision making about what to do next for a patient incorporates clinical judgement about the diagnosis with severity of symptoms and patient factors, such as their ideas and expectations for treatment. When evaluating patients for dementia, many GPs report using their own judgement to evaluate cognition, using information that is immediately available at the point of care, to decide whether someone has or does not have dementia, rather than more formal tests. OBJECTIVES To determine the diagnostic accuracy of GPs' clinical judgement for diagnosing cognitive impairment and dementia in symptomatic people presenting to primary care. To investigate the heterogeneity of test accuracy in the included studies. SEARCH METHODS We searched MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), Web of Science Core Collection (ISI Web of Science), and LILACs (BIREME) on 16 September 2021. SELECTION CRITERIA We selected cross-sectional and cohort studies from primary care where clinical judgement was determined by a GP either prospectively (after consulting with a patient who has presented to a specific encounter with the doctor) or retrospectively (based on knowledge of the patient and review of the medical notes, but not relating to a specific encounter with the patient). The target conditions were dementia and cognitive impairment (mild cognitive impairment and dementia) and we included studies with any appropriate reference standard such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), International Classification of Diseases (ICD), aetiological definitions, or expert clinical diagnosis. DATA COLLECTION AND ANALYSIS Two review authors screened titles and abstracts for relevant articles and extracted data separately with differences resolved by consensus discussion. We used QUADAS-2 to evaluate the risk of bias and concerns about applicability in each study using anchoring statements. We performed meta-analysis using the bivariate method. MAIN RESULTS We identified 18,202 potentially relevant articles, of which 12,427 remained after de-duplication. We assessed 57 full-text articles and extracted data on 11 studies (17 papers), of which 10 studies had quantitative data. We included eight studies in the meta-analysis for the target condition dementia and four studies for the target condition cognitive impairment. Most studies were at low risk of bias as assessed with the QUADAS-2 tool, except for the flow and timing domain where four studies were at high risk of bias, and the reference standard domain where two studies were at high risk of bias. Most studies had low concern about applicability to the review question in all QUADAS-2 domains. Average age ranged from 73 years to 83 years (weighted average 77 years). The percentage of female participants in studies ranged from 47% to 100%. The percentage of people with a final diagnosis of dementia was between 2% and 56% across studies (a weighted average of 21%). For the target condition dementia, in individual studies sensitivity ranged from 34% to 91% and specificity ranged from 58% to 99%. In the meta-analysis for dementia as the target condition, in eight studies in which a total of 826 of 2790 participants had dementia, the summary diagnostic accuracy of clinical judgement of general practitioners was sensitivity 58% (95% confidence interval (CI) 43% to 72%), specificity 89% (95% CI 79% to 95%), positive likelihood ratio 5.3 (95% CI 2.4 to 8.2), and negative likelihood ratio 0.47 (95% CI 0.33 to 0.61). For the target condition cognitive impairment, in individual studies sensitivity ranged from 58% to 97% and specificity ranged from 40% to 88%. The summary diagnostic accuracy of clinical judgement of general practitioners in four studies in which a total of 594 of 1497 participants had cognitive impairment was sensitivity 84% (95% CI 60% to 95%), specificity 73% (95% CI 50% to 88%), positive likelihood ratio 3.1 (95% CI 1.4 to 4.7), and negative likelihood ratio 0.23 (95% CI 0.06 to 0.40). It was impossible to draw firm conclusions in the analysis of heterogeneity because there were small numbers of studies. For specificity we found the data were compatible with studies that used ICD-10, or applied retrospective judgement, had higher reported specificity compared to studies with DSM definitions or using prospective judgement. In contrast for sensitivity, we found studies that used a prospective index test may have had higher sensitivity than studies that used a retrospective index test. AUTHORS' CONCLUSIONS Clinical judgement of GPs is more specific than sensitive for the diagnosis of dementia. It would be necessary to use additional tests to confirm the diagnosis for either target condition, or to confirm the absence of the target conditions, but clinical judgement may inform the choice of further testing. Many people who a GP judges as having dementia will have the condition. People with false negative diagnoses are likely to have less severe disease and some could be identified by using more formal testing in people who GPs judge as not having dementia. Some false positives may require similar practical support to those with dementia, but some - such as some people with depression - may suffer delayed intervention for an alternative treatable pathology.
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Affiliation(s)
| | | | - Ryan J Langdon
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | | | - Sarah Cullum
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Sarah Purdy
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
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An integrative review of system-level factors influencing dementia detection in primary care. J Am Assoc Nurse Pract 2020; 32:299-305. [PMID: 31274678 DOI: 10.1097/jxx.0000000000000230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of Alzheimer disease (AD) is increasing in the United States, yet more than half of the people with AD are diagnosed late in the course of the disease. Most are identified outside primary care. New approaches to prevention and treatment mean that early detection of AD may improve the quality of life of those affected by the disease. Nurse practitioners (NPs) have an important role in increasing early diagnosis of AD.The purpose of this systematic literature review is to identify health care system factors that contribute to missed or delayed diagnosis of dementia by primary care providers. METHODS Articles were identified through a systematic electronic search of the following databases: MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Results indicate considerable variation in the diagnostic accuracy of dementia by primary care providers. Missed or underdiagnosis of dementia results from organizational, provider, and patient factors. New treatments are under investigation that may slow the progression of AD much better than current therapy, emphasizing the need to improve early detection by clinicians, especially primary care NPs.
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Tung EE, Walston V, Bartley M. Approach to the Older Adult With New Cognitive Symptoms. Mayo Clin Proc 2020; 95:1281-1292. [PMID: 32498781 DOI: 10.1016/j.mayocp.2019.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/30/2019] [Accepted: 10/17/2019] [Indexed: 11/28/2022]
Abstract
Dementia affects nearly 50 million people worldwide, translating into one new case every 3 seconds. Dementia syndrome is one of the leading causes of disability among older adults, yet it remains vastly underdiagnosed. A timely diagnosis of dementia is essential to ensuring optimal care and support of individuals and their loved ones. Although there is no single test for dementia, health care providers can use a structured approach to the workup and management of new cognitive symptoms. Comprehensive MEDLINE and PubMed searches were performed to develop an unbiased, practical diagnostic approach to these symptoms. This review guides primary care providers in the workup, diagnosis, delivery, and initial management of patients presenting with new cognitive symptoms.
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Affiliation(s)
- Ericka E Tung
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN; Division of Community Internal Medicine and the Division of Geriatric Medicine and Gerontology, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - Victoria Walston
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN; Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Mairead Bartley
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN; Division of Community Internal Medicine and the Division of Geriatric Medicine and Gerontology, Mayo Clinic College of Medicine and Science, Rochester, MN
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Abstract
Computerized cognitive assessment tools may facilitate early identification of dementia in the primary care setting. We investigated primary care physicians' (PCPs') views on advantages and disadvantages of computerized testing based on their experience with the Computer Assessment of Mild Cognitive Impairment (CAMCI). Over a 2-month period, 259 patients, 65 years and older, from the family practice of 13 PCPs completed the CAMCI. Twelve PCPs participated in an individual interview. Generally, PCPs felt that the relationship between them and their patients helped facilitate cognitive testing; however, they thought available paper tests were time consuming and not sufficiently informative. Despite concerns regarding elderly patients' computer literacy, PCPs noticed high completion rates and that their patients had generally positive experiences completing the CAMCI. PCPs appreciated the time-saving advantage of the CAMCI and the immediately generated report, but thought the report should be shortened to 1 page and that PCPs should receive training in its interpretation. Our results suggest that computerized cognitive tools such as the CAMCI can address PCPs' concerns with cognitive testing in their offices. Recommendations to improve the practicality of computerized testing in primary care were suggested.
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Klimova B, Toman J, Kuca K. Effectiveness of the dog therapy for patients with dementia - a systematic review. BMC Psychiatry 2019; 19:276. [PMID: 31492131 PMCID: PMC6731615 DOI: 10.1186/s12888-019-2245-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/19/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Dementia represents a mental and economic burden for both patients and their caregivers. Therefore, the aim of this study is to explore the effectiveness of animal assisted therapy (AAT) with special focus on canis therapy among people with dementia, specifically Alzheimer's disease. METHODS The key method of this review study is a systematic review of the research studies detected in the Web of Science, Scopus and PubMed. The search was conducted for the studies dating from 2016 till 31 August 2018 because several review studies were published before. Eventually, only six studies were involved into the final analysis. RESULTS The findings of this review, based on significant effect sizes, reveal that AAT may work as a beneficial and effective complementary treatment, especially in the area of behavioral and psychological symptoms, for patients with different degree of dementia severity if AAT is targeted at their specific needs and interests. CONCLUSIONS More research in the area of methodology for the implementation of AAT is necessary, and more research should be conducted with respect to the use of AAT for the improvement of cognitive functions in people with dementia.
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Affiliation(s)
- Blanka Klimova
- 0000 0000 9258 5931grid.4842.aDepartment of Applied Linguistics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Josef Toman
- 0000 0000 9258 5931grid.4842.aDepartment of Applied Linguistics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Kamil Kuca
- Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic. .,Centre for Basic and Applied Research, Faculty of Informatics and Management, University of Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic.
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Abstract
Background:
Due to the increase in life expectancies and the number of aging population
worldwide, there is a rise of aging diseases, out of which the most common is dementia. Therefore,
researchers all over the world look for another alternative ways that can improve cognitive
competency and neuropsychiatric disorders of these people in order to assist them in maintaining the
quality of their life and reducing the overall economic burden. One of the alternative approache
seems to be non-pharmacological therapies, which are non-invasive, with minimum side effects and
definitely less costly, such as a music therapy (MT).
Objective:
The purpose of this review study is to discuss benefits and limitations of music therapy in
the management of dementia.
Method:
This was done by conducting a literature review of available sources found in the Web of
Science, Scopus and MEDLINE.
Results:
The findings show that MT may be a promising non-invasive strategy with a long history
of use, relatively favorable acceptance among patients with dementia, and its efficacy especially in
the treatment of psycho-behavioral symptoms of dementia.
Conclusion:
However, more research should be conducted in the area of cognitive functioning, as
well as on the mechanism of MT for dementia patients.
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Affiliation(s)
- Blanka Klímová
- Department of Applied Linguistics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Kamil Kuča
- Faculty of Education, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Martin Vališ
- Department of Neurology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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Pelegrini LNC, Mota GMP, Ramos CF, Jesus E, Vale FAC. Diagnosing dementia and cognitive dysfunction in the elderly in primary health care: A systematic review. Dement Neuropsychol 2019; 13:144-153. [PMID: 31285788 PMCID: PMC6601305 DOI: 10.1590/1980-57642018dn13-020002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/20/2019] [Indexed: 11/21/2022] Open
Abstract
Dementia is a public health issue making the screening and diagnosing of dementia and its prodromal phases in all health settings imperative. OBJECTIVE using PRISMA, this systematic review aimed to identify how low-, middle-, and high-income countries establish dementia and cognitive dysfunction diagnoses in primary health care. METHODS studies from the past five years in English, Spanish, and Portuguese were retrieved from Scopus, PubMed, Embase, Lilacs, Scielo, and Web of Science. Of 1987 articles, 33 were selected for analysis. RESULTS only three articles were from middle-income countries and there were no studies from low-income countries. The most used instrument was the Mini-Mental State Examination (MMSE). Mild Cognitive Impairment (MCI) and dementia criteria were based on experts' recommendation as well as on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD-10), respectively. CONCLUSION differences between these criteria among high- and middle-income countries were observed.
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Affiliation(s)
- Lucas N C Pelegrini
- PhD student on the Graduate Program in Fundamental Nursing - Nursing School of Ribeirão Preto/ University of São Paulo (EERP/USP), Ribeirão Preto, SP, Brazil
| | - Gabriela M P Mota
- Master's student on the Graduate Program in Nursing - Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Caio F Ramos
- Master's student on the Graduate Program in Nursing - Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | - Francisco A C Vale
- Professor on the Graduate Program in Nursing - Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
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Thoits T, Dutkiewicz A, Raguckas S, Lawrence M, Parker J, Keeley J, Andersen N, VanDyken M, Hatfield-Eldred M. Association Between Dementia Severity and Recommended Lifestyle Changes: A Retrospective Cohort Study. Am J Alzheimers Dis Other Demen 2018; 33:242-246. [PMID: 29439581 PMCID: PMC10852487 DOI: 10.1177/1533317518758785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Early diagnosis of dementia leads to early treatment which is beneficial to patients and the community. We reviewed initial evaluations from the Spectrum Health Medical Group Neurocognitive Clinic (SHMGNC) to evaluate dementia stage at the time of diagnosis. METHODS We retrospectively reviewed 110 randomly chosen initial evaluations from September 2008 to December 2015 at the SHMGNC. Patients underwent a neurological examination, Montreal Cognitive Assessment, and a battery of neuropsychological testing. RESULTS Of all, 78.9% had moderate or severe dementia at diagnosis. The SHMGNC recommended lifestyle changes (medication assistance, financial assistance, driving restrictions, and institutional care) in 75.8% of patients with dementia. The severity of dementia was associated with the number of lifestyle changes recommended. Cohabitation with a caregiver did not lead to an early diagnosis of dementia. CONCLUSIONS Patients are not undergoing evaluation at the onset of the dementia process. Diagnosis is delayed. Home-based, patient-centered care may improve early screening and detection of dementia.
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Eghdam A, Hamidi U, Bartfai A, Koch S. Facebook as communication support for persons with potential mild acquired cognitive impairment: A content and social network analysis study. PLoS One 2018; 13:e0191878. [PMID: 29377930 PMCID: PMC5788370 DOI: 10.1371/journal.pone.0191878] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 01/05/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Social media has the potential to increase social participation and support for the well-being of individuals with chronic medical conditions. To date, Facebook is the most popular social medium for different types of communication. However, there is a lack of knowledge about the potential use of Facebook as a means of communication for persons with potential Mild Acquired Cognitive Impairment (MACI), a non-progressive mild cognitive impairment after an acquired brain injury. The aim of this study was to explore how persons with potential MACI, specifically persons with perceived brain fatigue after brain injury, communicate through Facebook, to classify the content of the communication and to visualize the frequency and types of interactions. METHODS AND MATERIALS A social network analysis of the interactions between members' and a qualitative content analysis of a whole year's communication of a public Facebook group for Swedish speaking persons (1310 members) with perceived brain fatigue after an illness or injury to the brain were performed. RESULTS The results showed how members use social media technology and Facebook as a means for communication and support for their condition. Individual group members showed very different patterns of communication and interactions. However, for the group as a whole, the most frequent topics in their communication were related to informational support and banter in posts, and socialization in comments. The findings also showed that the majority of members only communicated with few other members and had few direct communications. The most used communication feature of Facebook was likes in form of "thumbs-up". CONCLUSIONS This study indicated that social media and in this case Facebook is used for communication and social support by persons with potential MACI, and revealed that their communication behavior is similar to the healthy population. Further studies relating specific cognitive problems of the participants to the use of social media would provide more reliable results for this specific group.
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Affiliation(s)
- Aboozar Eghdam
- Health Informatics Centre (HIC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Ulrika Hamidi
- Health Informatics Centre (HIC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Aniko Bartfai
- Division of Rehabilitation Medicine, Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sabine Koch
- Health Informatics Centre (HIC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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The Effects of Computerized Cognitive Testing of Older Patients on Primary Care Physicians' Approaches to Care: A Canadian Study. Alzheimer Dis Assoc Disord 2016; 31:62-68. [PMID: 27341011 DOI: 10.1097/wad.0000000000000159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We evaluated effects of providing primary care physicians (PCPs) with reports of their patients' results on the Computer Assessment of Mild Cognitive Impairment (CAMCI) by examining their documented care approaches after receipt of the report. METHODS Patients were 65 years and above, without a diagnosis or previous workup for dementia, seen consecutively over 2 months by one of 13 PCPs. PCPs indicated whether they, patients, or families had concerns about patients' cognition. A total of 259 patients individually completed the CAMCI and results were provided to the PCP. Two raters blind to CAMCI results recorded care approaches documented by PCPs at the first visit within 3 months of report (n=181). RESULTS In total, 28 different care approaches were grouped as related to Cognition or Safety/Self-Care. Negative binomial regression revealed that the number of care approaches was significantly associated with performance on the CAMCI for both Cognition and Safety/Self-care domains. These findings remained significant when covariates included PCPs' cognitive concern before CAMCI results, and patients' age, sex, number of comorbidities, and living arrangements. CONCLUSIONS Our findings indicate that PCPs documented more care approaches in patients with greater cognitive impairment based on the CAMCI results and this was independent of their, the patients', or families' prior concerns about their patients' cognition.
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Morley JE, Morris JC, Berg-Weger M, Borson S, Carpenter BD, Del Campo N, Dubois B, Fargo K, Fitten LJ, Flaherty JH, Ganguli M, Grossberg GT, Malmstrom TK, Petersen RD, Rodriguez C, Saykin AJ, Scheltens P, Tangalos EG, Verghese J, Wilcock G, Winblad B, Woo J, Vellas B. Brain health: the importance of recognizing cognitive impairment: an IAGG consensus conference. J Am Med Dir Assoc 2016; 16:731-9. [PMID: 26315321 DOI: 10.1016/j.jamda.2015.06.017] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 06/19/2015] [Indexed: 12/20/2022]
Abstract
Cognitive impairment creates significant challenges for patients, their families and friends, and clinicians who provide their health care. Early recognition allows for diagnosis and appropriate treatment, education, psychosocial support, and engagement in shared decision-making regarding life planning, health care, involvement in research, and financial matters. An IAGG-GARN consensus panel examined the importance of early recognition of impaired cognitive health. Their major conclusion was that case-finding by physicians and health professionals is an important step toward enhancing brain health for aging populations throughout the world. This conclusion is in keeping with the position of the United States' Centers for Medicare and Medicaid Services that reimburses for detection of cognitive impairment as part the of Medicare Annual Wellness Visit and with the international call for early detection of cognitive impairment as a patient's right. The panel agreed on the following specific findings: (1) validated screening tests are available that take 3 to 7 minutes to administer; (2) a combination of patient- and informant-based screens is the most appropriate approach for identifying early cognitive impairment; (3) early cognitive impairment may have treatable components; and (4) emerging data support a combination of medical and lifestyle interventions as a potential way to delay or reduce cognitive decline.
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Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St Louis, MO.
| | - John C Morris
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO
| | - Marla Berg-Weger
- Division of Geriatric Medicine, School of Social Work, Saint Louis University, St Louis, MO
| | - Soo Borson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Brian D Carpenter
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO
| | - Natalia Del Campo
- Institute of Aging, University Hospital of Toulouse, Toulouse, France
| | - Bruno Dubois
- Department of Neurology, Université Pierreet Marie Curie, Salpetriere Hospital, Paris, France
| | - Keith Fargo
- Scientific Programs and Outreach, Alzheimer's Association, Chicago, IL
| | - L Jaime Fitten
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA and Geriatric Psychiatry, Greater Los Angeles VA, Sepulveda Campus, Los Angeles, CA
| | - Joseph H Flaherty
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO
| | - Mary Ganguli
- Departments of Psychiatry, Neurology and Epidemiology, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, PA
| | - George T Grossberg
- Department of Neurology and Psychiatry, Geriatric Psychiatry, Saint Louis University School of Medicine, St Louis, MO
| | - Theodore K Malmstrom
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St Louis, MO
| | - Ronald D Petersen
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Carroll Rodriguez
- Public Policy and Communications, Alzheimer's Association, St Louis, MO
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences and the Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN
| | - Philip Scheltens
- VU University Medical Center, Alzheimer Center, Amsterdam, The Netherlands
| | | | - Joe Verghese
- Division of Geriatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Gordon Wilcock
- Nuffield Department of Clinical Medicine, Oxford Institute of Population Ageing, Oxford, United Kingdom
| | - Bengt Winblad
- Division for Neurogeriatrics, Care Sciences and Society, Department of NVS, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Bruno Vellas
- Department of Geriatrics, CHU Toulouse, Toulouse, France
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Shaik MA, Chan QL, Xu J, Xu X, Hui RJY, Chong SST, Chen CLH, Dong Y. Risk Factors of Cognitive Impairment and Brief Cognitive Tests to Predict Cognitive Performance Determined by a Formal Neuropsychological Evaluation of Primary Health Care Patients. J Am Med Dir Assoc 2016; 17:343-7. [PMID: 26785695 DOI: 10.1016/j.jamda.2015.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Case finding for cognitive impairment (CI) is recommended for all persons older than 70 years. OBJECTIVE The present study identified additional risk factors of CI so as to operationalize a composite total risk score (TRS) for case finding. We then examined the additive effect of the TRS and brief cognitive tests to improve the diagnosis of CI. METHODS The study was conducted in 2 primary health care centers in Singapore. A total of 1082 individuals (≥60 years old) were assessed for sociodemographic risk factors and their informants were administered the AD8; 309 individuals who agreed for further cognitive assessments completed the Mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA), and a neuropsychological battery at a research center. Primary health care medical records were accessed for data on vascular risk factors. RESULTS Of the 309 individuals who underwent neuropsychological evaluation, 4 were excluded due to missing medical data; 167 (54.8%) individuals had CI and 138 (45.2%) had No Cognitive Impairment (NCI). The β coefficients were standardized to calculate risk scores. CI was significantly predicted by age >70 years (odds ratio [OR] 5.99; score = 3), diabetes (OR 3.36; score = 2), stroke (OR 2.70; score = 1), female gender (OR 2.02; score = 1) and individual cognitive complaints (SCC) (OR 1.95; score = 1). The TRS had an optimal cutoff of ≥3 and explained considerable variance in global cognitive composite Z-scores (R(2) = 0.41, P < .001). The MoCA explained substantial variance compared with the MMSE and AD8 (R(2) changes of 0.474, 0.422, and 0.157, P < .001, respectively). CONCLUSION The TRS is a reasonable measure to predict individuals at risk of CI. The addition of the MoCA, in persons with positive TRS scores, is a useful approach to improve the diagnosis of CI for at-risk patients attending primary health care.
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Affiliation(s)
- Muhammad Amin Shaik
- Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Qun Lin Chan
- Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Jing Xu
- Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore
| | - Xin Xu
- Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore
| | | | | | - Christopher Li-Hsian Chen
- Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore
| | - YanHong Dong
- Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore; Centre for Healthy Brain Ageing (CHEBA) and Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia.
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15
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Borisovskaya A, Chen K, Borson S. Are we providing the best possible care for dementia patients? Neurodegener Dis Manag 2015; 5:217-24. [DOI: 10.2217/nmt.15.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
SUMMARY Healthcare for patients with dementia is often reactive, poorly organized and fragmented. We discuss opportunities for improvements in the care of individuals living with dementia at home that can be implemented by physicians in their practices today. In particular, we argue that systematic identification and diagnosis of cognitive impairment and dementia in their early stages, coupled with a coherent, evidence-informed management framework, would benefit patients with dementia substantially and ease the burden of their caregivers. We emphasize that dementia influences all aspects of patient care, and each medical decision must be passed through the filter of knowledge that patients with dementia have special needs that can be identified and addressed.
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Affiliation(s)
- Anna Borisovskaya
- University of Washington, Veterans’ Affairs Medical Center, 1660 South Columbian Way, S-116, Seattle, WA 98108, USA
- University of Washington, Department of Psychiatry & Behavioral Sciences, 1959 NE Pacific Street, Seattle, WA 98108, USA
| | - Kathryn Chen
- University of Washington, Veterans’ Affairs Medical Center, 1660 South Columbian Way, S-116, Seattle, WA 98108, USA
| | - Soo Borson
- University of Washington, Veterans’ Affairs Medical Center, 1660 South Columbian Way, S-116, Seattle, WA 98108, USA
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16
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Tai SY, Wang LC, Yang YH. Effect of music intervention on the cognitive and depression status of senior apartment residents in Taiwan. Neuropsychiatr Dis Treat 2015; 11:1449-54. [PMID: 26109859 PMCID: PMC4472066 DOI: 10.2147/ndt.s82572] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To identify the effect of music intervention on cognitive function and depression status of residents in senior citizen apartments based on the existing evidence regarding music therapy. METHODS An experimental study was conducted from November 2008 to December 2009. Sixty healthy senior apartment residents over 65 years of age were recruited and separated into two groups. According to their opinion, 41 took part in the music intervention group and 19 in the comparison group. The music intervention involved Buddhist hymns. The short-term effects were evaluated based on the measurement of cognitive function and depression level using the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale-short form (GDS-SF) at the baseline, 1 month, and 4 months. RESULTS The means of the initial and the 1-month MMSE and GDS-SF scores did not differ between the two groups. The 4-month MMSE score significantly declined compared with the initial level in the comparison group, whereas no significant change was observed in the experimental group. Moreover, the 4-month GDS-SF score significantly improved in both groups compared with the initial level. CONCLUSION Music intervention may postpone cognitive decline in healthy residents preferring Buddhist hymns in the senior citizen apartments in 4 months follow-up, and intense contact with participants may improve their mood status.
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Affiliation(s)
- Shu-Yu Tai
- Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan ; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ling-Chun Wang
- Mentality Protection Center, Fo Guang Shan Compassion Foundation, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yuan-Han Yang
- Mentality Protection Center, Fo Guang Shan Compassion Foundation, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan ; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan ; Department of Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan ; Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
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17
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Kuller LH, Lopez OL. Preventing Dementia in Older Cardiovascular Patients. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0401-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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