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Crivelli L, Quiroz YT, Calandri IL, Martin ME, Velilla LM, Cusicanqui MI, Yglesias FC, Llibre-Rodríguez JJ, Armele M, Román F, Barceló E, Dechent C, Carello MA, Olavarría L, Yassuda MS, Custodio N, Dansilio S, Sosa AL, Acosta DM, Brucki SMD, Caramelli P, Slachevsky A, Nitrini R, Carrillo MC, Allegri RF. Working Group Recommendations for the Practice of Teleneuropsychology in Latin America. Arch Clin Neuropsychol 2021; 37:553-567. [PMID: 34673890 PMCID: PMC8574290 DOI: 10.1093/arclin/acab080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Teleneuropsychology (teleNP) could potentially expand access to services for patients who are confined, have limited personal access to healthcare, or live in remote areas. The emergence of the COVID-19 pandemic has significantly increased the use of teleNP for cognitive assessments. The main objective of these recommendations is to identify which procedures can be potentially best adapted to the practice of teleNP in Latin America, and thereby facilitate professional decision-making in the region. METHOD Steps taken to develop these recommendations included (1) formation of an international working group with representatives from 12 Latin American countries; (2) assessment of rationale, scope, and objectives; (3) formulation of clinical questions; (4) evidence search and selection; (5) evaluation of existing evidence and summary; and (6) formulation of recommendations. Levels of evidence were graded following the Oxford Centre for Evidence-Based Medicine system. Databases examined included PubMed, WHO-IRIS, WHO and PAHO-IRIS, Índice Bibliográfico Español en Ciencias de la Salud (IBCS), and LILACS. RESULTS Working group members reviewed 18,400 titles and 422 abstracts and identified 19 articles meeting the criteria for level of evidence, categorization, and elaboration of recommendations. The vast majority of the literature included teleNP tests in the English language. The working group proposed a series of recommendations that can be potentially best adapted to the practice of teleNP in Latin America. CONCLUSIONS There is currently sufficient evidence to support the use of videoconferencing technology for remote neuropsychological assessments. These recommendations will likely contribute to the advancement of teleNP research and practice in the region.
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Affiliation(s)
- Lucía Crivelli
- Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina
| | - Yakeel T Quiroz
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Grupo de Neurociencias, Universidad de Antioquia, Medellin, Colombia
| | | | - María E Martin
- Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina
| | - Lina M Velilla
- Grupo de Neurociencias, Universidad de Antioquia, Medellin, Colombia
| | - María I Cusicanqui
- Department of Neurology, Hospital de Clínicas Universitario La Paz, La Paz, Bolivia
| | - Fernando Coto Yglesias
- Department of Geriatrics, Hospital Nacional de Geriatría y Gerontología, San José, Costa Rica
| | | | - Monserrat Armele
- Asociación Paraguaya de Neuropsicología, Facultad de Psicología Universidad Católica de Asunción, Asunción, Paraguay
| | - Fabián Román
- Department of Health Sciences, Universidad de la Costa, Barranquilla, Colombia.,Director of Red Iberoamericana de Neurociencia Cognitiva, Buenos Aires, Argentina
| | - Ernesto Barceló
- Department of Health Sciences, Universidad de la Costa, Barranquilla, Colombia
| | - Claudia Dechent
- Departamento de Medicina-Geriatría, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | - Loreto Olavarría
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
| | - Mônica S Yassuda
- Gerontologia, Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, São Paulo, Brazil
| | | | - Sergio Dansilio
- Facultad de Psicología, Universidad de la República, Montevideo, Uruguay
| | - Ana L Sosa
- Laboratory of the Dementias, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez of Mexico City, Mexico City, Mexico
| | - Daisy M Acosta
- Department of Internal Medicine, Universidad Nacional Pedro Henriquez Urena (UNPHU), Santo Domingo, República Dominicana
| | - Sonia M D Brucki
- Department of Neurology, Hospital das clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Caramelli
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism, University of Chile, Santiago, Chile.,Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Institute of Biomedical Sciences (ICBM), Neurocience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ricardo Nitrini
- Department of Neurology, Hospital das clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - María C Carrillo
- Chief Science Officer, Alzheimer's Association, Division of Medical and Scientific Relations, Chicago, IL, USA
| | - Ricardo F Allegri
- Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina.,Department of Health Sciences, Universidad de la Costa, Barranquilla, Colombia
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Matchanova A, Babicz MA, Medina LD, Rahman S, Johnson B, Thompson JL, Beltran-Najera I, Brooks J, Sullivan KL, Walker RL, Podell K, Woods SP. Latent Structure of a Brief Clinical Battery of Neuropsychological Tests Administered In-Home Via Telephone. Arch Clin Neuropsychol 2020; 36:874-886. [DOI: 10.1093/arclin/acaa111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
To examine the factor structure and sociodemographic correlates of a battery of clinical neuropsychological tests administered in-home and via telephone.
Method
Participants included 280 healthy adults who completed a 35–40 min battery consisting of seven auditory-verbal neuropsychological tests (i.e., 10 variables) that included digit span, list learning and memory, prospective memory, verbal fluency, and oral trail making.
Results
After removing oral trail making part A, a three-factor model comprised of executive functions, memory and attention demonstrated the best fit to the data. Nevertheless, the shared variance between the nine remaining neuropsychological variables was also adequately explained by a single-factor model and a two-factor model comprised of executive functions and memory. Factor scores were variably associated with education, race/ethnicity, and IQ, but not with sex or age.
Conclusions
Findings provide preliminary support for the feasibility and factor structure and sociodemographic correlates of a brief telephone-based screening neuropsychological battery comprised mostly of commonly administered clinical measures. Future studies are needed to determine the test–retest reliability, sensitivity, and ecological relevance of this battery, as well as equivalency to in-person assessment.
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Affiliation(s)
| | - Michelle A Babicz
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Samina Rahman
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Briana Johnson
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | | | | | - Jasmin Brooks
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Kelli L Sullivan
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Rheeda L Walker
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Kenneth Podell
- Department of Neurology, Methodist Hospital, Houston, TX 77030, USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, TX 77002, USA
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3
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Carlew AR, Fatima H, Livingstone JR, Reese C, Lacritz L, Pendergrass C, Bailey KC, Presley C, Mokhtari B, Cullum CM. Cognitive Assessment via Telephone: A Scoping Review of Instruments. Arch Clin Neuropsychol 2020; 35:1215-1233. [PMID: 33106856 PMCID: PMC7665291 DOI: 10.1093/arclin/acaa096] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Telephone-based cognitive assessment (TBCA) has long been studied but less widely adopted in routine neuropsychological practice. Increased interest in remote neuropsychological assessment techniques in the face of the coronavirus 2019 (COVID-19) pandemic warrants an updated review of relevant remote assessment literature. While recent reviews of videoconference-based neuropsychological applications have been published, no updated compilation of empirical TBCA research has been completed. Therefore, this scoping review offers relevant empirical research to inform clinical decision-making specific to teleneuropsychology. METHOD Peer-reviewed studies addressing TBCA were included. Broad search terms were related to telephone, cognitive, or neuropsychological assessment and screening. After systematic searching of the PubMed and EBSCO databases, 139 relevant articles were retained. RESULTS In total, 17 unique cognitive screening measures, 20 cognitive batteries, and 6 single-task measures were identified as being developed or adapted specifically for telephone administration. Tables summarizing the identified cognitive assessments, information on diagnostic accuracy, and comparisons to face-to-face cognitive assessment are included in supplementary materials. CONCLUSIONS Overall, literature suggests that TBCA is a viable modality for identifying cognitive impairment in various populations. However, the mode of assessment selected clinically should reflect an understanding of the purpose, evidence, and limitations for various tests and populations. Most identified measures were developed for research application to support gross cognitive characterization and to help determine when more comprehensive testing was needed. While TBCA is not meant to replace gold-standard, face-to-face evaluation, if appropriately utilized, it can expand scope of practice, particularly when barriers to standard neuropsychological assessment occur.
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Affiliation(s)
- Anne R Carlew
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Hudaisa Fatima
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Julia R Livingstone
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Caitlin Reese
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Laura Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Cody Pendergrass
- Mental Health Department, VA North Texas Health Care System, Dallas, TX 75216, USA
| | - Kenneth Chase Bailey
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Chase Presley
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Ben Mokhtari
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Colin Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
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4
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Bunker L, Hshieh TT, Wong B, Schmitt EM, Travison T, Yee J, Palihnich K, Metzger E, Fong TG, Inouye SK. The SAGES telephone neuropsychological battery: correlation with in-person measures. Int J Geriatr Psychiatry 2017; 32:991-999. [PMID: 27507320 PMCID: PMC5299071 DOI: 10.1002/gps.4558] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Neuropsychological test batteries are administered in person to assess cognitive function in both clinical and research settings. However, in-person administration holds a number of logistical challenges that makes it difficult to use in large or remote populations or for multiple serial assessments over time. The purpose of this descriptive study was to determine whether a telephone-administered neuropsychological test battery correlated well with in-person testing. METHODS Fifty English-speaking patients without dementia, over 70 years old, and part of a cohort of patients in a prospective cohort study examining cognitive outcomes following elective surgery were enrolled in this study. Five well-validated neuropsychological tests were administered by telephone to each participant by a trained interviewer within 2-4 weeks of the most recent in-person interview. Tests included the Hopkins Verbal Learning Test-Revised, Digit Span, Category Fluency, Phonemic Fluency, and Boston Naming Test. A General Cognitive Performance composite score was calculated from individual subtest scores as a Z-score. RESULTS Mean age was 74.9 years (SD = 4.1), 66% female, and 4% non-White. Mean and interquartile distributions of telephone scores were similar to in-person scores. Correlation analysis of test scores revealed significant correlations between telephone and in-person results for each individual subtest, as well as for the overall composite score. A Bland-Altman plot revealed no bias or trends in scoring for either test administration type. CONCLUSIONS In this descriptive study, the telephone version of a neuropsychological test battery correlated well with the in-person version and may provide a feasible supplement in clinical and research applications. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Tammy T. Hshieh
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston
| | - Bonnie Wong
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Eva M. Schmitt
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston
| | - Thomas Travison
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston
| | - Jacqueline Yee
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston
| | - Kerry Palihnich
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. MA
| | - Eran Metzger
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tamara G. Fong
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sharon K. Inouye
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. MA
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5
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Zhou J, Zhang X, Mundt JC, Wang L, Meng C, Chu C, Yang J, Chan P. A Comparison of Three Dementia Screening Instruments Administered by Telephone in China. DEMENTIA 2016. [DOI: 10.1177/1471301204039325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Implementation of valid and efficient case-finding methods to screen for cognitive impairment is important for identifying people during the earliest stages of dementia. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Information-Memory-Concentration Test (IMCT), and Blessed-Roth Dementia Scale (BRDS) are assessment tools commonly used in China. This study investigated the usefulness of administering these scales by telephone. Subjects ( N= 132: 74 females, 58 males) from Xuanwu Hospital, Capital University of Medical Sciences in Beijing, China were recruited for participation in this study; 132 collateral informants who accompanied the subjects to their appointments provided IQCODE and BRDS data. Senior neurologists using Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria (American Psychiatric Publishing, 2000), patient history, physical examination, neuropsychological tests, neuroradiology, and laboratory tests made the dementia diagnoses. Blinded personnel administered the IQCODE, IMCT, and BRDS by telephone and face-to-face in the clinic in counter-balanced administration order. Independent subsamples of 20 subjects were selected for assessment of test-retest and inter-rater reliabilities of the telephone assessments. Correlations between the face-to-face and telephone administrations of the scales were good, ranging from .80 to .97. The administration order of assessment methods did not affect the results. Inter-rater and test-retest reliabilities were satisfactory. The sensitivity and specificity of each scale exceeded 80 percent, demonstrating scale validity and clinical utility. The results support reliable and valid administration of these dementia assessments in person or over the telephone. The appropriate selection of assessment instruments is dependent upon the characteristics of the patient population and the intended use of the results. Use of telephone assessments may provide a valid and efficient method to screen elderly people for early detection of dementia symptoms and to monitor the effectiveness of treatment.
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Affiliation(s)
- Jingsheng Zhou
- Xuanwu Hospital, Capital University of Medical Sciences, Beijing
| | - Xinqing Zhang
- Xuanwu Hospital, Capital University of Medical Sciences, Beijing
| | | | - Lidong Wang
- Xuanwu Hospital, Capital University of Medical Sciences, Beijing
| | - Chao Meng
- Xuanwu Hospital, Capital University of Medical Sciences, Beijing
| | - Changbiao Chu
- Xuanwu Hospital, Capital University of Medical Sciences, Beijing
| | - Jing Yang
- Xuanwu Hospital, Capital Universityof Medical Sciences, Beijing
| | - Piao Chan
- Xuanwu Hospital, Capital Universityof Medical Sciences, Beijing
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Castanho TC, Amorim L, Zihl J, Palha JA, Sousa N, Santos NC. Telephone-based screening tools for mild cognitive impairment and dementia in aging studies: a review of validated instruments. Front Aging Neurosci 2014; 6:16. [PMID: 24611046 PMCID: PMC3933813 DOI: 10.3389/fnagi.2014.00016] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/25/2014] [Indexed: 11/13/2022] Open
Abstract
The decline of cognitive function in old age is a great challenge for modern society. The simultaneous increase in dementia and other neurodegenerative diseases justifies a growing need for accurate and valid cognitive assessment instruments. Although in-person testing is considered the most effective and preferred administration mode of assessment, it can pose not only a research difficulty in reaching large and diverse population samples, but it may also limit the assessment and follow-up of individuals with either physical or health limitations or reduced motivation. Therefore, telephone-based cognitive screening instruments can be an alternative and attractive strategy to in-person assessments. In order to give a current view of the state of the art of telephone-based tools for cognitive assessment in aging, this review highlights some of the existing instruments with particular focus on data validation, cognitive domains assessed, administration time and instrument limitations and advantages. From the review of the literature, performed using the databases EBSCO, Science Direct and PubMed, it was possible to verify that while telephone-based tools are useful in research and clinical practice, providing a promising approach, the methodologies still need refinement in the validation steps, including comparison with either single instruments or neurocognitive test batteries, to improve specificity and sensitivity to validly detect subtle changes in cognition that may precede cognitive impairment.
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Affiliation(s)
- Teresa C Castanho
- School of Health Sciences, Life and Health Sciences Research Institute, University of Minho Braga, Portugal ; PT Government Associate Laboratory, ICVS/3B's Braga/Guimarães, Portugal
| | - Liliana Amorim
- School of Health Sciences, Life and Health Sciences Research Institute, University of Minho Braga, Portugal ; PT Government Associate Laboratory, ICVS/3B's Braga/Guimarães, Portugal
| | - Joseph Zihl
- Department of Psychology-Neuropsychology, University of Munich Munich, Germany
| | - Joana A Palha
- School of Health Sciences, Life and Health Sciences Research Institute, University of Minho Braga, Portugal ; PT Government Associate Laboratory, ICVS/3B's Braga/Guimarães, Portugal
| | - Nuno Sousa
- School of Health Sciences, Life and Health Sciences Research Institute, University of Minho Braga, Portugal ; PT Government Associate Laboratory, ICVS/3B's Braga/Guimarães, Portugal
| | - Nadine C Santos
- School of Health Sciences, Life and Health Sciences Research Institute, University of Minho Braga, Portugal ; PT Government Associate Laboratory, ICVS/3B's Braga/Guimarães, Portugal
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Can smartphones enhance telephone-based cognitive assessment (TBCA)? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:7110-25. [PMID: 24351736 PMCID: PMC3881156 DOI: 10.3390/ijerph10127110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 11/21/2022]
Abstract
TBCA has emerged to solve the limitations of administering cognitive assessments face-to-face. The recent development of telephones and knowledge advances in the area of cognitive impairment may affect the development of TBCA. The purpose of this paper is to discuss how smartphones can be used to enhance the applicability of TBCA, which has previously been administered by conventional telephone. This paper will first review, describe and critique the existing TBCA instruments. It will then discuss the recent developments in tele-technology, the popularity of tele-technology among the elderly, potential benefits and challenges in using smartphones for cognitive assessment, and possible future developments in this technology. In the systematic review, eighteen TBCA instruments were identified. They were found to be valid in differentiating between people with and without dementia. TBCA was previously found to be launched on a conventional telephone platform. The advances in understanding of cognitive impairment may demand that telephones be equipped with more advanced features. Recently, the development and penetration of smartphones among the elderly has been rapid. This may allow the smartphone to enhance its TBCA applicability by overcoming the limitations of the conventional telephone, rendering the TBCA more efficient in addressing the increasing demand and complexity of cognitive assessments in the future. However, more research and technology developments are needed before smartphones can become a valid platform for TBCA.
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8
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Lachman ME, Agrigoroaei S, Tun PA, Weaver SL. Monitoring cognitive functioning: psychometric properties of the brief test of adult cognition by telephone. Assessment 2013; 21:404-17. [PMID: 24322011 DOI: 10.1177/1073191113508807] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Assessment of cognitive functioning is an important component of telephone surveys of health. Previous cognitive telephone batteries have been limited in scope with a primary focus on dementia screening. The Brief Test of Adult Cognition by Telephone (BTACT) assesses multiple dimensions central for effective functioning across adulthood: episodic memory, working memory, reasoning, verbal fluency, and executive function. The BTACT is the first instrument that includes measures of processing speed, reaction time, and task-switching/inhibitory control for use over the telephone. We administered the battery to a national sample (N = 4,268), age 32 to 84 years, from the study of Midlife in the United States (MIDUS) and examined age, education, and sex differences; reliability; and factor structure. We found good evidence for construct validity with a subsample tested in person. Implications of the findings are considered for efficient neuropsychological assessment and monitoring changes in cognitive aging, for clinical and research applications by telephone or in person.
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Kinsinger SW, Lattie E, Mohr DC. Relationship between depression, fatigue, subjective cognitive impairment, and objective neuropsychological functioning in patients with multiple sclerosis. Neuropsychology 2011; 24:573-80. [PMID: 20804245 DOI: 10.1037/a0019222] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study explored the influence of depression and fatigue on subjective cognitive complaints and objective neuropsychological impairment in patients with multiple sclerosis (MS). METHODS Data for this study were taken from a randomized controlled trial, comparing 16 weeks of telephone-administered cognitive-behavioral therapy and telephone-administered supportive emotion focused therapy for the treatment of depression. The sample includes 127 patients with MS. The following self-report measures were collected pre- and posttreatment: Perceived Deficits Questionnaire, Beck Depression Inventory-II, and Modified Fatigue Impact Scale. Measures of objective cognitive functioning and the Hamilton Rating Scale for Depression were administered over the telephone. RESULTS Our results showed that changes in depression and fatigue significantly predicted changes in subjective cognitive complaints from pre- to posttreatment, with patients perceiving fewer cognitive problems at posttreatment (beta = .36, p < .001 and beta = .61, p < .001, respectively). Changes in depression and fatigue were not significantly related to changes in objective neuropsychological performance. Improvements in depression and fatigue also predicted improved accuracy in perceiving cognitive abilities from pre- to posttreatment (OR = .77, p < .001 and OR = .90, p < .001, respectively). CONCLUSIONS The results of this study suggest that improvements in depression and fatigue through treatment do not influence objective neuropsychological performance in MS patients, but do relate to changes in subjective impairment. Furthermore, these changes improve patients' abilities to accurately perceive their cognitive functioning.
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Affiliation(s)
- Sarah W Kinsinger
- Division of Gastroenterology, Northwestern University, Feinberg School of Medicine, 676 N. St. Claire St., Suite 1400, Chicago, IL 60611, USA.
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Martin-Khan M, Wootton R, Gray L. A systematic review of the reliability of screening for cognitive impairment in older adults by use of standardised assessment tools administered via the telephone. J Telemed Telecare 2010; 16:422-8. [DOI: 10.1258/jtt.2010.100209] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a systematic review to identify the extent to which the process of screening for cognitive impairment in older adults has been validated for administration by telephone. A search of electronic databases and a handsearch of relevant journals and reference lists were carried out for studies published between 1966 and 2008. The database search identified 411 studies and handsearching found another seven. Fourteen studies were finally identified as relevant to the review: three concerned a modified telephone version of the Mini-Mental State Examination (MMSE); five concerned the Telephone Interview for Cognitive Status; one study tested a telephone-administered Short Portable Mental Status Questionnaire; four studies tested the validity of newly developed tools; and the remaining study considered the Confusion Assessment Method as a means of diagnosing delirium. The quality of the reference standard varied among the papers reviewed. The limited number of high quality studies with suitable reference standards makes it difficult to recommend a specific tool which should be used to assess the cognition of older adults by telephone. In advance of further studies, the 22-item MMSE is simple to administer and was shown to correlate well with the face-to-face MMSE. It appears to be a useful technique for telephone screening for cognitive impairment or delirium, if used in conjunction with the Delirium Symptom Interview.
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Affiliation(s)
- Melinda Martin-Khan
- Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Australia
| | - Richard Wootton
- National Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Len Gray
- Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Australia
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11
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Telephone-administered cognitive tests as tools for the identification of eligible study participants for population-based research in aging. Can J Aging 2010; 28:251-9. [PMID: 19860980 DOI: 10.1017/s0714980809990092] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACTAs part of its recruitment process, the Canadian Longitudinal Study on Aging (CLSA) will face the challenge of screening out individuals who are sufficiently impaired in their ability to provide informed consent. In the process of developing the design of the CLSA, a review of the literature was performed with the goal of identifying currently existing telephone cognitive screening tools that can be used to identify eligible study participants for population-based research on aging. We identified 12 telephone screening tools, four of which were based on the Mini-Mental State Exam (MMSE) and eight that were based on other face-to-face screening tools. Characteristics - including the constructs measured, the length of time for administration, the scoring/classification scheme, and any information regarding the validation of each tool - were extracted and summarized.
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12
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Lacoste L, Trivalle C. Adaptation française d’un outil d’évaluation par téléphone des troubles mnésiques : le French Telephone Interview for Cognitive Status Modified (F-TICS-m). ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.npg.2008.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Fritsch T, McClendon MJ, Smyth KA, Lerner AJ, Friedland RP, Larsen JD. Cognitive functioning in healthy aging: the role of reserve and lifestyle factors early in life. THE GERONTOLOGIST 2007; 47:307-22. [PMID: 17565095 DOI: 10.1093/geront/47.3.307] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE According to the reserve perspective on cognitive aging, individuals are born with or can develop resources that help them resist normal and disease-related cognitive changes that occur in aging. The reserve perspective is becoming more sophisticated, but gaps in knowledge persist. In the present research, we considered three understudied questions about reserve: Is reserve primarily static (unchangeable) throughout the life course or dynamic (changeable, in terms of increases or decreases)? Can reserve be increased at any point in life, or are there optimal time periods--such as early life, midlife, or late life--to increase it? Does participation in different types of leisure and occupational activities in early life and midlife have different effects depending on specific domains of late-life cognitive functioning? Here we link early cognitive and activity data--gathered from archival sources--with cognitive data from older adults to examine these issues. DESIGN AND METHODS 349 participants, all mid-1940s graduates of the same high school, underwent telephone cognitive screening. All participants provided access to adolescent IQ scores; we determined activity levels from yearbooks. We used path analysis to evaluate the complex relationships between early life, midlife, and late-life variables. RESULTS Adolescent IQ had strong direct effects on global cognitive functioning, episodic memory, verbal fluency, and processing speed. Participants' high school mental activities had direct effects on verbal fluency, but physical and social activities did not predict any cognitive measure. Education had direct effects on global cognitive functioning, episodic memory, and, most strongly, processing speed, but other midlife factors (notably, occupational demands) were not significant predictors of late-life cognition. There were weak indirect effects of adolescent IQ on global cognitive functioning, episodic memory, and processing speed, working through high school mental activities and education. Verbal fluency, in contrast, was affected by adolescent IQ through links with high school mental activities, but not education. IMPLICATIONS Our study suggests that reserve is dynamic, but it is most amenable to change in early life. We conclude that an active, engaged lifestyle, emphasizing mental activity and educational pursuits in early life, can have a positive impact on cognitive functioning in late life.
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Affiliation(s)
- Thomas Fritsch
- Center on Age & Community, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201, USA.
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Christie JD, Biester RCP, Taichman DB, Shull WH, Hansen-Flaschen J, Shea JA, Hopkins RO. Formation and validation of a telephone battery to assess cognitive function in acute respiratory distress syndrome survivors. J Crit Care 2006; 21:125-32. [PMID: 16769455 DOI: 10.1016/j.jcrc.2005.11.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Revised: 08/17/2005] [Accepted: 11/16/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE Describe initial development and validation of a test battery composed of established instruments designed to detect, via telephone interview, cognitive abnormalities in survivors of acute respiratory distress syndrome. METHODS Two cross-sectional studies were performed, including the following phases: (1) initial battery construction, (2) feasibility, (3) item reduction, (4) convergent and divergent validity, and (5) telephone administration compared with in-face interviews in a separate population. RESULTS There was a broad range of cognitive function detected in the derivation population, and all subjects completed the interview. There was convergence of cognitive impairment with moderate/severe anxiety (P = .008), the Sickness Impact Profile Psychosocial Summary Score (mean difference, 15.3; 95% CI, 7.74-22.9; P = .0001), and the mental health domains of the Short Form 36. Subjects with cognitive impairment had no detectable difference in the physical function domains of the Short Form 36. When administered to the validation population, telephone tests of memory, attention, reasoning, and executive functions had good intraclass correlation with the in-face interviews (P < .01). CONCLUSIONS Detection of cognitive abnormalities in acute respiratory distress syndrome survivors using a telephone-administered test battery derived from standard cognitive tests is feasible and has evidence of construct validity. This battery may be useful as a research tool when in-face interviews are not feasible.
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Affiliation(s)
- Jason D Christie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Fritsch T, Smyth KA, McClendon MJ, Ogrocki PK, Santillan C, Larsen JD, Strauss ME. Associations Between Dementia/Mild Cognitive Impairment and Cognitive Performance and Activity Levels in Youth. J Am Geriatr Soc 2005; 53:1191-6. [PMID: 16108937 DOI: 10.1111/j.1532-5415.2005.53361.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the associations between dementia/mild cognitive impairment (MCI) and cognitive performance and activity levels in youth. DESIGN Retrospective cohort study. SETTING Research volunteers living throughout the United States. PARTICIPANTS A total of 396 persons (mean age 75) who were graduates of the same high school in the mid-1940s. MEASUREMENTS Adolescent intelligence quotient (IQ) scores were gathered from archived student records, and activity levels were determined from yearbooks. A two-stage telephone screening procedure (Modified Telephone Interview for Cognitive Status or Informant Questionnaire on Cognitive Decline in the Elderly followed by Dementia Questionnaire) was used to determine adult cognitive status. Data were analyzed using logistic regression to model the risk of cognitive impairment (dementia/MCI) versus no cognitive impairment as a function of IQ and activity level, adjusting for sex and education. RESULTS High adolescent IQ and greater activity level were each independently associated with a lower risk for dementia/MCI (odds ratio (OR) for a 1-standard deviation increase in IQ=0.51, 95% confidence interval (CI)=0.32-0.79; OR for a unit increase in activity=0.32, 95% CI=0.12-0.84). No association was found between sex or education and adult cognitive status in this model. CONCLUSION High IQ and greater activity levels in youth reduce the risk for cognitive impairments in aging. The mechanism(s) underlying these associations are unknown, but intelligence may be a marker for cognitive/neurological "reserve," and involvement in activities may contribute to "reserve." Early neuropathology and ascertainment bias are also possible explanations for the observed associations.
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Affiliation(s)
- Thomas Fritsch
- University Memory and Aging Center, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio 44120, USA
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Taichman DB, Christie J, Biester R, Mortensen J, White J, Kaplan S, Hansen-Flaschen J, Palevsky HI, Elliott CG, Hopkins RO. Validation of a brief telephone battery for neurocognitive assessment of patients with pulmonary arterial hypertension. Respir Res 2005; 6:39. [PMID: 15850486 PMCID: PMC1112616 DOI: 10.1186/1465-9921-6-39] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 04/25/2005] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The effects of pulmonary arterial hypertension on brain function are not understood, despite patients' frequent complaints of cognitive difficulties. Using clinical instruments normally administered during standard in-person assessment of neurocognitive function in adults, we assembled a battery of tests designed for administration over the telephone. The purpose was to improve patient participation, facilitate repeated test administration, and reduce the cost of research on the neuropsychological consequences of acute and chronic cardiorespiratory diseases. We undertook this study to validate telephone administration of the tests. METHODS 23 adults with pulmonary arterial hypertension underwent neurocognitive assessment using both standard in-person and telephone test administration, and the results of the two methods compared using interclass correlations. RESULTS For most of the tests in the battery, scores from the telephone assessment correlated strongly with those obtained by in-person administration of the same tests. Interclass correlations between 0.5 and 0.8 were observed for tests that assessed attention, memory, concentration/working memory, reasoning, and language/crystallized intelligence (p < or = 0.05 for each). Interclass correlations for the Hayling Sentence Completion test of executive function approached significance (p = 0.09). All telephone tests were completed within one hour. CONCLUSION Administration of this neurocognitive test battery by telephone should facilitate assessment of neuropsychological deficits among patients with pulmonary arterial hypertension living across broad geographical areas, and may be useful for monitoring changes in neurocognitive function in response to PAH-specific therapy or disease progression.
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Affiliation(s)
- Darren B Taichman
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jason Christie
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Rosette Biester
- Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jennifer Mortensen
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Joanne White
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Sandra Kaplan
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - John Hansen-Flaschen
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Harold I Palevsky
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - C Gregory Elliott
- Department of Medicine, Pulmonary and Critical Care Divisions, University of Utah and LDS Hospital, Salt Lake City, Utah, USA
| | - Ramona O Hopkins
- Department of Medicine, Pulmonary and Critical Care Divisions, University of Utah and LDS Hospital, Salt Lake City, Utah, USA
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA
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Mohr DC, Goodkin DE, Nelson S, Cox D, Weiner M. Moderating effects of coping on the relationship between stress and the development of new brain lesions in multiple sclerosis. Psychosom Med 2002; 64:803-9. [PMID: 12271111 PMCID: PMC1893006 DOI: 10.1097/01.psy.0000024238.11538.ec] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Many patients with multiple sclerosis (MS) report that stress can trigger disease exacerbations. Considerable research has supported a relationship between stress and both clinical exacerbation and the development of new brain lesions. However, these relationships are not always consistent either within patients or across patients, suggesting the presence of moderators. This study examined the hypothesis that coping moderates the subsequent relationship between stress and the development of new brain lesions in MS. METHODS Thirty-six patients (mean age = 44.4; 22 women, 14 men) with relapsing forms of MS were assessed once every 4 weeks for 28-100 weeks. New brain lesions were identified using monthly Gd+ MRI. Stress was measured within 24 hours before MRI using a modified version of the Social Readjustment Rating Scale that assessed Conflict and Disruption in Routine. Coping was measured at baseline using the Coping with Health Injuries and Problems questionnaire, which produces four scales: distraction, instrumental, palliative, and emotional preoccupation. Data were analyzed using mixed effects logistic regression to account for within-subject correlations. Analyses were lagged such that stress assessments predicted new Gd+ MRI brain lesions 8 weeks later. RESULTS As reported previously, stress was significantly related to the development of new Gd+ brain lesions 8 weeks later (OR = 1.62, p =.009). Greater use of distraction was found to be a significant moderator of the relationship between stress and new Gd+ lesions (OR = 0.69, p =.037) such that greater use of distraction was associated with a decreased relationship between stress and new Gd+ lesions. Increased instrumental coping was marginally associated with a decreased relationship between stress and new Gd+ lesions (OR = 0.77, p =.081), while increased emotional preoccupation was marginally associated with an increased relationship between stress and new Gd+ lesions (OR = 1.46, p =.088). There was no significant moderating effect for palliative coping (p =.27) and no significant main effects for any coping variables and the subsequent development of new Gd+ brain lesions (p values >.21). CONCLUSIONS These findings provide modest support for the hypothesis that coping can moderate the relationship between stress and the MS disease activity. Several limitations in this study are discussed. While these findings suggest areas of potentially fruitful research, readers are cautioned that these are preliminary results; inferences regarding the clinical importance of these findings are premature.
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Affiliation(s)
- David C Mohr
- University of California, VAMC, San Francisco, CA 94121, USA.
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Petrill SA, Rempell J, Oliver B, Plomin R. Testing cognitive abilities by telephone in a sample of 6- to 8-year-olds. INTELLIGENCE 2002. [DOI: 10.1016/s0160-2896(02)00087-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mohr DC, Boudewyn AC, Likosky W, Levine E, Goodkin DE. Injectable medication for the treatment of multiple sclerosis: the influence of self-efficacy expectations and injection anxiety on adherence and ability to self-inject. Ann Behav Med 2001; 23:125-32. [PMID: 11394554 DOI: 10.1207/s15324796abm2302_7] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The management of many chronic illnesses involves medications that must be injected on a frequent basis. With fewer support resources available, patients are increasingly being obliged to manage injectable medications themselves. Interferon beta-1a (IFNbeta-1a), recommended for the treatment of multiple sclerosis (MS), must be injected intramuscularly on a weekly basis. Patients are generally advised and taught to self-inject, if possible. This longitudinal study examined cognitive and affective contributions to the ability to self-inject and adherence to IFNbeta-1a over 6 months following initiation of medication. Participants were 101 patients with a relapsing form of MS. Injection self-efficacy expectations, injection anxiety, adherence expectations, method of injection administration, and 6-month adherence to IFNbeta-1a were fitted to a path analytic model. Pretreatment injection self-efficacy expectations were significantly related to 6-month adherence. This relation was mediated by the patient's ability to self-inject. Patients 'experienced level of injection anxiety was related to adherence but not to method of injection.
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Affiliation(s)
- D C Mohr
- University of California, San Francisco, USA.
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Abstract
INTRODUCTION With the increased administration of outpatient electroconvulsive therapy (ECT), it is important to develop methods for monitoring patients for adverse effects of treatment. This pilot study was designed to evaluate the utility of using telephone assessments to determine whether patents receiving maintenance ECT (MECT) experience cognitive deficits related to individual treatments. METHOD Patients were recruited from an existing population of outpatients receiving MECT. The consenting patients were called on three occasions and given a battery of telephone cognitive assessments including Orientation-Memory-Concentration, Buschke Selective Reminding, Verbal Fluency, "World" Backwards, Serial Sevens, and Wechsler Logical Memory. The occasions for the telephone interviews were the day before ECT, the day after a treatment, and a week later. RESULTS Sixteen patients completed the study. The correlation between baseline and time 3 ranged from 1.00 for spelling "world" backward to 0.509 for Verbal Fluency Category, indicating considerable variability in test-retest reliability. One test, Verbal Fluency Category, showed group level effects, with decrements in performance the day after a treatment. One of the 16 patients showed global cognitive deficits the day after a treatment. DISCUSSION The pilot results suggest that telephone assessment may be a useful approach for monitoring patients receiving outpatient ECT. Monitoring may serve to guide clinicians in advising individuals and their caregivers about the return to activities after an individual treatment. Overall these findings support the tolerability of MECT.
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Affiliation(s)
- C J Datto
- Hospital of the University of Pennsylvania and Friends Hospital, Philadelphia, Pennsylvania 19104, USA.
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Ball LJ, Ogden A, Mandi D, Birge SJ. The validation of a mailed health survey for screening of dementia of the Alzheimer's type. J Am Geriatr Soc 2001; 49:798-802. [PMID: 11454121 DOI: 10.1046/j.1532-5415.2001.49159.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To test the efficacy of a mailed health survey, which included the Clock Completion Test (CCT), to screen previously undiagnosed older adults for dementia of the Alzheimer's type (DAT) in a community-dwelling population, and to determine whether the addition of selected risk factors for Alzheimer's disease (AD) would enhance the screening instrument's operating characteristics. DESIGN Comparison of the results of a self-administered screen for DAT with the diagnosis of DAT by clinician evaluation or telephone interviews. SETTING A geriatric assessment clinic. PARTICIPANTS Three hundred and five women age 65 and older from St. Louis, Missouri. MEASUREMENTS The sensitivity and specificity of the CCT and the CCT plus risk factors for AD were evaluated using two standards: The Short Blessed Test (SBT) and the physician diagnosis of probable AD using National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. RESULTS Sensitivity and specificity for the CCT by SBT criteria were 63% and 79%, respectively. Using the physician's assessment as a criterion, the CCT had better sensitivity (67%) but poorer specificity (69%). Adding two or more risk factors for AD improved sensitivity and specificity to 71% and 89% and, in the physician assessment subgroup, to 75% and 87%, primarily by halving the false-positive rate. CONCLUSION The combination of the simple, self-administered CCT and two or more AD risk factors is a more effective screening instrument for DAT and potentially preclinical DAT than the CCT alone. However, the instrument may be better suited for use in an office setting because of a poor response rate by subjects with dementia.
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Affiliation(s)
- L J Ball
- Older Adult Health Center, Division of Geriatrics and Gerontology, Washington University School of Medicine, St. Louis, Missouri, USA
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Watkins RA, Guariglia R, Kaye JA, Janowsky JS. Informants' knowledge of reproductive history and estrogen replacement. J Gerontol A Biol Sci Med Sci 2001; 56:M176-9. [PMID: 11253159 DOI: 10.1093/gerona/56.3.m176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There has been much interest in assessing estrogen use in healthy older women and those with Alzheimer's disease. However, data for the women with Alzheimer's disease must be obtained from an informant. The aim of this study was to better understand what informants are likely to know about reproductive history and estrogen use. METHODS Reproductive history data from informants of Alzheimer's patients were modeled by comparing responses from 40 cognitively healthy older women with that of a designated informant. The designated informants were similar in demographics to informants for patients with Alzheimer's disease. RESULTS Informant data regarding reproductive history was likely to be accurate, when known. However, 30% of the subjects did not identify an informant who had personal knowledge of them. Of those informants who had personal knowledge of the subject, accuracy for those who reported that they knew the information varied depending on the aspect of reproductive history assessed (age of menarche, 29%; age of menopause, 20%; pregnancies, 63%; live births, 92%; hysterectomy, 92%; and postmenopausal estrogen use, 82%). Daughters served as the most likely and most accurate informants in this study. CONCLUSION This study demonstrates that information obtained from informants for patients with Alzheimer's disease is likely to be accurate for some but not all aspects of reproductive history. Of concern for such studies will be the 30% of patients who do not have an informant with personal knowledge about them.
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Affiliation(s)
- R A Watkins
- Department of Neurology, Oregon Health Sciences University, Portland 97201-3098, USA
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Mohr DC, Goodkin DE, Bacchetti P, Boudewyn AC, Huang L, Marrietta P, Cheuk W, Dee B. Psychological stress and the subsequent appearance of new brain MRI lesions in MS. Neurology 2000; 55:55-61. [PMID: 10891906 DOI: 10.1212/wnl.55.1.55] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the relationship between stressful life events and psychological distress, and the subsequent development of gadolinium-enhancing (Gd+) brain lesions. BACKGROUND It has long been speculated that stressful life events and psychological distress are associated with disease exacerbation in MS. This is the first prospective longitudinal study of the relationship between stressful life events, psychological distress, and disease activity as measured by Gd+ brain MRI. METHODS Thirty-six patients (mean age, 44.4 years; 22 women, 14 men) with relapsing forms of MS were assessed once every 4 weeks for 28 to 100 weeks. Assessments included Gd+ MRI, the Social Readjustment Rating Scale (SRRS), the Hassles Scale, and the Profile of Mood States. The SRRS was altered in the following manner: 1) three items that confounded with MS were eliminated, 2) endorsed items were rated for intensity, and 3) the scale was divided into three subscales: major negative events, conflict and disruption in routine, and positive life events. Data were analyzed using mixed-effects logistic regression to account for intrasubject correlations. Stress and distress measures were used to predict concurrent and future MRI activity. RESULTS For the total sample of patients, increased conflict and disruption in routine was followed by increased odds of developing new Gd+ brain lesions 8 weeks later (odds ratio, 1.64; p = 0.00083). There was no strong evidence of a relationship between psychological stress or distress and clinical exacerbation. CONCLUSIONS These data provide support for the notion that conflict and disruption in routine are related to subsequent disease activity in MS. However, this relationship is not sufficiently robust to predict clinical exacerbations reliably in individual patients.
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Affiliation(s)
- D C Mohr
- University of California at San Francisco, CA 94115-1642, USA
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Debanne SM, Rowland DY, Riedel TM, Cleves MA. Association of Alzheimer's disease and smoking: the case for sibling controls. J Am Geriatr Soc 2000; 48:800-6. [PMID: 10894320 DOI: 10.1111/j.1532-5415.2000.tb04756.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To study the association between cigarette smoking and Alzheimer's Disease (AD). DESIGN Intrafamily case-control, with sibling controls and a variable number of controls per case. SETTING AD cases were identified through the Research Registry of the University Hospitals of the Cleveland/Case Western Reserve University Alzheimer Center. PARTICIPANTS Study subjects were 86 probable AD cases (index cases) and all of their full siblings, alive or dead, aged > or = 50 years, a total of 238 subjects. MEASUREMENTS Exposure for each individual was ascertained with a questionnaire answered by several informants. Cognitive status of siblings of the AD cases (impaired or intact) was ascertained by telephone using validated instruments. Diagnosis of dementia in cognitively impaired siblings of index cases was not attempted. RESULTS Chi-square analysis tested for departure from a random distribution of disease across smokers and nonsmokers within families. No significant departure was found utilizing all families (P > .40) nor utilizing those families where only the index case was affected (P > .90). Conditional logistic regression evaluated the association within families, controlling for age, sex, and education. Analyses both included and excluded secondary cases of cognitive impairment. No association was found between smoking and disease (OR = 1.26; 95% confidence interval, 0.66-2.42, and OR = 1.42; 95% confidence interval, 0.69-2.89, respectively). CONCLUSIONS No significant association was found between smoking and cognitive status. Further, analyses based on the comparison of persons with AD with their unaffected siblings also suggest that smoking does not decrease the risk of AD.
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Affiliation(s)
- S M Debanne
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio 44106-4945, USA
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Mohr DC, Likosky W, Bertagnolli A, Goodkin DE, Van Der Wende J, Dwyer P, Dick LP. Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis. J Consult Clin Psychol 2000; 68:356-61. [PMID: 10780138 DOI: 10.1037/0022-006x.68.2.356] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the efficacy of an 8-week telephone-administered cognitive-behavioral therapy (CBT) for the treatment of depressive symptomatology in multiple sclerosis (MS) patients. The treatment, Coping with MS (CMS), included a patient workbook designed to structure the treatment, provide visual aids, and help with homework assignments. Thirty-two patients with MS, who scored at least 15 on the Profile of Mood States Depression-Dejection scale, were randomly assigned to either the telephone CMS or to a usual-care control (UCC) condition. Depressive symptomatology decreased significantly in the CMS condition compared with the UCC condition. Furthermore, adherence to interferon beta-1a, a disease-modifying medication for the treatment of MS, was significantly better at the 4-month follow-up among patients who received CMS as compared with those in the UCC condition.
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Affiliation(s)
- D C Mohr
- Department of Neurology, University of California, San Francisco (UCSF) 94115-1642, USA.
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