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Carlisle TC, Fought AJ, Olson KE, Lopez-Esquibel N, Simpson A, Medina LD, Holden SK. Original research: longitudinal evaluation of cognitively demanding daily function using performance-based functional assessment highlights heterogeneous trajectories in cognitive and functional abilities in people with Parkinson's disease. Front Neurosci 2023; 17:1200347. [PMID: 37434765 PMCID: PMC10330725 DOI: 10.3389/fnins.2023.1200347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
Background Longitudinal assessment of functional abilities in Parkinson's disease (PD) is needed to determine the efficacy of cognitive interventions in providing meaningful improvements in daily life. Additionally, subtle changes in instrumental activities of daily living may precede a clinical diagnosis of dementia and could aid earlier detection of and intervention for cognitive decline. Objective The primary goal was to validate the longitudinal application of the University of California San Diego Performance-Based Skills Assessment (UPSA). An exploratory secondary goal was to determine whether UPSA may identify individuals at higher risk of cognitive decline in PD. Methods Seventy participants with PD completed the UPSA with at least one follow-up visit. Linear mixed effects modeling was used to identify associations between baseline UPSA score and cognitive composite score (CCS) over time. Descriptive analysis of four heterogeneous cognitive and functional trajectory groups and individual case examples was performed. Results Baseline UPSA score predicted CCS at each timepoint for functionally impaired and unimpaired groups (p < 0.01) but did not predict the rate change in CCS over time (p = 0.83). Participants displayed heterogenous trajectories in both UPSA and CCS during the follow-up period. Most participants maintained both cognitive and functional performance (n = 54), though some displayed cognitive and functional decline (n = 4), cognitive decline with functional maintenance (n = 4), and functional decline with cognitive maintenance (n = 8). Conclusion The UPSA is a valid measure of cognitive functional abilities over time in PD. Given the heterogeneity of functional and cognitive trajectories, this performance-based assessment did not predict cognitive decline with this relatively short follow-up. Further work is needed to understand longitudinal functional assessments in PD-associated cognitive impairment.
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Affiliation(s)
- Tara C. Carlisle
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Behavioral Neurology Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
| | - Angela J. Fought
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Kaitlin E. Olson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | | | - Abigail Simpson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Luis D. Medina
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Samantha K. Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- Behavioral Neurology Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
- University of Colorado Movement Disorders Center, Aurora, CO, United States
- University of Colorado Alzheimer’s and Cognition Center, Aurora, CO, United States
- Movement Disorders Section, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
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2
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Bock MA, Tanner CM. The epidemiology of cognitive function in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:3-37. [PMID: 35248199 DOI: 10.1016/bs.pbr.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epidemiology is the study of the distribution of disease in human populations, which is important in evaluating burden of illness, identifying modifiable risk factors, and planning for current and projected needs of the health care system. Parkinson's disease (PD) is the second most common serious neurodegenerative illness and is expected to further increase in prevalence. Cognitive changes are increasingly viewed as an integral non-motor feature in PD, emerging even in the prodromal phase of the disease. The prevalence of PD-MCI ranges from 20% to 40% depending on the population studied. The incidence of PD-dementia increases with duration of disease, with estimates growing from 3% to 30% of individuals followed for 5 years or less to over 80% after 20 years. There are several challenges in estimating the frequency of cognitive change, including only recently standardized diagnostic criteria, variation depending on exact neuropsychological evaluations performed, and differences in population sampling. Clinical features associated with cognitive decline include older age, increased disease duration and severity, early gait dysfunction, dysautonomia, hallucinations and other neuropsychiatric features, the presence of REM behavior disorder, and posterior predominant dysfunction on neuropsychological testing. There is increasing evidence that genetic risk factors, in particular GBA and MAPT mutations, contribute to cognitive change. Possible protective factors include higher cognitive reserve and regular exercise. Important sequelae of cognitive decline in PD include higher caregiver burden, decreased functional status, and increased risk of institutionalization and mortality. Many remaining uncertainties regarding the epidemiology of cognitive change in PD require future research, with improved biomarkers and more sensitive and convenient outcome measures.
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Affiliation(s)
- Meredith A Bock
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Mental Illness Research, Education, and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States
| | - Caroline M Tanner
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States.
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3
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Objective sleep data as predictors of cognitive decline in dementia with Lewy Bodies and Parkinson's disease. Sleep Med 2021; 80:273-278. [PMID: 33610074 DOI: 10.1016/j.sleep.2021.01.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/11/2021] [Accepted: 01/25/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) and Dementia with Lewy Bodies (DLB) prognosis depends on cognitive function evolution. Sleep disorders, as objectivated by polysomnography (PSG), are intimately connected with PD and DLB pathophysiology, but have seldomly been used to predict cognitive decline. METHODS 20 DLB and 49 PD patients underwent one-night in-lab video-PSG. Sleep variables were defined, including REM sleep motor events, Tonic and phasic REM sleep muscular tone and RBD diagnosis. Cognitive state (assessed with the Global Deterioration Scale (GDS) was collected from case files for 6 months intervals, for a maximum period of 3.5 years or until death/drop-out.). The relation between PSG data at baseline and variation of GDS scores over time was tested with mixed linear regression analysis. RESULTS GDS scores were higher in DLB, than in PD. We confirmed significant cognitive decline in both disorders, but no significant differences in progression between them. There were no significant interactions between PSG data and GDS variation for the entire group and DLB separately. In PD patients, there was a significant interaction between RBD diagnosis and tonic excessive muscular tone and GDS increase. CONCLUSION Our data suggests that PSG data can be useful in predicting cognitive decline in PD but not in DLB patients. In PD patients, an RBD diagnosis is predictive of cognitive deterioration, confirming the notion that this non-motor symptom relates to a malignant sub-type. Tonic excessive muscular activity, but not other RBD features, had predictive value in this group, pointing to a specific relation with the disease pathophysiology.
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A Comprehensive Meta-analysis on Short-term and Working Memory Dysfunction in Parkinson's Disease. Neuropsychol Rev 2021; 31:288-311. [PMID: 33523408 DOI: 10.1007/s11065-021-09480-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/05/2021] [Indexed: 12/29/2022]
Abstract
A previous meta-analysis demonstrated short-term memory (STM) and working memory (WM) dysfunction in patients with Parkinson's disease (PD). However, considerable research on the topic that calls into question the extent of such impairments in PD has since been published. The aim of the present quantitative review was to provide the largest statistical overview on STM and WM dysfunction in Parkinson's disease (PD), while simultaneously providing novel insights on moderating factors of effect size heterogeneity in PD. The systematic literature search in PubMed, PsycINFO, PsycArticles, Scopus and Web of Science databases allowed us to estimate 350 effect sizes from 145 empirical studies that reported STM and WM scores for patients with PD against healthy controls. The outcomes indicated general dysfunction in the visuospatial domain and poor verbal WM in PD. Subgroup analyses suggested that mild cognitive impairment is associated with STM and WM difficulties in PD. Furthermore, meta-regression analyses revealed that disease duration accounted for more than 80% of the visuospatial STM effect size variance (β = 0.136, p < .001, R2 = .8272), larger daily levodopa equivalent dose was associated with WM dysfunction (verbal: β = -0.001, p = .016, R2 = .1812; visuospatial: β = 0.003, p = .069, R2 = .2340), and years of education partially explained the verbal STM effect size variance (β = -0.027, p = .040, R2 = .1171). Collectively, these findings advance our understanding of underlying factors that influence STM and WM functioning in PD, while at the same time providing novel directions for future research.
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Abstract
Dementia is characterized by a decline in memory, language, problem-solving and in other cognitive domains that affect a person's ability to perform everyday activities and social functioning. It is consistently agreed that cognitive impairment is an important risk factor for developing functional disabilities in patients with dementia. Functional status can be conceptualized as the ability to perform self-care, self- maintenance and physical activity. A person with dementia usually requires help with more complex tasks, such as managing bills and finances, or simply maintaining a household. Good functional performance is fundamental for elderly people to maintain independency and avoid institutionalization. The purpose of this review is to describe functional changes in demented patients, evaluating the variability in subgroups of dementias.
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Affiliation(s)
- Gabriele Cipriani
- MD,Versilia Hospital, Neurology Unit, Lido di Camaiore (Lu), Italy.,MD, Versilia Hospital, Psychiatry Unit, Lido di Camaiore (Lu), Italy
| | - Sabrina Danti
- PhD, Clinical and Health Psychology Unit, Hospital of Pontedera, Pontedera (PI), Italy
| | - Lucia Picchi
- PsyD, Clinical Psychology Unit, Hospital of Leghorn, Leghorn (LI), Italy
| | - Angelo Nuti
- MD,Versilia Hospital, Neurology Unit, Lido di Camaiore (Lu), Italy
| | - Mario Di Fiorino
- MD, Versilia Hospital, Psychiatry Unit, Lido di Camaiore (Lu), Italy
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Ord AS, Phillips JI, Wolterstorff T, Kintzing R, Slogar SM, Sautter SW. Can deficits in functional capacity and practical judgment indicate cognitive impairment in older adults? APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:737-744. [PMID: 31835920 DOI: 10.1080/23279095.2019.1698582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Neuropsychological literature has demonstrated a significant relationship between cognitive decline and functional capacity, but the directionality of this relationship is still not well understood. Further, the construct of practical judgment has been linked to both cognitive impairment and functional capacity, but these associations are still under-researched. Moreover, few studies to date have examined the relationships among all three constructs utilizing performance-based, ecologically valid and psychometrically sound measures. The present study aimed to address this gap in published literature and investigated whether a practical judgment and functional capacity can help differentiate individuals with cognitive dysfunction from those without. Participants were 270 community-dwelling individuals aged 56-95 years referred for neuropsychological evaluation in an outpatient setting. Bivariate correlations revealed moderate to strong relationships among the three studied variables. Additionally, logistic regression analysis indicated that ability to make sound practical judgments and ability to perform instrumental activities of daily living (IADL) can be used as indicators of cognitive impairment. The clinical implications of these findings are discussed.
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Affiliation(s)
- Anna S Ord
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA.,W. G. Hefner VA Medical Center, Salisbury, NC, USA.,Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC, USA
| | - Jacob I Phillips
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA
| | - Trevor Wolterstorff
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA
| | - Rebekah Kintzing
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA
| | - Sue-Mei Slogar
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA
| | - Scott W Sautter
- School of Psychology and Counseling, Regent University, Virginia Beach, VA, USA
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7
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MacPherson MK. Cognitive Load Affects Speech Motor Performance Differently in Older and Younger Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1258-1277. [PMID: 31051090 DOI: 10.1044/2018_jslhr-s-17-0222] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of this study was to determine the impact of cognitive load imposed by a speech production task on the speech motor performance of healthy older and younger adults. Response inhibition, selective attention, and working memory were the primary cognitive processes of interest. Method Twelve healthy older and 12 healthy younger adults produced multiple repetitions of 4 sentences containing an embedded Stroop task in 2 cognitive load conditions: congruent and incongruent. The incongruent condition, which required participants to suppress orthographic information to say the font colors in which color words were written, represented an increase in cognitive load relative to the congruent condition in which word text and font color matched. Kinematic measures of articulatory coordination variability and movement duration as well as a behavioral measure of sentence production accuracy were compared between groups and conditions and across 3 sentence segments (pre-, during-, and post-Stroop). Results Increased cognitive load in the incongruent condition was associated with increased articulatory coordination variability and movement duration, compared to the congruent Stroop condition, for both age groups. Overall, the effect of increased cognitive load was greater for older adults than younger adults and was greatest in the portion of the sentence in which cognitive load was manipulated (during-Stroop), followed by the pre-Stroop segment. Sentence production accuracy was reduced for older adults in the incongruent condition. Conclusions Increased cognitive load involving response inhibition, selective attention, and working memory processes within a speech production task disrupted both the stability and timing with which speech was produced by both age groups. Older adults' speech motor performance may have been more affected due to age-related changes in cognitive and motoric functions that result in altered motor cognition.
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Affiliation(s)
- Megan K MacPherson
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant
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8
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Badrkhahan SZ, Sikaroodi H, Sharifi F, Kouti L, Noroozian M. Validity and reliability of the Persian version of the Montreal Cognitive Assessment (MoCA-P) scale among subjects with Parkinson's disease. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:431-439. [PMID: 30821505 DOI: 10.1080/23279095.2019.1565762] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Parkinson's disease (PD) is a progressive multifactorial degenerative disorder that has both motor and nonmotor features. Among the nonmotor features of PD, cognitive impairment; Mild Cognitive Impairment (MCI) and dementia, poses one of the most significant implications for disability. Because of the high possibility of developing Dementia in PD, it is essential to obtain a reliable cognitive screen. Two commonly used cognitive measures include the Mini Mental Status Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The MoCA is a more sensitive tool for the detection of MCI in compared to the MMSE. Because of the cultural differences, in this study, we evaluated the psychometric properties of the Persian version of the MoCA (MoCA-P) in a group of participants with PD in Iran. Participants were assessed by MMSE, Geriatric Depression Scale (GDS), and Functional Assessment Staging Test (FAST). If they met study eligibility, the MoCA-P scale was administered. Receiver Operating Characteristic (ROC) curve analyses showed that the MoCA-P scale produced significant discrimination of PD with Dementia (PDD) from PD with MCI (PD-MCI). It seems that the MoCA-P has adequate psychometric properties as a screening instrument for the detection of PD-MCI and PDD in Iranian patients. As near to 30% of patients with PD go on to develop dementia, the MoCA-P can be useful in the detection of cognitive impairment in patients with PD and is suitable for executive function assessment.
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Affiliation(s)
- Seyedeh Zahra Badrkhahan
- Department of Geriatric Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hajir Sikaroodi
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Kouti
- Clinical Pharmacy Department, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Iran
| | - Maryam Noroozian
- Cognitive Neurology & Neuropsychiatry Division, Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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9
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Seubert-Ravelo AN, Yáñez-Téllez MG, Salgado-Ceballos H, Escartín-Pérez RE, Neri-Nani GA, Velázquez-Osuna S. Mild Cognitive Impairment in Patients with Early-Onset Parkinson's Disease. Dement Geriatr Cogn Disord 2018; 42:17-30. [PMID: 27467581 DOI: 10.1159/000447533] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Few studies have described mild cognitive impairment (MCI) and cognitive characteristics in early-onset Parkinson's disease (EOPD). This study describes attention/working memory, language, memory, visuospatial abilities, executive function, and frequency of MCI and dementia in EOPD. METHODS Eighty-one EOPD patients were administered neuropsychological tests and the Beck Depression Inventory. Scores were compared with age/education-appropriate norms and were correlated to years of disease progression and severity of motor symptoms. The frequency of MCI and dementia was determined by the Movement Disorder Society criteria. RESULTS Thirty-one percent of patients met the MCI criteria, but none had dementia. Commonly affected domains were memory, visuospatial, and executive function. Cognitive dysfunction was not explained by depression or severity of motor symptoms. CONCLUSION One third of EOPD patients presented with MCI, which was not associated with the same risk factors as reported in late-onset Parkinson's disease. MCI could have a different prognostic value in EOPD.
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Affiliation(s)
- Ana Natalia Seubert-Ravelo
- Interdisciplinary Investigation Unit in Health and Education Sciences, Master in Psychology, Clinical Neuropsychology Residency Program, FES Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
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10
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Beach TG, Adler CH, Sue LI, Serrano G, Shill HA, Walker DG, Lue L, Roher AE, Dugger BN, Maarouf C, Birdsill AC, Intorcia A, Saxon-Labelle M, Pullen J, Scroggins A, Filon J, Scott S, Hoffman B, Garcia A, Caviness JN, Hentz JG, Driver-Dunckley E, Jacobson SA, Davis KJ, Belden CM, Long KE, Malek-Ahmadi M, Powell JJ, Gale LD, Nicholson LR, Caselli RJ, Woodruff BK, Rapscak SZ, Ahern GL, Shi J, Burke AD, Reiman EM, Sabbagh MN. Arizona Study of Aging and Neurodegenerative Disorders and Brain and Body Donation Program. Neuropathology 2015; 35:354-89. [PMID: 25619230 DOI: 10.1111/neup.12189] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/11/2014] [Indexed: 12/13/2022]
Abstract
The Brain and Body Donation Program (BBDP) at Banner Sun Health Research Institute (http://www.brainandbodydonationprogram.org) started in 1987 with brain-only donations and currently has banked more than 1600 brains. More than 430 whole-body donations have been received since this service was commenced in 2005. The collective academic output of the BBDP is now described as the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND). Most BBDP subjects are enrolled as cognitively normal volunteers residing in the retirement communities of metropolitan Phoenix, Arizona. Specific recruitment efforts are also directed at subjects with Alzheimer's disease, Parkinson's disease and cancer. The median age at death is 82. Subjects receive standardized general medical, neurological, neuropsychological and movement disorders assessments during life and more than 90% receive full pathological examinations by medically licensed pathologists after death. The Program has been funded through a combination of internal, federal and state of Arizona grants as well as user fees and pharmaceutical industry collaborations. Subsets of the Program are utilized by the US National Institute on Aging Arizona Alzheimer's Disease Core Center and the US National Institute of Neurological Disorders and Stroke National Brain and Tissue Resource for Parkinson's Disease and Related Disorders. Substantial funding has also been received from the Michael J. Fox Foundation for Parkinson's Research. The Program has made rapid autopsy a priority, with a 3.0-hour median post-mortem interval for the entire collection. The median RNA Integrity Number (RIN) for frozen brain and body tissue is 8.9 and 7.4, respectively. More than 2500 tissue requests have been served and currently about 200 are served annually. These requests have been made by more than 400 investigators located in 32 US states and 15 countries. Tissue from the BBDP has contributed to more than 350 publications and more than 200 grant-funded projects.
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Affiliation(s)
- Thomas G Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Lucia I Sue
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Geidy Serrano
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Holly A Shill
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - LihFen Lue
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Alex E Roher
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Chera Maarouf
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Alex C Birdsill
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | | | - Joel Pullen
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Jessica Filon
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Sarah Scott
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Angelica Garcia
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | | | | | | | - Kathryn J Davis
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Kathy E Long
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | | | - Lisa D Gale
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | | | | | | | | | - Jiong Shi
- Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Anna D Burke
- Banner Alzheimer Institute, Phoenix, Arizona, USA
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The tools of the trade: A state of the art “How to Assess Cognition” in the patient with Parkinson's disease. Mov Disord 2014; 29:584-96. [DOI: 10.1002/mds.25874] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/07/2014] [Accepted: 02/27/2014] [Indexed: 01/08/2023] Open
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12
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Reginold W, Duff-Canning S, Meaney C, Armstrong MJ, Fox S, Rothberg B, Zadikoff C, Kennedy N, Gill D, Eslinger P, Marshall F, Mapstone M, Chou KL, Persad C, Litvan I, Mast B, Tang-Wai D, Lang AE, Marras C. Impact of mild cognitive impairment on health-related quality of life in Parkinson's disease. Dement Geriatr Cogn Disord 2014; 36:67-75. [PMID: 23774742 DOI: 10.1159/000350032] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To assess the impact of mild cognitive impairment (MCI) or cognitive decline on health-related quality of life (HR-QOL) in Parkinson's disease (PD). METHODS HR-QOL measured by the Parkinson Disease Quality of Life Questionnaire (PDQ-39), MCI according to Movement Disorder Society Task Force criteria and cognitive decline from premorbid baseline were assessed in non-demented PD patients at 6 movement disorder clinics. RESULTS Among 137 patients, after adjusting for education, gender, disease duration, and Movement Disorder Society Unified Parkinson's Disease Rating Scale total score, MCI was associated with worse scores within the PDQ-39 dimension of communication (p = 0.008). Subjects were divided into tertiles of cognitive decline from premorbid level. Scores in the dimension of stigma were worst in the second tertile of cognitive decline (p = 0.03). MCI was associated with worse social support scores in the second tertile of cognitive decline (p = 0.008). CONCLUSION MCI and cognitive decline from premorbid baseline are associated with reduced HR-QOL in communication, stigma, and social support domains. The cognitive decline from premorbid baseline modifies the association between MCI and HR-QOL in PD and knowing both will allow a better appreciation of difficulties patients face in daily life.
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13
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Kudlicka A, Clare L, Hindle JV. Quality of life, health status and caregiver burden in Parkinson's disease: relationship to executive functioning. Int J Geriatr Psychiatry 2014; 29:68-76. [PMID: 23625583 DOI: 10.1002/gps.3970] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 01/12/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High-quality person-centred care for people with Parkinson's disease (PwPD) and their families relies on identifying and addressing factors that specifically impact on quality of life (QoL). Deficits in executive functions (EF) are common in Parkinson's disease, but their impact on PwPD and their caregivers is not well understood. The present study evaluated how EF contributes to QoL and health status for the PwPD and caregiver burden. METHODS Sixty-five PwPD completed measures of QoL, health status and EF, and 50 caregivers rated the EF of the PwPD and their own burden. Multiple regression analyses examined predictors of QoL (general life, health and movement disorders domains), health status and caregiver burden. RESULTS Quality of life in the health and movement disorders domains was best explained by caregiver-rated EF, whereas QoL in the general life domain was best explained by level of depression. Health status was predicted by self-rated EF, with an objective EF measure also included in the regression model. Caregiver burden was best explained by caregiver-rated EF and disease severity, with general cognition and other factors also included in the regression model. CONCLUSIONS Executive functions-related behavioural problems may contribute to QoL and health status in PwPD and affect caregiver burden. The findings support the view that the concepts of subjective QoL and self-assessed health status are only partially related and should not be seen as identical. Adequate strategies to reduce the impact of EF deficits are needed as this may have the potential to improve QoL in PwPD.
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14
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Watson GS, Cholerton BA, Gross RG, Weintraub D, Zabetian CP, Trojanowski JQ, Montine TJ, Siderowf A, Leverenz JB. Neuropsychologic assessment in collaborative Parkinson's disease research: a proposal from the National Institute of Neurological Disorders and Stroke Morris K. Udall Centers of Excellence for Parkinson's Disease Research at the University of Pennsylvania and the University of Washington. Alzheimers Dement 2013; 9:609-14. [PMID: 23164549 PMCID: PMC3612566 DOI: 10.1016/j.jalz.2012.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 11/23/2022]
Abstract
Cognitive impairment (CI) and behavioral disturbances can be the earliest symptoms of Parkinson's disease (PD), ultimately afflict the vast majority of PD patients, and increase caregiver burden. Our two Morris K. Udall Centers of Excellence for Parkinson's Disease Research were supported by the National Institute of Neurological Disorders and Stroke (NINDS) in an effort to recommend a comprehensive yet practical approach to cognitive and behavioral assessment to further collaborative research. We recommend a stepwise approach with two levels of standardized evaluation to establish a common battery, as well as an alternative testing recommendation for severely impaired subjects, and review supplemental tests that may be useful in specific research settings. Our flexible approach may be applied to studies with varying emphasis on cognition and behavior, does not place undue burden on participants or resources, and has a high degree of compatibility with existing test batteries to promote collaboration.
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Affiliation(s)
- G. Stennis Watson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Brenna A. Cholerton
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Rachel G. Gross
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Cyrus P. Zabetian
- Geriatric, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Parkinson’s Disease Research, Education and Clinical Centers, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Department of Neurology, University of Washington, Seattle, WA
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
- Institute on Aging, University of Pennsylvania, Philadelphia, PA
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Philadelphia, PA
| | | | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - James B. Leverenz
- Mental Illness, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Parkinson’s Disease Research, Education and Clinical Centers, Veterans Affairs-Puget Sound Health Care System, Seattle WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Department of Neurology, University of Washington, Seattle, WA
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15
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Martin RC, Triebel KL, Kennedy RE, Nicholas AP, Watts RL, Stover NP, Brandon M, Marson DC. Impaired financial abilities in Parkinson's disease patients with mild cognitive impairment and dementia. Parkinsonism Relat Disord 2013; 19:986-90. [PMID: 23899743 DOI: 10.1016/j.parkreldis.2013.06.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/18/2013] [Accepted: 06/25/2013] [Indexed: 01/30/2023]
Abstract
PURPOSE Financial capacity (FC) is an instrumental activity of daily living (IADL) critical to independent functioning and sensitive to cognitive impairment in dementia. Little is known about FC in cognitively impaired patients with Parkinson's disease (PD). The present study investigated FC in PD patients with prodromal and clinical dementia. METHODS Participants were 20 older controls and 35 PD patients who met consensus criteria for either mild cognitive impairment (PD-MCI, n = 18) or PD dementia (PDD, n = 17). FC was assessed using a standardized performance based measure consisting of 9 domain and two global scores (Financial Capacity Instrument; FCI) (1). FCI domain and global performance scores were compared across groups. Capacity impairment ratings (no impairment, mild/moderate impairment, severe impairment) were calculated for each PD patient's domain and global scores. RESULTS Relative to controls, PD-MCI patients were impaired on both FCI global scores and domains of basic monetary skills, financial concepts, and investment decision-making. Relative to both controls and PD-MCI patients, PDD patients were impaired on virtually all FCI variables. With respect to impairment ratings, greater than 50% of PD-MCI patients and greater than 90% of PDD patients were classified as either mild/moderate or severely impaired on the two FCI global scores. CONCLUSIONS Impairment of financial capacity is already present in PD-MCI and is advanced in PDD. Complex cognitively-mediated IADLs such as financial capacity appear to be impaired early in the course of PD dementia.
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Affiliation(s)
- Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; Alzheimer's Disease Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Mayo AM, Wallhagen M, Cooper BA, Mehta K, Ross L, Miller B. The relationship between functional status and judgment/problem solving among individuals with dementia. Int J Geriatr Psychiatry 2013; 28:514-21. [PMID: 22786576 PMCID: PMC3496819 DOI: 10.1002/gps.3854] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 06/14/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the relationship between functional status (independent activities of daily living) and judgment/problem solving and the extent to which select demographic characteristics such as dementia subtype and cognitive measures may moderate that relationship in older adult individuals with dementia. METHODS The National Alzheimer's Coordinating Center Universal Data Set was accessed for a study sample of 3,855 individuals diagnosed with dementia. Primary variables included functional status, judgment/problem solving, and cognition. RESULTS Functional status was related to judgment/problem solving (r = 0.66; p < 0.0005). Functional status and cognition jointly predicted 56% of the variance in judgment/problem solving (R(2) = 0.56, p < 0.0005). As cognition decreases, the prediction of poorer judgment/problem solving by functional status became stronger. CONCLUSIONS Among individuals with a diagnosis of dementia, declining functional status as well as declining cognition should raise concerns about judgment/problem solving.
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Affiliation(s)
- Ann M. Mayo
- Hahn School of Nursing & Health Science; University of San Diego; San Diego CA USA
| | | | - Bruce A. Cooper
- University of California San Francisco; San Francisco CA USA
| | - Kala Mehta
- University of California San Francisco; San Francisco CA USA
| | - Leslie Ross
- University of California San Francisco; San Francisco CA USA
| | - Bruce Miller
- University of California San Francisco; San Francisco CA USA
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17
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Pontone GM, Palanci J, Williams JR, Bassett SS. Screening for DSM-IV-TR cognitive disorder NOS in Parkinson's disease using the Mattis Dementia Rating Scale. Int J Geriatr Psychiatry 2013; 28:364-71. [PMID: 22628158 PMCID: PMC3449223 DOI: 10.1002/gps.3833] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 04/24/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study explores the utility of the Mattis Dementia Rating Scale (MDRS) as a screening tool for the Diagnostic and Statistical Manual for Mental Disorders 4th edition (DSM-IV-TR) diagnosis cognitive disorder not otherwise specified (NOS) in Parkinson's disease (PD). METHODS A total of 125 individuals with PD were diagnosed using DSM-IV-TR criteria for cognitive disorder NOS and dementia. Receiver operating characteristics (ROC) tested the discriminant validity of the MDRS, with the clinician's diagnosis serving as the gold standard. RESULTS The MDRS ROC curve to discriminate subjects with cognitive disorder NOS from non-demented subjects had an area under the curve of 0.59 (standard error = 0.08, 95% CI: 0.43-0.74). CONCLUSIONS The MDRS is not effective for identifying PD patients with cognitive disorder NOS without dementia.
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Affiliation(s)
- Gregory M. Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD,Morris K. Udall Parkinson’s Disease Research Center of Excellence at Johns Hopkins,Correspondence to: Greg Pontone, MD, Johns Hopkins University School of Medicine, 600 N. Wolfe Street - Phipps 300, Baltimore, MD 21287, , o:(410) 502-0477/f:(410)614-3676
| | - Justin Palanci
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD,Morris K. Udall Parkinson’s Disease Research Center of Excellence at Johns Hopkins
| | - James R. Williams
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD,Biogen Idec, Cambridge, MA
| | - Susan Spear Bassett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD,Morris K. Udall Parkinson’s Disease Research Center of Excellence at Johns Hopkins
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18
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Martyr A, Clare L. Executive function and activities of daily living in Alzheimer's disease: a correlational meta-analysis. Dement Geriatr Cogn Disord 2012; 33:189-203. [PMID: 22572810 DOI: 10.1159/000338233] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The assessment of executive function (EF) and activities of daily living (ADL) are important elements in the diagnosis of Alzheimer's disease. METHODS Following a comprehensive search in three databases, a random-effects meta-analysis was used to investigate the association between ADL ability and seventeen tests of EF, three tests of attention and working memory and the Mini-Mental State Examination. The association between EF and ADL ability was further investigated in relation to four different methods of assessing ADL, and one specific ADL, driving. RESULTS Forty-nine studies met the inclusion criteria, and a total of 3,663 participants were included, the majority of whom were diagnosed with Alzheimer's disease. Most of the individual tests, including commonly used tests of EF such as the Clock Drawing Test, Letter Fluency and the Trail Making Test Part B, showed a significant moderate association with ADL. Associations between EF and ADL ability were similar for all four methods of assessing ADL ability. Driving ability was also moderately associated with EF. CONCLUSION The meta-analysis suggests a consistent moderate association between ADL and EF, supporting the growing evidence for a link between ADL and executive dysfunction in early dementia.
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Affiliation(s)
- Anthony Martyr
- School of Psychology, Bangor University, Bangor, Gwynedd, UK.
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19
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McColgan P, Evans JR, Breen DP, Mason SL, Barker RA, Williams-Gray CH. Addenbrooke's Cognitive Examination-Revised for mild cognitive impairment in Parkinson's disease. Mov Disord 2012; 27:1173-7. [PMID: 22733390 DOI: 10.1002/mds.25084] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/25/2012] [Accepted: 05/02/2012] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Cognitive impairment is common in Parkinson's disease (PD), even in the early stages, and appropriate screening tools are needed. METHODS We investigated the utility of the Addenbrooke's Cognitive Examination-Revised for detecting mild cognitive impairment (MCI) in PD in an incident population-representative cohort (n = 132) and investigated the relationship between performance on this instrument and behavior and quality of life (n = 219). RESULTS Twenty-two percent met criteria for MCI. Receiver operating curve analysis revealed an area under the curve of 0.81. A cutoff <89 gave a sensitivity of 69% and specificity of 84%. Scores on this instrument were highly correlated with the Parkinson's Disease Cognitive Rating Scale, and there were significant correlations with the Cambridge Behavioral Inventory-Revised and Parkinson's Disease Questionnaire 39. CONCLUSION This instrument is a useful screening tool for PD-MCI, and poor performance is significantly related to impaired behavior and quality of life.
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Affiliation(s)
- Peter McColgan
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
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20
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Le T, Wilamowska K, Demiris G, Thompson H. Integrated data visualisation: an approach to capture older adults' wellness. INTERNATIONAL JOURNAL OF ELECTRONIC HEALTHCARE 2012; 7:89-104. [PMID: 23079025 PMCID: PMC3668565 DOI: 10.1504/ijeh.2012.049872] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Informatics tools can help support the health and independence of older adults. In this paper, we present an approach towards integrating health-monitoring data and describe several techniques for the assessment and visualisation of integrated health and well-being of older adults. We present three different visualisation techniques to provide distinct alternatives towards display of the same information, focusing on reducing the cognitive load of data interpretation. We demonstrate the feasibility of integrating health-monitoring information into a comprehensive measure of wellness, while also highlighting the challenges of designing visual displays targeted at multiple user groups. These visual displays of wellness can be incorporated into personal health records and can be an effective support for informed decision-making.
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Affiliation(s)
- Thai Le
- Department of Biomedical Informatics and Medical Education, University of Washington, Box 357240, 1959 NE Pacific Street, HSB I-264, Seattle, WA 98195, USA
| | - Katarzyna Wilamowska
- Department of Biomedical Informatics and Medical Education, University of Washington, Box 357240, 1959 NE Pacific Street, HSB I-264, Seattle, WA 98195, USA
| | - George Demiris
- Department of Biomedical Informatics and Medical Education, University of Washington, Box 357240, 1959 NE Pacific Street, HSB I-264, Seattle, WA 98195, USA
| | - Hilaire Thompson
- Biobehavioral Nursing and Health Systems, University of Washington, Box 357266, Seattle, WA 98195, USA
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Thompson HJ, Demiris G, Rue T, Shatil E, Wilamowska K, Zaslavsky O, Reeder B. A Holistic approach to assess older adults' wellness using e-health technologies. Telemed J E Health 2011; 17:794-800. [PMID: 22011052 DOI: 10.1089/tmj.2011.0059] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To date, methodologies are lacking that address a holistic assessment of wellness in older adults. Technology applications may provide a platform for such an assessment, but have not been validated. We set out to demonstrate whether e-health applications could support the assessment of older adults' wellness in community-dwelling older adults. MATERIALS AND METHODS Twenty-seven residents of independent retirement community were followed over 8 weeks. Subjects engaged in the use of diverse technologies to assess cognitive performance, physiological and functional variables, as well as psychometric components of wellness. Data were integrated from various e-health sources into one study database. Correlations were assessed between different parameters, and hierarchical cluster analysis was used to explore the validity of the wellness model. RESULTS We found strong associations across multiple parameters of wellness within the conceptual model, including cognitive, functional, and physical. However, spirituality did not correlate with any other parameter studied in contrast to prior studies of older adults. Participants expressed overall positive attitudes toward the e-health tools and the holistic approach to the assessment of wellness, without expressing any privacy concerns. CONCLUSIONS Parameters were highly correlated across multiple domains of wellness. Important clusters were noted to be formed across cognitive and physiological domains, giving further evidence of need for an integrated approach to the assessment of wellness. This finding warrants further replication in larger and more diverse samples of older adults to standardize and deploy these technologies across population groups.
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Affiliation(s)
- Hilaire J Thompson
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, Washington 98195-7266, USA.
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Kolanowski AM, Fick DM, Litaker MS, Clare L, Leslie D, Boustani M. Study protocol for the recreational stimulation for elders as a vehicle to resolve delirium superimposed on dementia (Reserve For DSD) trial. Trials 2011; 12:119. [PMID: 21569370 PMCID: PMC3113988 DOI: 10.1186/1745-6215-12-119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/11/2011] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Delirium is a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Delirium is common and deadly in older adults with dementia, and is often referred to as delirium superimposed on dementia, or DSD. Interventions that treat DSD are not well-developed because the mechanisms involved in its etiology are not completely understood. We have developed a theory-based intervention for DSD that is derived from the literature on cognitive reserve and based on our prior interdisciplinary work on delirium, recreational activities, and cognitive stimulation in people with dementia. Our preliminary work indicate that use of simple, cognitively stimulating activities may help resolve delirium by helping to focus inattention, the primary neuropsychological deficit in delirium. Our primary aim in this trial is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD). METHODS/DESIGN This randomized repeated measures clinical trial will involve participants being recruited and enrolled at the time of admission to post acute care. We will randomize 256 subjects to intervention (RESERVE-DSD) or control (usual care). Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. We hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. We will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status). Our secondary aim is to describe the costs associated with RESERVE-DSD. DISCUSSION Our theory-based intervention, which uses simple, inexpensive recreational activities for delivering cognitive stimulation, is innovative because, to our knowledge it has not been tested as a treatment for DSD. This novel intervention for DSD builds on our prior delirium, recreational activity and cognitive stimulation research, and draws support from cognitive reserve theory. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01267682
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Affiliation(s)
- Ann M Kolanowski
- School of Nursing, Pennsylvania State University, University Park, PA, USA.
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23
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Demiris G, Thompson HJ, Reeder B, Wilamowska K, Zaslavsky O. Using informatics to capture older adults' wellness. Int J Med Inform 2011; 82:e232-41. [PMID: 21482182 DOI: 10.1016/j.ijmedinf.2011.03.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 08/13/2010] [Accepted: 03/10/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this paper is to demonstrate how informatics applications can support the assessment and visualization of older adults' wellness. A theoretical framework is presented that informs the design of a technology enhanced screening platform for wellness. We highlight an ongoing pilot demonstration in an assisted living facility where a community room has been converted into a living laboratory for the use of diverse technologies (including a telehealth component to capture vital signs and customized questionnaires, a gait analysis component and cognitive assessment software) to assess the multiple aspects of wellness of older adults. METHODS A demonstration project was introduced in an independent retirement community to validate our theoretical framework of informatics and wellness assessment for older adults. Subjects are being recruited to attend a community room and engage in the use of diverse technologies to assess cognitive performance, physiological and gait variables as well as psychometrics pertaining to social and spiritual components of wellness for a period of eight weeks. Data are integrated from various sources into one study database and different visualization approaches are pursued to efficiently display potential correlations between different parameters and capture overall trends of wellness. RESULTS Preliminary findings indicate that older adults are willing to participate in technology-enhanced interventions and embrace different information technology applications given appropriate and customized training and hardware and software features that address potential functional limitations and inexperience with computers. CONCLUSION Informatics can advance health care for older adults and support a holistic assessment of older adults' wellness. The described framework can support decision making, link formal and informal caregiving networks and identify early trends and patterns that if addressed could reduce adverse health events.
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Affiliation(s)
- George Demiris
- Biomedical and Health Informatics, School of Medicine, University of Washington, United States; Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, United States.
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Tsai CF, Wang SJ, Zheng L, Fuh JL. Category verbal fluency predicted changes in behavioral and psychological symptoms of dementia in patients with Alzheimer's disease. Psychiatry Clin Neurosci 2010; 64:408-14. [PMID: 20573053 DOI: 10.1111/j.1440-1819.2010.02107.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Alzheimer's disease (AD) is characterized by cognitive symptoms and behavioral symptoms, and their association is inconsistent. The aim of this study was to investigate the relationship between cognitive function and the changes in behavioral and psychological symptoms of dementia (BPSD) in patients with AD. METHODS A total of 101 patients with probable AD were enrolled (57 women and 44 men, mean age 77.6 +/- 7.7 years). The Category Verbal Fluency Test (CVFT), the Mini-Mental State Examination (MMSE), the Constructional Praxis Test, the Delayed Word Recall Test, the Clinical Dementia Rating Scale, and the Neuropsychiatry Inventory (NPI) were administered at baseline. The NPI was reassessed with a median follow-up duration of 10 months (range 6-18 months). The change in the NPI scores was defined as the end-point score of the NPI minus the initial one. The associations between the changes in NPI total score, its four subdomains (hyperactivity, psychosis, affection, and apathy), and cognitive function were examined using multivariate linear models. The results were adjusted for confounders including demographics, baseline NPI, and duration of follow up. RESULTS The mean MMSE was 18.6 +/- 5.6, the CVFT score was 7.1 +/- 3.9, and the NPI score was 10.9 +/- 13.8. Regression analyses found that the CVFT score (beta = -0.32, P = 0.004) was significantly associated with the change in NPI score, but not the MMSE, the Delayed Word Recall score, or the Constructional Praxis score. The CVFT score was significantly associated with changes in the psychosis subdomain (beta = -0.34, P = 0.001), but not the other subdomains. CONCLUSIONS Our study showed that CVFT was predictive of the changes in behavior disturbance in patients with AD, particularly in the psychosis domain.
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Affiliation(s)
- Chia-Fen Tsai
- Departments of Psychiatry, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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25
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Impaired access to semantic memory for the cognition of geographic space in Alzheimer's disease. Arch Gerontol Geriatr 2010; 50:198-201. [DOI: 10.1016/j.archger.2009.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 03/25/2009] [Accepted: 03/27/2009] [Indexed: 11/23/2022]
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Profiles of functional deficits in mild cognitive impairment and dementia: benefits from objective measurement. J Int Neuropsychol Soc 2010; 16:297-305. [PMID: 20175938 DOI: 10.1017/s1355617709991330] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The magnitude of functional impairment that may indicate the threshold between MCI and incipient Alzheimer's disease (AD) has not been clearly defined. The objective was to examine the pattern of functional impairment in the continuum MCI-AD. Eighty-nine older adults (32 cognitively unimpaired, 31 MCI, and 26 AD patients) were examined with the Brazilian version of the Direct Assessment of Functional Status (DAFS-BR) at a university-based memory clinic. MCI patients were sub-divided according to the progression to AD upon follow-up, and had baseline cognitive, functional and biological variables analyzed. MCI patients displayed mild deficits in functional abilities, with intermediate scores as compared to controls and AD. The DAFS-BR items that differentiated MCI from controls involved the ability to deal with finances and shopping skills. At baseline, scores obtained by MCI patients who converted to AD were not significantly different from scores of nonconverters. The magnitude of functional deficits was associated with AD-like pathological findings in the CSF. In conclusion, MCI patients present with early functional changes in complex, instrumental abilities that require the integrity of memory and executive functions. The objective measurement of the functional state may help identify older adults with increased risk of developing dementia in the MCI-AD continuum.
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Martin RC, Okonkwo OC, Hill J, Griffith HR, Triebel K, Bartolucci A, Nicholas AP, Watts RL, Stover N, Harrell LE, Clark D, Marson DC. Medical decision-making capacity in cognitively impaired Parkinson's disease patients without dementia. Mov Disord 2009; 23:1867-74. [PMID: 18759361 DOI: 10.1002/mds.22170] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Little is currently known about the higher order functional skills of patients with Parkinson disease and cognitive impairment. Medical decision-making capacity (MDC) was assessed in patients with Parkinson's disease (PD) with cognitive impairment and dementia. Participants were 16 patients with PD and cognitive impairment without dementia (PD-CIND), 16 patients with PD dementia (PDD), and 22 healthy older adults. All participants were administered the Capacity to Consent to Treatment Instrument (CCTI), a standardized capacity instrument assessing MDC under five different consent standards. Parametric and nonparametric statistical analyses were utilized to examine capacity performance on the consent standards. In addition, capacity outcomes (capable, marginally capable, or incapable outcomes) on the standards were identified for the two patient groups. Relative to controls, PD-CIND patients demonstrated significant impairment on the understanding treatment consent standard, clinically the most stringent CCTI standard. Relative to controls and PD-CIND patients, PDD patients were impaired on the three clinical standards of understanding, reasoning, and appreciation. The findings suggest that impairment in decisional capacity is already present in cognitively impaired patients with PD without dementia and increases as these patients develop dementia. Clinicians and researchers should carefully assess decisional capacity in all patients with PD with cognitive impairment.
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Affiliation(s)
- Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0017, USA
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Current world literature. Trauma and rehabilitation. Curr Opin Neurol 2008; 21:762-4. [PMID: 18989123 DOI: 10.1097/wco.0b013e32831cbb85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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