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Tsiaras Y, Kiosseoglou G, Dardiotis E, Yannakoulia M, Hadjigeorgiou GM, Sakka P, Ntanasi E, Scarmeas N, Kosmidis MH. Predictive ability of the clock drawing test to detect mild cognitive impairment and dementia over time: Results from the HELIAD study. Clin Neuropsychol 2023; 37:1651-1668. [PMID: 36645823 DOI: 10.1080/13854046.2023.2167736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
Objective: We investigated the diagnostic accuracy of the Clock Drawing Test (CDT) in discriminating Mild Cognitive Impairment (MCI) and dementia from normal cognition. Additionally, its clinical utility in predicting the transition from normal cognition to MCI and dementia over the course of several years was explored. Method: In total, 1037 older adults (633 women) who completed the CDT in a baseline assessment were drawn from the population-based HELIAD cohort. Among these, 848 participants were identified as cognitively normal, 142 as having MCI and 47 with dementia during the baseline assessment. Of these individuals, 565 attended the follow-up assessment (mean interval: 3.21 years). ROC curve and binary logistic regression analyses were performed. Results: The CDT exhibited good diagnostic accuracy for the discrimination between dementia and normal cognition (AUC = .879, SN = .813, SP = .778, LR+ = 3.66, LR- = .240, < .001, d = 1.655) and acceptable diagnostic accuracy for the discrimination between dementia and MCI (AUC=.761, SN= .750, SP= .689, LR+ = 2.41, LR- = .362, p < .001, d = 1.003). We found limited diagnostic accuracy, however, for the discrimination between MCI and normal cognition (AUC = .686, SN = .764, SP = .502, LR+ = 1.53, LR- = .470, p < .001, d = .685). Moreover, the CDT significantly predicted the transition from normal cognition to dementia [Exp(B)= 1.257, p = .022], as well as the transition from MCI to normal cognition [Exp(B) = 1.334, p = .023] during the longitudinal investigation. Conclusions: The CDT is a neuropsychological test with acceptable diagnostic accuracy for the discrimination of dementia from MCI and normal cognition. Furthermore, it has an important predictive value for the transition from normal cognition to dementia and from MCI to normal cognition.
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Affiliation(s)
- Yiannis Tsiaras
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Psychiatric Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Grigoris Kiosseoglou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, University of Thessaly, Volos, Greece
| | - Mary Yannakoulia
- Department of Nutrition and-Dietetics, Harokopio University, Kallithea, Greece
| | | | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece
| | - Eva Ntanasi
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Τhe Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, ΝΥ, USA
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Nousia A, Martzoukou M, Petri MC, Messinis L, Nasios G. Face-to-face vs. Telerehabilitation language and cognitive training in patients with multi-domain amnestic mild cognitive impairment. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-9. [PMID: 37734418 DOI: 10.1080/23279095.2023.2259035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The recent coronavirus emergency raised the question of whether telerehabilitation could be as effective as conventional face-to-face intervention. The aim of the present study was to compared language and cognitive training delivered to patients from a distance, through telecommunication systems, for the same intervention conducted on a face-to-face mode in patients with multi domain amnestic MCI (md-aMCI). To this end, 30 patients diagnosed with md-aMCI took part in the present study. The participants divided into two groups; one group received conventional face-to-face training and the other group received Telerehabilitation training. Both groups received language training using paper and pencil tasks and cognitive training using the Rehacom software. The training lasted 15 weeks and was delivered twice a week, for 60 minutes per session. The conventional face-to-face mode had a significant impact on cognitive (delayed and working memory, processing speed, executive function, and attention) and language domains (naming, word recognition, and semantic fluency). The telerehabilitation method had a beneficial impact on delayed memory, naming, and semantic fluency. The results of our study provide evidence that both telerehabilitation and face-to-face language and cognitive training seem to have a positive impact in patients with md-aMCI, with face-to-face training improving more domains than telerehabilitation.
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Affiliation(s)
- Anastasia Nousia
- Department of Speech and Language Therapy, University of Peloponnese, Kalamata, Greece
| | - Maria Martzoukou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessalonike, Greece
| | - Maria Christina Petri
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessalonike, Greece
| | - Lambros Messinis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessalonike, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina, Greece
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3
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Smith C, Seematter-Bagnoud L, Santos-Eggimann B, Krief H, Bula CJ. Executive function and prospective falls: a 6-year longitudinal study in community-dwelling older adults. BMC Geriatr 2023; 23:140. [PMID: 36899323 PMCID: PMC10007810 DOI: 10.1186/s12877-023-03790-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/01/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Older people with impaired executive function (EF) might have an increased fall risk, but prospective studies with prolonged follow-up are scarce. This study aimed to investigate the association between a) EF at baseline; b) 6-year decline in EF performance; and fall status 6 years later. METHODS Participants were 906 community-dwelling adults aged 65-69 years, enrolled in the Lausanne 65 + cohort. EF was measured at baseline and at 6 years using clock drawing test (CDT), verbal fluency (VF), Trail Making Test (TMT) A and B, and TMT ratio (TMT-B - TMT-A/TMT-A). EF decline was defined as clinically meaningful poorer performance at 6 years. Falls data were collected at 6 years using monthly calendars over 12 months. RESULTS Over 12-month follow-up, 13.0% of participants reported a single benign fall, and 20.2% serious (i.e., multiple and/or injurious) falls. In multivariable analysis, participants with worse TMT-B performance (adjusted Relative Risk Ratio, adjRRRTMT-B worst quintile = 0.38, 95%CI:0.19-0.75, p = .006) and worse TMT ratio (adjRRRTMT ratio worst quintile = 0.31, 95%CI:0.15-0.64, p = .001) were less likely to report a benign fall, whereas no significant association was observed with serious falls. In a subgroup analysis among fallers, participants with worse TMT-B (OR:1.86, 95%CI = 0.98-3.53, p = .059) and worse TMT ratio (OR:1.84,95%CI = 0.98-3.43,p = .057) tended to have higher odds of serious falls. EF decline was not associated to higher odds of falls. CONCLUSIONS Participants with worse EF were less likely to report a single benign fall at follow-up, while fallers with worse EF tended to report multiple and/or injurious falls more frequently. Future studies should investigate the role of slight EF impairment in provoking serious falls in active young-old adults.
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Affiliation(s)
- Cindi Smith
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Mont Paisible 16, 1011, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Mont Paisible 16, 1011, Lausanne, Switzerland. .,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de La Corniche 10, 1010, Lausanne, Switzerland.
| | - Brigitte Santos-Eggimann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de La Corniche 10, 1010, Lausanne, Switzerland
| | - Helene Krief
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Mont Paisible 16, 1011, Lausanne, Switzerland
| | - Christophe J Bula
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Mont Paisible 16, 1011, Lausanne, Switzerland
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Nousia A, Pappa E, Siokas V, Liampas I, Tsouris Z, Messinis L, Patrikelis P, Manouilidou C, Dardiotis E, Nasios G. Evaluation of the Efficacy and Feasibility of a Telerehabilitation Program Using Language and Cognitive Exercises in Multi-Domain Amnestic Mild Cognitive Impairment. Arch Clin Neuropsychol 2023; 38:224-235. [PMID: 36156732 DOI: 10.1093/arclin/acac078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the efficacy and feasibility of a telerehabilitation program in multi-domain amnestic Mild Cognitive Impairment (md-aMCI). The study sample consisted of 30 patients with md-aMCI and aged 60-80 years. METHODS The participants were randomly divided into two groups. The Training Group (TG), which received cognitive training by using the RehaCom software as well as paper-pencil language training and the Control Group (CG) which received standard clinical care (e.g., psychotherapy or/and physiotherapy). Duration of the telerehabilitation intervention was 15 weeks (twice a week for 60 min/session). RESULTS Our results revealed that the neuropsychological performance of the TG group after the telerehabilitation intervention improved on a statistically significant level on the domains of delayed and working memory, confrontation naming, verbal fluency, and global cognition. Comparison between the TG and CG revealed a significant impact of the telerehabilitation program on the domains of memory (delay and working) and language (naming and verbal fluency) as well as global cognition performance. CONCLUSION The findings of the study are promising in that the telerehabilitation intervention appears to be a useful method in improving or stabilizing cognitive decline in md-aMCI individuals and was a particularly effective alternative approach during the period of the pandemic lockdown. Specifically, the beneficial impact of the telerehabilitation intervention on episodic memory (which is one of the first domains to show impairment in md-aMCI patients) provides us with hope and evidence that these types of interventions may be applied with similar success using face-to-face interventions.
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Affiliation(s)
- Anastasia Nousia
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Evangelia Pappa
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Vasileios Siokas
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, Greece
| | - Ioannis Liampas
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, Greece
| | - Lambros Messinis
- Departement of Psychology, Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Panayiotis Patrikelis
- Departement of Psychology, Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Christina Manouilidou
- Department of Comparative and General Linguistics, University of Ljubljana, Ljubljana, Slovenia
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
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5
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Ramos-Henderson M, Calderón C, Domic-Siede M. Education bias in typical brief cognitive tests used for the detection of dementia in elderly population with low educational level: a critical review. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36519252 DOI: 10.1080/23279095.2022.2155521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Dementia is a significant decline in cognition that interfere with independent, daily functioning. Dementia is a syndrome caused by a myriad and include primary neurologic, neuropsychiatric, and medical conditions. It has been projected that the prevalence of dementia will triple in the elderly population by the year 2050. Despite the benefits of early diagnosis, there is an effective under-detection of around 62% of people with mild cognitive impairment (MCI) or dementia. One of the factors associated with this problem is that diagnostic techniques are affected by the educational level of those evaluated. This is an important aspect to consider in the use of brief cognitive tests for the detection of dementia. This review presents and critically analyzes the available evidence regarding the effect of educational level on the diagnostic utility of three of the most widely used tools in the clinical setting: the Mini-mental Test Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Addenbrooke's Cognitive Examination (ACE). Previous evidence shows that the tasks that require reading, writing, calculation, phonological fluency, and visuoconstruction are affected by educational level. These results lead to discourage the use of these tests in older people with less than 6 years of schooling. The development of brief cognitive tests appropriate for people with a low educational level is recommended. We posit that adequate cognitive tests should not consider tasks or items that resemble characteristics of academic contexts and should be more analogous to daily activities situations.
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Affiliation(s)
- Miguel Ramos-Henderson
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
- Centro de Investigación e Innovación en Gerontología Aplicada CIGAP, Facultad de Salud, Universidad Santo Tomás, Antofagasta, Chile
| | - Carlos Calderón
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
| | - Marcos Domic-Siede
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
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Esteves CDS, Oliveira CRD, Lima MP, Gonzatti V, Irigary TQ. Teste do Desenho do Relógio: Dados Normativos Para Idosos. PSICO-USF 2022. [DOI: 10.1590/1413-82712027270306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Resumo Trata-se de um estudo quantitativo, retrospectivo, correlacional e de corte transversal, com objetivo de fornecer dados normativos do TDR para idosos, levando em consideração diferentes faixas etárias e níveis de escolaridade. Duzentos e trinta e cinco foram entrevistados individualmente, distribuídos em cinco grupos etários e quatro níveis de escolaridade. Os instrumentos foram Ficha de Dados Sociodemográficos, Miniexame do Estado Mental (MEEM), Escala de Depressão Geriátrica, versão reduzida (GDS-15), Tarefa de Fluência Verbal Semântica (TFVS) e o TDR. Utilizou-se estatísticas descritivas, correlação de Pearson e análise univariada (one-way ANOVA) com post hoc Scheffe. Os escores do TDR apresentaram associações significativas com os anos de idade, anos de escolaridade, MEEM, TFVS e GDS-15. Houve diferença de desempenho no TDR ao considerarem os grupos por idade. O estudo fornece valores normativos para o TDR em uma amostra de idosos do sul do Brasil que foram influenciados pela idade, escolaridade, sintomatologia depressiva e fluência verbal.
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7
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GÖÇMEZ YILMAZ G, OZGE A, ŞAHİN M, KIRAL K. Saat çizme testinin çeşitli demans tiplerini ayırt etmedeki etkinliği. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.983409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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8
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Chu NM, Xue QL, McAdams-DeMarco MA, Carlson MC, Bandeen-Roche K, Gross AL. Frailty-a risk factor of global and domain-specific cognitive decline among a nationally representative sample of community-dwelling older adult U.S. Medicare beneficiaries. Age Ageing 2021; 50:1569-1577. [PMID: 34097002 DOI: 10.1093/ageing/afab102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES frail older adults may be more vulnerable to stressors, resulting in steeper declines in cognitive function. Whether the frailty-cognition link differs by cognitive domain remains unclear; however, it could lend insight into underlying mechanisms. METHODS we tested whether domain-specific cognitive trajectories (clock-drawing test, (CDT), immediate and delayed recall, orientation to date, time, president and vice-president naming) measured annually (2011-2016) differ by baseline frailty (physical frailty phenotype) in the National Health and Aging Trends Study (n = 7,439), a nationally representative sample of older adult U.S. Medicare beneficiaries, using mixed effects models to describe repeated measures of each cognitive outcome. To determine if the association between frailty and subsequent cognitive change differed by education, we tested for interaction using the Wald test. RESULTS we observed steeper declines for frail compared to non-frail participants in each domain-specific outcome, except for immediate recall. Largest differences in slope were observed for CDT (difference = -0.12 (standard deviations) SD/year, 95%CI: -0.15, -0.08). By 2016, mean CDT scores for frail participants were 1.8 SD below the mean (95%CI: -1.99, -1.67); for non-frail participants, scores were 0.8 SD below the mean (95%CI: -0.89, -0.69). Associations differed by education for global cognitive function (Pinteraction < 0.001) and for each domain-specific outcome: CDT (Pinteraction < 0.001), orientation (Pinteraction < 0.001), immediate (Pinteraction < 0.001) and delayed (Pinteraction < 0.001) word recalls. CONCLUSION frailty is associated with lower levels and steeper declines in cognitive function, with strongest associations for executive function. These findings suggest that aetiologies are multifactorial, though primarily vascular related; further research into its association with dementia sub-types and related pathologies is critical.
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Affiliation(s)
- Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Qian-Li Xue
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Michelle C Carlson
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Karen Bandeen-Roche
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
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Badea R, Terecoasa E, Ribigan A, Dimitriade A, Carp A, Dorobat B, Antochi F, Bajenaru O. Factors Associated with Severe Carotid Artery Stenosis in a Population with One of the Highest Incidences of Ischemic Stroke in Europe - Single National Center Analysis. MAEDICA 2020; 15:339-347. [PMID: 33312250 PMCID: PMC7726510 DOI: 10.26574/maedica.2020.15.3.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction: Despite significant advances in its prevention and acute-phase treatment, stroke is still one of the leading causes of disability and death worldwide. Ischemic stroke accounts for 80 to 87% of all strokes, with 15-30% of cases being caused by extracranial carotid artery (CA) stenosis. Methods: This is an observational, cross-sectional, single-center, prospective, registry-based study. The current research presents the preliminary results after analyzing the demographic features, biological data, and cardio- and cerebro-vascular risk factors of the first 74 patients included in the first "Romanian registry for cervical and cerebral arterial stenosis." Results: In our group of patients, the severity of carotid artery stenosis was related to fibrinogen, total cholesterol, and triglyceride blood levels. Moreover, patients who underwent carotid artery stenosis were more prone to having peri-procedural complications if they had a low blood platelet count. Concerning the associated pathologies of patients with severe carotid atheromatosis, the risk of having lower cognitive abilities was higher in subjects with atrial fibrillation, regardless of the severity of carotid artery stenosis. Conclusions: The presented study brings essential information about a population more prone to cerebral ischemic events than that of most other countries. All data obtained until this moment and which will further result from analyzing the clinical, demographic, and biological features of patients included in this registry should be used for implementing populational strategies for preventing further strokes.
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Affiliation(s)
- R Badea
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - E Terecoasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - A Ribigan
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - A Dimitriade
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - A Carp
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - B Dorobat
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - F Antochi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - O Bajenaru
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
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Chu NM, Bandeen-Roche K, Tian J, Kasper JD, Gross AL, Carlson MC, Xue QL. Hierarchical Development of Frailty and Cognitive Impairment: Clues Into Etiological Pathways. J Gerontol A Biol Sci Med Sci 2020; 74:1761-1770. [PMID: 31120105 DOI: 10.1093/gerona/glz134] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Frailty and cognitive impairment (CI) are associated and often coexist in older adults. Whether temporal patterns of occurrence reflect different etiologies remain unknown. METHODS Participants from the National Health and Aging Trends Study were assessed annually (2011-2016) for frailty (Fried's criteria) and CI (bottom quintile of clock drawing test or immediate and delayed recall; proxy-report of dementia diagnosis or AD8 ≥ 2). We used the Fine & Gray model to identify correlates of frailty onset before CI, CI onset before frailty, and frailty-CI co-occurrence, accounting for death as a competing risk. RESULTS Of 3,848 free of frailty, CI, and dementia at baseline, 2,183 (61.2%) developed neither frailty nor CI during the 5-year follow-up; 343 (8.3%) developed frailty first; 1,014 (24.4%) developed CI first; and 308 (6.0%) developed frailty-CI co-occurrence. Incident dementia, as a marker of underlying neuropathologies, was associated with greater likelihood of CI onset first (subdistribution hazard ratios [SHR] = 2.60, 95% confidence interval [ci] 2.09 to 3.24), and frailty-CI co-occurrence (SHR = 8.77, 95% ci 5.79 to 13.28), but lower likelihood of frailty onset first (SHR = 0.38, 95% ci 0.21 to 0.68). Number of comorbidities was only associated with frailty occurrence first (1 comorbidity: SHR = 2.51, 95% ci 1.15 to 5.47; 4+ comorbidities: SHR = 6.48, 95% ci 2.78 to 15.48). CONCLUSIONS Different patterns of frailty and CI occurrence exist, and dementia-related pathologies and comorbidities may be important correlates of order of emergence, potentially reflecting different etiologies. Future investigation into relationships between these patterns and dementia subtypes and related pathologies is needed to elucidate etiologic pathways and to provide new targets for prevention, intervention, and risk screening.
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Affiliation(s)
- Nadia M Chu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle C Carlson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Qian-Li Xue
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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11
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Eckardt N, Braun C, Kibele A. Instability Resistance Training improves Working Memory, Processing Speed and Response Inhibition in Healthy Older Adults: A Double-Blinded Randomised Controlled Trial. Sci Rep 2020; 10:2506. [PMID: 32054896 PMCID: PMC7018952 DOI: 10.1038/s41598-020-59105-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 01/24/2020] [Indexed: 12/18/2022] Open
Abstract
Aging is associated with declines in physical and cognitive performance. While there is no doubt about beneficial effects of physical exercise on proxies of strength and balance, the overall evidence for positive effects of resistance and balance training on executive functions is rather inconsistent. Whether the simultaneous exercising of strength and balance, i.e., instability resistance training, promotes executive functions in older adults is unknown. In the present trial, we tested the effects of unstable vs. stable resistance training on executive functions. Sixty-eight healthy older adults aged 65–79 years were randomly assigned to either an instability free-weight resistance training or one of two stable machine-based resistance training programs. Each group exercised twice a week on non-consecutive days for 10 weeks. Four tests to evaluate specific domains of executive functions were administered prior and following training: working memory, processing speed, response inhibition and set-shifting. The instability resistance training group improved working memory, processing speed and response inhibition from pre to post-test. In contrast, we found no improvements in executive functions for both stable resistance training groups. Our results demonstrate that 10 weeks of instability resistance training suffice to improve executive functions in older adults.
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Affiliation(s)
- Nils Eckardt
- University of Kassel, Institute of Sports and Sport Science, Department of Training and Movement Science, Kassel, 34121, Germany. .,Carl von Ossietzky University of Oldenburg, Institute of Sport Science, Department of Sport and Movement Science, Oldenburg, 26129, Germany.
| | - Claudia Braun
- University of Kassel, Institute of Sports and Sport Science, Department of Training and Movement Science, Kassel, 34121, Germany
| | - Armin Kibele
- University of Kassel, Institute of Sports and Sport Science, Department of Training and Movement Science, Kassel, 34121, Germany
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12
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Nousia A, Martzoukou M, Siokas V, Aretouli E, Aloizou AM, Folia V, Peristeri E, Messinis L, Nasios G, Dardiotis E. Beneficial effect of computer-based multidomain cognitive training in patients with mild cognitive impairment. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:717-726. [DOI: 10.1080/23279095.2019.1692842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Anastasia Nousia
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Maria Martzoukou
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleni Aretouli
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vasiliki Folia
- Department of Neurology, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleni Peristeri
- Department of Neurology, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Lambros Messinis
- Neuropsychology Section, Department of Neurology, University of Patras Medical School, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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13
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The Patient Beyond the Sphincter-Cognitive and Functional Considerations Affecting the Natural History of Artificial Urinary Sphincters. Urology 2019; 137:14-18. [PMID: 31794813 DOI: 10.1016/j.urology.2019.11.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/31/2019] [Accepted: 11/25/2019] [Indexed: 11/21/2022]
Abstract
Artificial urinary sphincters (AUS) are common. Life expectancy at average implantation (71.5 years) is 14 years. During this period patients must still possess manual dexterity and cognitive capabilities needed to operate the AUS, otherwise it is practically unfunctional. Still, available data regarding AUS durability deal with medical and mechanical factors. Issues as age-related deteriorating manual dexterity and cognitive capabilities precluding patients from operating an apparently intact AUS have not been addressed. We set to focus on these aspects. We review the natural history of manual dexterity, physical, and cognitive deterioration of aging men and propose counseling and screening algorithms for evaluating these aspects.
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14
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Nelson KP, Edwards D. A paired kappa to compare binary ratings across two medical tests. Stat Med 2019; 38:3272-3287. [PMID: 31099902 DOI: 10.1002/sim.8200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/09/2019] [Accepted: 04/19/2019] [Indexed: 11/06/2022]
Abstract
Agreement between experts' ratings is an important prerequisite for an effective screening procedure. In clinical settings, large-scale studies are often conducted to compare the agreement of experts' ratings between new and existing medical tests, for example, digital versus film mammography. Challenges arise in these studies where many experts rate the same sample of patients undergoing two medical tests, leading to a complex correlation structure between experts' ratings. Here, we propose a novel paired kappa measure to compare the agreement between the binary ratings of many experts across two medical tests. Existing approaches can accommodate only a small number of experts, rely heavily on Cohen's kappa and Scott's pi measures of agreement, and thus are prone to their drawbacks. The proposed kappa appropriately accounts for correlations between ratings due to patient characteristics, corrects for agreement due to chance, and is robust to disease prevalence and other flaws inherent in the use of Cohen's kappa. It can be easily calculated in the software package R. In contrast to existing approaches, the proposed measure can flexibly incorporate large numbers of experts and patients by utilizing the generalized linear mixed models framework. It is intended to be used in population-based studies, increasing efficiency without increasing modeling complexity. Extensive simulation studies demonstrate low bias and excellent coverage probability of the proposed kappa under a broad range of conditions. Methods are applied to a recent nationwide breast cancer screening study comparing film mammography to digital mammography.
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Affiliation(s)
- Kerrie P Nelson
- Department of Biostatistics, Boston University, Boston, Massachusetts
| | - Don Edwards
- Department of Statistics, University of South Carolina, Columbia, South Carolina
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15
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Eckardt N, Rosenblatt NJ. Instability Resistance Training Decreases Motor Noise During Challenging Walking Tasks in Older Adults: A 10-Week Double-Blinded RCT. Front Aging Neurosci 2019; 11:32. [PMID: 30873017 PMCID: PMC6400996 DOI: 10.3389/fnagi.2019.00032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/04/2019] [Indexed: 12/01/2022] Open
Abstract
Locomotor stability is challenged by internal perturbations, e.g., motor noise, and external perturbations, e.g., changes in surface compliance. One means to compensate for such perturbations is to employ motor synergies, defined here as co-variation among a set of elements that acts to stabilize, or provide similar trial-to-trial (or step-to-step) output, even in the presence of small variations in initial conditions. Whereas evidence exists that synergies related to the upper extremities can be trained, the extent to which lower limb synergies, such as those which may be needed to successfully locomote in complex environments, remains unknown. The purpose of this study was to evaluate if resistance training (RT) in unstable environments could promote coordination patterns associated with stronger synergies during gait. Sixty-eight participants between the age of 65 and 80 were randomly assigned to one of three different RT modalities: stable whole-limb machine-based RT (S-MRT), instability free-weight RT (I-FRT), and stable machine-based adductor/abductor RT (S-MRTHIP). Before and after RT, participants walked across an even lab floor and a more challenging uneven surface with and without holding a weighted bag. The uncontrolled manifold control analysis (UCM) was used to calculate the synergy index (i.e., strength of the kinematic synergy) related to stabilization of our performance variable, the mediolateral trajectory of the swing foot, under each condition. Regardless of RT group, there was no effect of RT on the synergy index when walking across the even lab floor. However, the synergy index during the two uneven surface conditions was stronger after I-FRT but was not affected by the other RT modalities. The stronger synergy index for the I-FRT group was due to improved coordination as quantified by an overall increase in variability in elemental variable space but a decrease in the variability that negatively affects performance. The unstable environment offered by I-FRT allows for exploration of motor solutions in a manner that appears to transfer to challenging locomotor tasks. Introducing tasks that promote, rather than limit, exploration of motor solutions seems to be a valuable exercise modality to strengthen kinematic synergies that cannot be achieved with traditional strengthening paradigms (e.g., S-MRT). Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03017365.
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Affiliation(s)
- Nils Eckardt
- Department of Training and Movement Science, Institute for Sport and Sports Science, University of Kassel, Kassel, Germany.,Department of Sport and Movement Science, Institute of Sport Science, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Noah J Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
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16
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Potier F, Degryse JM, Bihin B, Debacq-Chainiaux F, Charlet-Renard C, Martens H, de Saint-Hubert M. Health and frailty among older spousal caregivers: an observational cohort study in Belgium. BMC Geriatr 2018; 18:291. [PMID: 30477431 PMCID: PMC6258488 DOI: 10.1186/s12877-018-0980-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/13/2018] [Indexed: 11/16/2022] Open
Abstract
Background Among older couples, spouses are first in line to provide care, and they are key elements in the home support of dependent older persons. In this context, ensuring the health of these older spousal caregivers should be an important issue for all of the providers who care for older adults. The aim of this study was to longitudinally assess the health of older spousal caregivers considering frailty, nutrition, cognition, physical performance and mood disorders. Methods In this longitudinal, observational cohort study, participants were assessed at home in Wallonia, Belgium. At baseline, 82 community-dwelling spouses of older patients with cognitive deficits or functional impairment were assessed; 78 caregivers were assessed at follow-up (16 months). The clinical instruments used included Frailty Phenotype (Fried), the Mini Nutritional Assessment-short form (MNA-SF), Short Physical Performance Battery (SPPB), Geriatric Depression Scale (GDS-15), clock drawing test, medications, Zarit Burden Index (ZBI), and Caregiver Reaction Assessment (CRA). Biological assessments included plasma interleukin-6 (IL-6), ultrasensitive C-reactive protein (CRP), cortisol, albumin and insulin growth factor-1 (IGF-1). Results Among caregivers, 54% were women, and the mean age was 80 years. Among care-receivers, 83% had cognitive impairment. Caregivers were more likely to be in a pre-frail stage. In one-third of the caregivers, the frailty status worsened. Transitions were observed between each of the states, except from frail to robust. In contrast to frailty, items including nutrition, cognitive status, SPPB and mood assessments were stable over time, with approximately 70% of the caregivers not experiencing significant change at follow-up. Caregiver experiences assessed with the Zarit Burden Interview and CRA were relatively stable over 16 months. Conclusion Many caregivers of geriatric patients are spouses who are old themselves. A failure in the health of the caregiver may anticipate an undesired care breakdown. Caregiver health and its determinants should be explored in future longitudinal studies that cover a longer time period. Electronic supplementary material The online version of this article (10.1186/s12877-018-0980-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florence Potier
- Department of Geriatrics, CHU Université Catholique de Louvain, 1, rue Dr G. Therasse, 5530 Mont-Godinne, Namur, Belgium. .,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
| | - Jean-Marie Degryse
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.,Departments of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Benoit Bihin
- Scientific Support Unit, CHU Université Catholique de Louvain, Namur, Belgium
| | | | | | - Henri Martens
- GIGA Research Institute, University of Liège, Liège, Belgium
| | - Marie de Saint-Hubert
- Department of Geriatrics, CHU Université Catholique de Louvain, 1, rue Dr G. Therasse, 5530 Mont-Godinne, Namur, Belgium.,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
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17
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Heymann P, Gienger R, Hett A, Müller S, Laske C, Robens S, Ostermann T, Elbing U. Early Detection of Alzheimer's Disease Based on the Patient's Creative Drawing Process: First Results with a Novel Neuropsychological Testing Method. J Alzheimers Dis 2018; 63:675-687. [PMID: 29689720 DOI: 10.3233/jad-170946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Based on the knowledge of art therapy, we developed a new neuropsychological drawing test in order to identify individuals with mild cognitive impairment (MCI) as well as dementia patients and healthy controls (HC). By observing a variety of drawing characteristics of 92 participants with a mean age of 67.7, art therapy and dementia experts discriminate HC from MCI, early dementia of the Alzheimer-type (eDAT), and moderate dementia of the Alzheimer-type (mDAT) by the process analysis of tree drawings on a digitizing tablet. The art therapist's average categorical rating of healthy and MCI or demented individuals matched the clinical diagnosis by 88%. In a first small study, we analyzed interrater reliability, sensitivity, specificity, negative and positive predicted values of our tree drawing test (TDT) in comparison with the clock drawing test (CDT). Similar values of moderate interrater reliability were found for the TDT (0.56) as well as for the CDT (0.54). A significant high sensitivity of 0.9 within this binary impairment scale (HC versus impaired or demented) can be demonstrated. Substantial values for the specificity (0.67) could be obtained that however remain under a perfect value of the CDT (1.0). Considering 31 individuals that received the clinical diagnosis "impaired or demented" the TDT shows a higher recognition rate for the MCI group than the CDT. Furthermore in 8 of 12 borderline cases of clinical diagnosis, the outcome of the TDT diagnosis was consistent with the final clinical result.
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Affiliation(s)
- Petra Heymann
- Institute for Research and Development in the Art Therapies Nürtingen-Geislingen University, Nürtingen, Germany
| | - Regine Gienger
- Institute for Research and Development in the Art Therapies Nürtingen-Geislingen University, Nürtingen, Germany
| | - Andreas Hett
- Institute for Research and Development in the Art Therapies Nürtingen-Geislingen University, Nürtingen, Germany
| | - Stephan Müller
- Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | - Christoph Laske
- Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | - Sibylle Robens
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Ulrich Elbing
- Institute for Research and Development in the Art Therapies Nürtingen-Geislingen University, Nürtingen, Germany
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18
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Rose M, Yang A, Welz M, Masik A, Staples M. Novel modification of the Reported Edmonton Frail Scale. Australas J Ageing 2018; 37:305-308. [PMID: 29635729 DOI: 10.1111/ajag.12533] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The Reported Edmonton Frail Scale (REFS) uses clock drawing as a measure of cognition. However, many patients in the acute hospital setting present with an inability to clock-draw. We considered an alternative method for assessing cognition based on a history of cognitive impairment. METHODS We created a modified version of the REFS (mod-REFS), utilising the same domains as the REFS, in which a screening question of cognition substitutes the clock-drawing task. Data were collected from a prospective cohort study. RESULTS Of 181 participants, frailty measured with either the REFS or the mod-REFS found equivalence. A comparison between clock drawing and cognitive question scores demonstrated a complete agreement for 152 patients (84%), a reduction in cognition score for 25 (14%) and an increase for 4 (2%). CONCLUSION We suggest the mod-REFS will improve the frailty assessment in the acute hospital setting, overcoming the limitations associated with clock drawing.
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Affiliation(s)
- Michael Rose
- Cabrini Medical Centre, Melbourne, Victoria, Australia
| | - Allan Yang
- Monash Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Martina Welz
- Cabrini Medical Centre, Melbourne, Victoria, Australia
| | - Anna Masik
- Cabrini Medical Centre, Melbourne, Victoria, Australia
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19
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The Persian Version of the "Life Satisfaction Scale": Construct Validity and Test-Re-Test Reliability among Iranian Older Adults. J Cross Cult Gerontol 2017; 33:121-134. [PMID: 29230605 PMCID: PMC5845598 DOI: 10.1007/s10823-017-9340-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
After forward-backward translation, the LSS was administered to 334 Persian speaking, cognitively healthy elderly aged 60 years and over recruited through convenience sampling. To analyze the validity of the model’s constructs and the relationships between the constructs, a confirmatory factor analysis followed by PLS analysis was performed. The Construct validity was further investigated by calculating the correlations between the LSS and the “Short Form Health Survey” (SF-36) subscales measuring similar and dissimilar constructs. The LSS was re-administered to 50 participants a month later to assess the reliability. For the eight-factor model of the life satisfaction construct, adequate goodness of fit between the hypothesized model and the model derived from the sample data was attained (positive and statistically significant beta coefficients, good R-squares and acceptable GoF). Construct validity was supported by convergent and discriminant validity, and correlations between the LSS and SF-36 subscales. Minimum Intraclass Correlation Coefficient level of 0.60 was exceeded by all subscales. Minimum level of reliability indices (Cronbach’s α, composite reliability and indicator reliability) was exceeded by all subscales. The Persian-version of the Life Satisfaction Scale is a reliable and valid instrument, with psychometric properties which are consistent with the original version.
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20
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Vyhnálek M, Rubínová E, Marková H, Nikolai T, Laczó J, Andel R, Hort J. Clock drawing test in screening for Alzheimer's dementia and mild cognitive impairment in clinical practice. Int J Geriatr Psychiatry 2017; 32:933-939. [PMID: 27466038 DOI: 10.1002/gps.4549] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/12/2016] [Accepted: 06/16/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The clock drawing test (CDT) is a commonly used brief cognitive measure. We evaluated diagnostic accuracy of subjective ratings of CDT by physicians (with/without specialty in cognitive neurology) and neuropsychologists in discriminating amnestic mild cognitive impairment (aMCI), Alzheimer's dementia (AD) and cognitively healthy older adults. We further compared the diagnostic accuracy of subjective categorical ratings with complex scoring of CDT. METHODS Three cognitive neurologists, three neuropsychologists and six neurology residents without experience in cognitive neurology blinded to the diagnosis rated 187 CDTs (50 mild AD, 49 aMCI and 88 cognitively healthy older adults) using a "yes" (abnormal) versus "suspected" versus "no" (normal) classification. The rating suspected was combined with yes or no to obtain two sets of sensitivity estimates. We also used a 17-point CDT rating system. RESULTS When using the categorical rating, neuropsychologists had highest sensitivity (89%) in differentiating patients with mild AD (yes/suspected versus no), followed by neurologic residents (80%) and cognitive neurologists (79%). When differentiating patients with aMCI (yes/suspected versus no), the sensitivity was 84% for neuropsychologists, 64% for cognitive neurologists and 62% for residents. The sensitivity using the complex scoring system was 92% in patients with mild AD and 69% in patients with aMCI. CONCLUSIONS A categorical rating of CDT shows high sensitivity for mild AD even in non-experienced raters. Neuropsychologists outperformed physicians in differentiating patients with aMCI from cognitively healthy older adults (specificity), which was counterbalanced by the lower specificity of their ratings. The diagnostic accuracy was not substantially improved by using complex scoring system. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Martin Vyhnálek
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Eva Rubínová
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Hana Marková
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Tomáš Nikolai
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Jan Laczó
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ross Andel
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Jakub Hort
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
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21
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Spenciere B, Alves H, Charchat-Fichman H. Scoring systems for the Clock Drawing Test: A historical review. Dement Neuropsychol 2017; 11:6-14. [PMID: 29213488 PMCID: PMC5619209 DOI: 10.1590/1980-57642016dn11-010003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Clock Drawing Test (CDT) is a simple neuropsychological screening instrument
that is well accepted by patients and has solid psychometric properties. Several
different CDT scoring methods have been developed, but no consensus has been
reached regarding which scoring method is the most accurate. This article
reviews the literature on these scoring systems and the changes they have
undergone over the years. Historically, different types of scoring systems
emerged. Initially, the focus was on screening for dementia, and the methods
were both quantitative and semi-quantitative. Later, the need for an early
diagnosis called for a scoring system that can detect subtle errors, especially
those related to executive function. Therefore, qualitative analyses began to be
used for both differential and early diagnoses of dementia. A widely used
qualitative method was proposed by Rouleau et al. (1992). Tracing the historical
path of these scoring methods is important for developing additional scoring
systems and furthering dementia prevention research.
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Affiliation(s)
- Bárbara Spenciere
- BsC, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ - Brazil
| | - Heloisa Alves
- PhD, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ - Brazil
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22
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Buongiorno M, Antonelli F, Compta Y, Fernandez Y, Pavia J, Lomeña F, Ríos J, Ramírez I, García JR, Soler M, Cámara A, Fernández M, Basora M, Salazar F, Sanchez-Etayo G, Valldeoriola F, Barrio JR, Marti MJ. Cross-Sectional and Longitudinal Cognitive Correlates of FDDNP PET and CSF Amyloid-β and Tau in Parkinson’s Disease1. J Alzheimers Dis 2016; 55:1261-1272. [DOI: 10.3233/jad-160698] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Mariateresa Buongiorno
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, Spain Instituto de Investigaciones Biomédicas August Pi i Sunyer IDIBAPS, Barcelona, Catalonia, Spain CIBER
| | - Francesca Antonelli
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, Spain Instituto de Investigaciones Biomédicas August Pi i Sunyer IDIBAPS, Barcelona, Catalonia, Spain CIBER
| | - Yaroslau Compta
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, Spain Instituto de Investigaciones Biomédicas August Pi i Sunyer IDIBAPS, Barcelona, Catalonia, Spain CIBER
| | | | - Javier Pavia
- Nuclear Medicine Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre on Bioengineering, Biomaterials and. Nanomedicine (CIBER-BBN), Barcelona, Catalonia, Spain
| | - Francisco Lomeña
- Nuclear Medicine Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Biomedical Research Networking Centre for Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
| | - José Ríos
- Medical Statistics Core Facility, IDIBAPS, (Hospital Clinic), Barcelona, Spain. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona. Catalonia, Spain
| | | | | | - Marina Soler
- CETIR Nuclear Medicine Esplugues de Llobregat, Catalonia, Spain
| | - Ana Cámara
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, Spain Instituto de Investigaciones Biomédicas August Pi i Sunyer IDIBAPS, Barcelona, Catalonia, Spain CIBER
| | - Manel Fernández
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, Spain Instituto de Investigaciones Biomédicas August Pi i Sunyer IDIBAPS, Barcelona, Catalonia, Spain CIBER
| | - Misericòrdia Basora
- Anaesthesiology Service, Hospital Clínic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Fàtima Salazar
- Anaesthesiology Service, Hospital Clínic, IDIBAPS, Barcelona, Catalonia, Spain
| | | | - Francesc Valldeoriola
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, Spain Instituto de Investigaciones Biomédicas August Pi i Sunyer IDIBAPS, Barcelona, Catalonia, Spain CIBER
| | - Jorge Raúl Barrio
- Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California, USA
| | - Maria Jose Marti
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, Spain Instituto de Investigaciones Biomédicas August Pi i Sunyer IDIBAPS, Barcelona, Catalonia, Spain CIBER
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23
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Roalf DR, Moore TM, Wolk DA, Arnold SE, Mechanic-Hamilton D, Rick J, Kabadi S, Ruparel K, Chen-Plotkin AS, Chahine LM, Dahodwala NA, Duda JE, Weintraub DA, Moberg PJ. Defining and validating a short form Montreal Cognitive Assessment (s-MoCA) for use in neurodegenerative disease. J Neurol Neurosurg Psychiatry 2016; 87:1303-1310. [PMID: 27071646 PMCID: PMC5061594 DOI: 10.1136/jnnp-2015-312723] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/19/2016] [Accepted: 03/22/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Screening for cognitive deficits is essential in neurodegenerative disease. Screening tests, such as the Montreal Cognitive Assessment (MoCA), are easily administered, correlate with neuropsychological performance and demonstrate diagnostic utility. Yet, administration time is too long for many clinical settings. METHODS Item response theory and computerised adaptive testing simulation were employed to establish an abbreviated MoCA in 1850 well-characterised community-dwelling individuals with and without neurodegenerative disease. RESULTS 8 MoCA items with high item discrimination and appropriate difficulty were identified for use in a short form (s-MoCA). The s-MoCA was highly correlated with the original MoCA, showed robust diagnostic classification and cross-validation procedures substantiated these items. DISCUSSION Early detection of cognitive impairment is an important clinical and public health concern, but administration of screening measures is limited by time constraints in demanding clinical settings. Here, we provide as-MoCA that is valid across neurological disorders and can be administered in approximately 5 min.
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Affiliation(s)
- David R Roalf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Alzheimer's Disease Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Steven E Arnold
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Alzheimer's Disease Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dawn Mechanic-Hamilton
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Alzheimer's Disease Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jacqueline Rick
- Udall Center for Parkinson's Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sushila Kabadi
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kosha Ruparel
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alice S Chen-Plotkin
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lama M Chahine
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nabila A Dahodwala
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John E Duda
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Parkinson's Disease Research, Education and Clinical Center (PADRECC) at the Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Daniel A Weintraub
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Udall Center for Parkinson's Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Parkinson's Disease Research, Education and Clinical Center (PADRECC) at the Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Paul J Moberg
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Alzheimer's Disease Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Eckardt N. Lower-extremity resistance training on unstable surfaces improves proxies of muscle strength, power and balance in healthy older adults: a randomised control trial. BMC Geriatr 2016; 16:191. [PMID: 27881086 PMCID: PMC5122203 DOI: 10.1186/s12877-016-0366-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 11/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well documented that both balance and resistance training have the potential to mitigate intrinsic fall risk factors in older adults. However, knowledge about the effects of simultaneously executed balance and resistance training (i.e., resistance training conducted on unstable surfaces [URT]) on lower-extremity muscle strength, power and balance in older adults is insufficient. The objective of the present study was to compare the effects of machine-based stable resistance training (M-SRT) and two types of URT, i.e., machine-based (M-URT) and free-weight URT (F-URT), on measures of lower-extremity muscle strength, power and balance in older adults. METHODS Seventy-five healthy community-dwelling older adults aged 65-80 years, were assigned to three intervention groups: M-SRT, M-URT and F-URT. Over a period of ten weeks, all participants exercised two times per week with each session lasting ~60 min. Tests included assessment of leg muscle strength (e.g., maximal isometric leg extension strength), power (e.g., chair rise test) and balance (e.g., functional reach test), carried out before and after the training period. Furthermore, maximal training load of the squat-movement was assessed during the last training week. RESULTS Maximal training load of the squat-movement was significantly lower in F-URT in comparison to M-SRT and M-URT. However, lower-extremity resistance training conducted on even and uneven surfaces meaningfully improved proxies of strength, power and balance in all groups. M-URT produced the greatest improvements in leg extension strength and F-URT in the chair rise test and functional reach test. CONCLUSION Aside from two interaction effects, overall improvements in measures of lower-extremity muscle strength, power and balance were similar across training groups. Importantly, F-URT produced similar results with considerably lower training load as compared to M-SRT and M-URT. Concluding, F-URT seems an effective and safe alternative training program to mitigate intrinsic fall risk factors in older adults. TRIAL REGISTRATION This trial has been registered with clinicaltrials.gov ( NCT02555033 ) on 09/18/2015.
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Affiliation(s)
- Nils Eckardt
- Department of Training and Movement Science, Institute of Sport and Sports Science, University of Kassel, Damaschkestraße 25, 34121, Kassel, Germany.
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Hill LL, Rybar J, Stowe J, Jahns J. Development of a curriculum and roadside screening tool for Law enforcement identification of medical impairment in aging drivers. Inj Epidemiol 2016; 3:13. [PMID: 27747550 PMCID: PMC4858548 DOI: 10.1186/s40621-016-0078-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/20/2016] [Indexed: 11/28/2022] Open
Abstract
Background An estimated one in five drivers will be over 65 by 2030. Compared with their younger counterparts, older adults are more likely to experience health and functional impairments, including cognitive dysfunction, which may interfere with their ability to drive safely. Law enforcement officers, as part of the public safety community, need help in developing the necessary skills to identify and manage these medically affected drivers. Methods To address this need, in partnership with the California Highway Patrol (CHP), Training, Research and Education for Driving Safety (TREDS) at the University of California, San Diego, developed a certified two-hour training curriculum. To complement the training, the TREDS team also developed a roadside screening tool to assess for disorientation related to person, place, and time. The tool was developed, validated with a sample of persons with dementia compared to cognitively normal controls, and deployed in the training. A total of 2,018 police officers received instruction at 103 training sessions. Results At baseline, prior to training, only 26 % of officers had reported drivers to the Department of Motor Vehicles in the previous 6 months. After training, 96 % stated they were likely to use their standard reporting forms, and 90 % reported they were likely to use the roadside screening tool. Conclusions The certified training and tool were well received and resulted in changes to knowledge, attitudes, and intention to incorporate their new knowledge and tools into roadside screening.
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Affiliation(s)
- Linda L Hill
- University of California, 9500 Gilman Drive #0811, La Jolla, San Diego, CA, 92093-0811, USA.
| | - Jill Rybar
- University of California, 9500 Gilman Drive #0811, La Jolla, San Diego, CA, 92093-0811, USA
| | - James Stowe
- Washington University in St. Louis, School of Medicine, 660 S. Euclid Ave., Campus Box 8303, St. Louis, MO, 63110, USA.,Missouri Coalition for Roadway Safety, Subcommittee on Elder Mobility and Safety (SEMS), Jefferson City, USA
| | - Jana Jahns
- University of California, 9500 Gilman Drive #0811, La Jolla, San Diego, CA, 92093-0811, USA
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Mazancova AF, Nikolai T, Stepankova H, Kopecek M, Bezdicek O. The Reliability of Clock Drawing Test Scoring Systems Modeled on the Normative Data in Healthy Aging and Nonamnestic Mild Cognitive Impairment. Assessment 2016; 24:945-957. [DOI: 10.1177/1073191116632586] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Clock Drawing Test (CDT) is a commonly used tool in clinical practice and research for cognitive screening among older adults. The main goal of the present study was to analyze the interrater reliability of three different CDT scoring systems (by Shulman et al., Babins et al., and Cohen et al.). We used a clock with a predrawn circle. The CDT was evaluated by three independent raters based on the normative data set of healthy older and very old adults and patients with nonamnestic mild cognitive impairment (naMCI; N = 438; aged 61-94). We confirmed a high interrater reliability measured by the intraclass correlation coefficients (ICCs): Shulman ICC = .809, Babins ICC = .894, and Cohen ICC = .862, all p < .001. We found that age and education levels have a significant effect on CDT performance, yet there was no influence of gender. Finally, the scoring systems differentiated between naMCI and age- and education-matched controls: Shulman’s area under the receiver operating characteristic curve (AUC) = .84, Cohen AUC = .71, all p < .001; and a slightly lower discriminative ability was shown by Babins: AUC = .65, p = .012.
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Affiliation(s)
- Adela Fendrych Mazancova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Tomas Nikolai
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Hana Stepankova
- National Institute of Mental Health, Klecany, Czech Republic
| | | | - Ondrej Bezdicek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
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Mendes-Santos LC, Mograbi D, Spenciere B, Charchat-Fichman H. Specific algorithm method of scoring the Clock Drawing Test applied in cognitively normal elderly. Dement Neuropsychol 2015; 9:128-135. [PMID: 29213954 PMCID: PMC5619351 DOI: 10.1590/1980-57642015dn92000007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Clock Drawing Test (CDT) is an inexpensive, fast and easily administered measure of cognitive function, especially in the elderly. This instrument is a popular clinical tool widely used in screening for cognitive disorders and dementia. The CDT can be applied in different ways and scoring procedures also vary. Objective The aims of this study were to analyze the performance of elderly on the CDT and evaluate inter-rater reliability of the CDT scored by using a specific algorithm method adapted from Sunderland et al. (1989). Methods We analyzed the CDT of 100 cognitively normal elderly aged 60 years or older. The CDT ("free-drawn") and Mini-Mental State Examination (MMSE) were administered to all participants. Six independent examiners scored the CDT of 30 participants to evaluate inter-rater reliability. Results and Conclusion A score of 5 on the proposed algorithm ("Numbers in reverse order or concentrated"), equivalent to 5 points on the original Sunderland scale, was the most frequent (53.5%). The CDT specific algorithm method used had high inter-rater reliability (p<0.01), and mean score ranged from 5.06 to 5.96. The high frequency of an overall score of 5 points may suggest the need to create more nuanced evaluation criteria, which are sensitive to differences in levels of impairment in visuoconstructive and executive abilities during aging.
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Affiliation(s)
| | - Daniel Mograbi
- PhD, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ, Brazil.,Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Bárbara Spenciere
- BsC, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ, Brazil
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Abstract
Little is known about how African American men with schizophrenia experience their every day existence. Through applying interpretive phenomenology and using a methodological structure designed by van Manen (1990, 1997), this research aimed to enrich the current understanding of what it is like for these African American males to live with schizophrenia. In this study, five men ranging in age from 21 to 57 described their lives within the context of existing with the diagnosis of schizophrenia. The lived experiences across the interviews revealed four overarching themes: They know that they are mentally ill; they make a special effort to test reality; they assert their autonomy and; they experience reality differently, which they see as a gift. To provide appropriate treatment support to African American males diagnosed with schizophrenia, it is important to recognize the clients' ability to assert their autonomy and appreciate each man's view of himself as unique and special. Moreover, in terms of symptom management, it is pivotal to understand that although the client may not be free of hallucinations and delusions, he nevertheless may be at his optimum state of wellness. The realization that these men have transcended their diagnosis of schizophrenia rather than being crushed by their condition is evident in their stories.
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Motor phenotype of decline in cognitive performance among community-dwellers without dementia: population-based study and meta-analysis. PLoS One 2014; 9:e99318. [PMID: 24911155 PMCID: PMC4049832 DOI: 10.1371/journal.pone.0099318] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/13/2014] [Indexed: 11/19/2022] Open
Abstract
Background Decline in cognitive performance is associated with gait deterioration. Our objectives were: 1) to determine, from an original study in older community-dwellers without diagnosis of dementia, which gait parameters, among slower gait speed, higher stride time variability (STV) and Timed Up & Go test (TUG) delta time, were most strongly associated with lower performance in two cognitive domains (i.e., episodic memory and executive function); and 2) to quantitatively synthesize, with a systematic review and meta-analysis, the association between gait performance and cognitive decline (i.e., mild cognitive impairment (MCI) and dementia). Methods Based on a cross-sectional design, 934 older community-dwellers without dementia (mean±standard deviation, 70.3±4.9years; 52.1% female) were recruited. A score at 5 on the Short Mini-Mental State Examination defined low episodic memory performance. Low executive performance was defined by clock-drawing test errors. STV and gait speed were measured using GAITRite system. TUG delta time was calculated as the difference between the times needed to perform and to imagine the TUG. Then, a systematic Medline search was conducted in November 2013 using the Medical Subject Heading terms “Delirium,” “Dementia,” “Amnestic,” “Cognitive disorders” combined with “Gait” OR “Gait disorders, Neurologic” and “Variability.” Findings A total of 294 (31.5%) participants presented decline in cognitive performance. Higher STV, higher TUG delta time, and slower gait speed were associated with decline in episodic memory and executive performances (all P-values <0.001). The highest magnitude of association was found for higher STV (effect size = −0.74 [95% Confidence Interval (CI): −1.05;−0.43], among participants combining of decline in episodic memory and in executive performances). Meta-analysis underscored that higher STV represented a gait biomarker in patients with MCI (effect size = 0.48 [95% CI: 0.30;0.65]) and dementia (effect size = 1.06 [95% CI: 0.40;1.72]). Conclusion Higher STV appears to be a motor phenotype of cognitive decline.
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Decreased cognitive function in extended family members from the single late-onset-Alzheimer's-disease pedigree. J Int Neuropsychol Soc 2013; 19:809-19. [PMID: 23742872 PMCID: PMC3734807 DOI: 10.1017/s1355617713000581] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A family history of dementia is associated with an increased risk of developing Alzheimer's disease (AD) late in life (LOAD). This study marked the first attempt to assess the familial contribution to differences in cognitive performance in a large family-based group in the Chinese community. We enrolled 168 participants without dementia from a single pedigree with 9 probable AD patients diagnosed after age 65. These participants were evaluated with a comprehensive neuropsychological battery, the Chinese version of the Mini Mental State Examination, and the Alzheimer Disease Assessment Scale-Cognitive Subscale. Analyses found that extended family members of the LOAD pedigree showed similar performance on measures of global cognitive function and semantic memory compared to controls, but lower scores on episodic memory, attention, and executive function measures. These results indicate that the genetic influences on certain sub-cognitive domains are more detectable despite normal global cognitive function, and that family members with the LOAD pedigree are at risk for developing LOAD by virtue of their family history with an additive risk due to increased age. The findings in this study support the importance of documenting if there is a positive family history of AD in clinical evaluations.
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Muir SW, Beauchet O, Montero-Odasso M, Annweiler C, Fantino B, Speechley M. Association of executive function impairment, history of falls and physical performance in older adults: a cross-sectional population-based study in eastern France. J Nutr Health Aging 2013; 17:661-5. [PMID: 24097019 DOI: 10.1007/s12603-013-0045-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To estimate: (1) the association between executive function (EF) impairment and falls; and (2) the association of EF impairment on tests of physical function used in the evaluation of fall risk. DESIGN Cross-sectional study. SETTING Thirteen health examination centres in Eastern France. PARTICIPANTS Four thousand four hundred and eighty one community-dwelling older adults without dementia aged 65 to 97 years (mean age 71.8±5.4, women 47.6%). MEASUREMENTS Participants underwent a comprehensive medical assessment that included evaluations of EF using the Clock Drawing Test and of physical performance using the Timed Up and Go Test (TUG). Analysis used multivariable modified Poisson regression to evaluate the association between impaired EF and each of the fall outcomes (any fall, recurrent falls, fall-related injuries). Multivariable linear regression was used to evaluate the association between EF impairment and performance on the TUG and grip strength. RESULTS EF impairment, assessed using the clock drawing test, was present in 24.9% of participants. EF impairment was independently associated with an increased risk of any fall (RR=1.13, 95% CI (1.03, 1.25)) and major soft tissue fall-related injury (RR= 2.42, 95% CI (1.47, 4.00)). Additionally, EF impairment was associated with worse performance on the TUG (p<0.0001). CONCLUSIONS EF impairment among older adults without dementia was highly prevalent and was independently associated with an increased risk for falls, fall-related injuries and with decreased physical function. The use of the Clock Drawing Test is an easy to administer measure of EF that can be used routinely in comprehensive fall risk evaluations.
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Affiliation(s)
- S W Muir
- Susan W Muir PT PhD, Parkwood Hospital, Division of Geriatrics Room A-350, 801 Commissioners Rd E. London, Ontario, Canada N6A 5A5, Tel: 519-685-4292 ext. 42577,
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Price CC, Cunningham H, Coronado N, Freedland A, Cosentino S, Penney DL, Penisi A, Bowers D, Okun MS, Libon DJ. Clock drawing in the Montreal Cognitive Assessment: recommendations for dementia assessment. Dement Geriatr Cogn Disord 2011; 31:179-87. [PMID: 21389719 PMCID: PMC3065510 DOI: 10.1159/000324639] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clock drawing is part of the Montreal Cognitive Assessment (MoCA) test but may have administration and scoring limitations. We assessed (1) the reliability of the MoCA clock criteria relative to a published error scoring approach, (2) whether command-only administration could distinguish dementia from cognitively intact individuals and (3) the value of adding a clock copy condition to the MoCA. METHODS Three novice raters and clocks from dementia and control participants were used to assess the 3 aims. RESULTS MoCA interrater and intrarater reliability were low (i.e. intraclass correlation coefficient = 0.12-0.31) and required repeat training. Clocks drawn to command classified dementia at chance. Inclusion of a copy condition demonstrated expected dementia subgroup patterns. CONCLUSION Reliable clock scoring with MoCA criteria requires practice. Supplementing a clock copy to the standard MoCA test (takes <1 min) will improve dementia assessment.
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Affiliation(s)
- Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, 101 S. Newell Drive, Gainesville, FL 32610, USA.
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