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Honjo Y, Kawasaki I, Nagai K, Harada S, Ogawa N. Families of patients with Alzheimer's disease dementia notice progression from symptoms of disorientation and visual memory disturbance. Psychogeriatrics 2023; 23:747-751. [PMID: 37313639 DOI: 10.1111/psyg.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Alzheimer's disease dementia (ADD) is the most common cognitive disease, but patients' families may notice some symptoms yet not recognise that they indicate ADD. This study investigated the symptoms that families notice as ADD as the disease progresses. METHODS New outpatients diagnosed with ADD (n = 315) at five memory clinics completed two cognitive assessments, the Revised Hasegawa Dementia Scale (HDS-R) and Mini-Mental State Examination (MMSE). During an interview, family members completed the Functional Assessment Staging Test (FAST), an observational assessment tool that classifies ADD progression into seven stages. We then examined the relationship of the family-assessed FAST score with clinician-assessed HDS-R and MMSE domain scores by comparing between patients with FAST 1-3 and FAST 4-7. Next, we divided the FAST 4-7 group into the FAST 4-5 and FAST 6-7 subgroups and divided the FAST 1-3 group into the FAST 1-2 and FAST 3 subgroups. RESULTS Surprisingly, half of the families did not recognise that the symptoms indicated ADD. Scores for orientation of time and place on the HDS-R and MMSE and for visual memory on the HDS-R were significantly related to family-assessed FAST score. Moreover, the orientation of time and place score on both scales and visual memory on the HDS-R were significantly worse in the FAST 4-7 group than in FAST 1-3 group. In the FAST 4-7 group, scores for age on the HDS-R and for reading and drawing on the MMSE were significantly worse in the FAST 6-7 subgroup. In the analysis of the FAST 1-3 group, there was no significant difference among the HDS-R and MMSE domains between the FAST 1-2 and FAST 3 subgroups. CONCLUSIONS Family members of patients with ADD tend to notice the progression of ADD from the symptoms of disorientation and visual memory.
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Affiliation(s)
- Yasuyuki Honjo
- Kyoto Kaisei Hospital, Kyoto, Japan
- Kyoto Miniren Asukai Hospital, Kyoto, Japan
- Kyoto Narabigaoka Hospital, Kyoto, Japan
| | - Ippei Kawasaki
- Department of Occupational Therapy, Faculty of Health Science, Kyoto Tachibana University, Kyoto, Japan
| | - Kuniaki Nagai
- Department of Occupational Therapy, Faculty of Health Science, Kyoto Tachibana University, Kyoto, Japan
| | - Shun Harada
- Department of Occupational Therapy, Faculty of Health Science, Kyoto Tachibana University, Kyoto, Japan
| | - Noriyuki Ogawa
- Department of Occupational Therapy, Faculty of Health Science, Kyoto Tachibana University, Kyoto, Japan
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Baptista MAT, Lacerda IB, Belfort T, Nogueira MML, de Oliveira Silva F, Dourado MCN. Awareness of Disease and Its Domains in Young-onset and Late-onset Dementia: The Role of Executive Function. Alzheimer Dis Assoc Disord 2023; 37:200-206. [PMID: 37561987 DOI: 10.1097/wad.0000000000000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/23/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Executive function (EF) involves a general cognitive process linked to strategic organization and control of complex goal-oriented tasks. In young-onset dementia (YOD), especially Alzheimer's disease, the symptoms that stand out in the initial stage are deficits in attention, visual-spatial function, praxis, and language. The present study aims to investigate what components of EF differ in young and late-onset dementia (LOD) and its impact on awareness and its domains. METHODS Using a cross-sectional design, we included 44 people with YOD and 70 with LOD. We assessed awareness and its domains, cognition, dementia severity, EF, functionality, and neuropsychiatric symptoms. RESULTS The YOD group was more impaired in general cognition ( P =0.017) and had a worse performance in Wechsler Digit Span Backward (DSB) ( P =0.007) and Phonemic fluency task (FAS) ( P =0.046) tests. In the LOD group, deficits in EF had a greater impact on awareness and on most domains (awareness total score, cognitive functioning and health condition, functional activity impairments and social function). CONCLUSIONS Our study findings support the heterogeneity of awareness, not only with regard to the difference between the domains and the measures of EF, but also to the groups studied.
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Affiliation(s)
- Maria Alice Tourinho Baptista
- Center for Alzheimer's disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Honjo Y, Kawasaki I, Nagai K, Harada S, Ogawa N. Living Arrangements and Education Duration Associated With Memory Clinic Attendance in Alzheimer's Disease. J Appl Gerontol 2023:7334648231155442. [PMID: 36738268 DOI: 10.1177/07334648231155442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Some new outpatients with mild cognitive impairment (MCI) or Alzheimer's disease (AD) do not regularly attend treatment appointments at memory clinics. To explore factors related to non-regular attendance, we divided new outpatients according to regular or non-regular attendance during the first 6 months of treatment and analyzed the relationship between individual patient factors and attendance. Approximately half of patients living alone did not regularly attend appointments. Living with family and longer duration of school education were significantly associated with regular attendance. Patients with mild or moderate AD attended appointments more regularly than patients with MCI or moderate-to-severe AD. Patients in Kyoto City had significantly better cognitive function than patients in satellite cities, and there were a significantly higher proportion of patients with MCI or AD at first visit in Kyoto City. Living arrangements and duration of education are important patient factors to consider to promote regular attendance at treatment appointments.
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Affiliation(s)
- Yasuyuki Honjo
- Memory Clinic, Kyoto-Kaisei Hospital, Japan.,Memory Clinic, Kyoto Miniren Asukai Hospital, Japan.,Memory Clinic, Seika Town National Health Insurance Hospital, Japan.,Memory Clinic, Kyoto Narabigaoka Hospital, Japan.,Department of Occupational Therapy, Faculty of Health Science, Kyoto Tachibana University, Japan
| | - Ippei Kawasaki
- Department of Occupational Therapy, Faculty of Health Science, Kyoto Tachibana University, Japan
| | - Kuniaki Nagai
- Department of Occupational Therapy, Faculty of Health Science, Kyoto Tachibana University, Japan
| | - Shun Harada
- Department of Occupational Therapy, Faculty of Health Science, Kyoto Tachibana University, Japan
| | - Noriyuki Ogawa
- Department of Occupational Therapy, Faculty of Health Science, Kyoto Tachibana University, Japan
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Honjo Y, Ide K, Takechi H. Most families tend to realize progress of Alzheimer's disease when behavioural and psychological symptoms are obvious. Psychogeriatrics 2022; 22:317-323. [PMID: 35146847 DOI: 10.1111/psyg.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/20/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a common cognitive disease that can progress at an accelerating rate. Even with early diagnosis, the families might not recognize AD progressing unless behavioural and psychological symptoms of dementia (BPSD) develop. In many cases, discrepancies could exist between family-assessed AD stage and diagnosed AD stage. This study explored such discrepancies and potential clinical implications. METHODS Participants were 161 new outpatients with AD or mild cognitive impairment at four memory clinics whose AD stage was diagnosed using the Revised Hasegawa Dementia Scale (HDS-R) and Mini-Mental State Examination (MMSE). We classified patients into four groups according to AD severity. Family members completed the Functional Assessment Staging (FAST) scale during an interview. We then assigned patients to three groups according to discrepancies between family-assessed and diagnosed AD stage. Families also completed the Neuropsychiatric Inventory Questionnaire (NPI-Q), which assesses 12 neuropsychiatric domains, in order to examine the presence of BPSD in relation to AD stage. RESULTS Most families (74%-80%) assessed patients as having milder AD than the diagnosed stage. NPI-Q scores and duration of education significantly affected discrepancies with HDS-R and MMSE scores. The NPI-Q domains of anxiety, apathy/indifference, aberrant motor behaviours, and appetite/eating disturbance significantly affected family-assessed FAST. Families of patients with more years of education assessed the AD stage as more advanced than the diagnosed stage. Surprisingly, living together did not significantly affect the discrepancy. CONCLUSIONS Most families assessed AD as milder than the clinically diagnosed AD stage. In addition, high NPI-Q scores and more years of school education significantly affected the discrepancy. Family-assessed FAST was significantly affected by the NPI-Q domains of anxiety, apathy/indifference, aberrant motor behaviours, and appetite/eating disturbance. These results suggest that obvious BPSD are significant factors for Japanese families to recognize AD progress.
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Affiliation(s)
- Yasuyuki Honjo
- Department of Memory Clinic, Kyoto Min-iren Asukai Hospital, Kyoto, Japan.,Department of Memory Clinic, Kyoto-Kaisei Hospital, Kyoto, Japan.,Department of Memory Clinic, Seika-cho National Health Insurance Hospital, Kyoto, Japan
| | - Kazuki Ide
- Center for Infectious Disease Education and Research, Osaka University 2-8 Yamadaoka, Osaka, Japan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Toyoake, Japan
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Mayelle A, Hazebrouck C, El Haj M, Mograbi DC, Antoine P. Awareness for People With Alzheimer’s Disease: Profiles and Weekly Trajectories. Front Aging Neurosci 2022; 13:781426. [PMID: 35095469 PMCID: PMC8792992 DOI: 10.3389/fnagi.2021.781426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To understand awareness and fluctuations of awareness in Alzheimer’s disease (AD), it is fruitful to consider the objects of awareness, e.g., cognitive functioning or recognition of the disease, as well as the mechanisms and modes of expression underlying awareness. With a holistic and discourse-centered approach, we aimed to identify different awareness profiles and test whether these profiles were stable or whether transitions from one profile to another occurred over short time intervals. Methods: Twenty-eight residents of nursing homes with a diagnosis of AD participated in four semistructured interviews at biweekly intervals. These interviews were cluster analyzed to determine profiles of awareness. A Markov chain was applied to model their fluctuation. Results: Five awareness profiles were observed that differed in terms of objects and underlying processes. Awareness proved to be quite stable for four of the five profiles. Interindividual variability in awareness was also observed through numerous different trajectories that were identified. Discussion: Self-awareness and disease awareness are characterized by profiles that vary subtly between individuals. Fluctuations in awareness underscore the need to employ assessment intervals that closely reflect daily life in institutions.
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Affiliation(s)
- Amandine Mayelle
- Univ. Lille, CNRS, UMR 9193—SCALab—Sciences Cognitives et Sciences Affectives, Lille, France
| | - Capucine Hazebrouck
- Etablissements Pour Personnes Âgées Dépendantes La Colombe, Roncq and L’Orée du Monde, Halluin, France
| | - Mohamad El Haj
- Nantes Université, Univ Angers, Laboratoire de Psychologie des Pays de la Loire (LPPL—EA 4638), Nantes, France
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France
- Institut Universitaire de France, Paris, France
| | - Daniel C. Mograbi
- Pontifical Catholic University, Rio de Janeiro, Brazil
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Pascal Antoine
- Univ. Lille, CNRS, UMR 9193—SCALab—Sciences Cognitives et Sciences Affectives, Lille, France
- *Correspondence: Pascal Antoine,
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Abstract
BACKGROUND There is a lack of research investigating whether there are differences in the domains of awareness according to the age at onset of dementia. OBJECTIVE This study is designed to investigate differences in awareness of cognitive functioning and health condition, functional activity impairments, emotional state, and social functioning and relationships among people with young onset (YOD) and late onset dementia (LOD); and examine associations between awareness and its domains with cognition, functionality, neuropsychiatric symptoms, social and emotional functioning, and quality of life (QoL) in both groups. METHODS A group of 136 people with dementia and their respective caregivers (YOD = 50 and LOD = 86) were consecutively selected. We assessed awareness of disease, dementia severity, cognition, functionality, neuropsychiatric symptoms, social and emotional functioning, and QoL. RESULTS People with YOD had more neuropsychiatric symptoms than people with LOD. People with YOD were more aware of disease (total score), of their cognitive functioning and health condition and of their functional activity impairments, even if this group was more severely cognitive impaired and had a worse level of functionality than LOD group. Multivariate linear regressions showed that functionality has a wide relationship to awareness for people with YOD. While neuropsychiatric symptoms and QoL has a greater relation to awareness for people with LOD. CONCLUSION Different clinical variables are associated to different domains in YOD and LOD groups, reinforcing the heterogeneity of awareness in dementia.
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Affiliation(s)
- Maria Alice Tourinho Baptista
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Nathália Kimura
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Isabel Barbeito Lacerda
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Felipe de Oliveira Silva
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcia Cristina Nascimento Dourado
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Trindade PGE, Santos RL, Johannessen A, Neto JPS, Dourado MCN. Awareness of Functional Status: People with Alzheimer's Disease Abilities to Self-Report Impairment in Activities of Daily Living. J Alzheimers Dis Rep 2020; 4:405-415. [PMID: 33283162 PMCID: PMC7683098 DOI: 10.3233/adr-200227] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Awareness of functional status may underlie specific profiles and differences related to stage severity in individuals with Alzheimer's disease (AD). OBJECTIVE This study aimed to assess self-reported experiences of awareness of functional activity in people with mild and moderate AD. METHODS This is a mixed methods approach. The qualitative part was conducted through semi-structured interviews concerning the experiences and awareness of deficits in 38 older adults with mild or moderate AD. The quantitative approach included a comparison between groups with regard to concerns of awareness and clinic and demographic data. RESULTS Impairment on awareness of disease and awareness of functional deficits was observed even in the mild stages of AD. There was also a noticeable progression of impairments of both kinds of awareness from mild to moderate stage of disease. The majority of participants with mild and moderate AD were partially aware of their functional deficits. Both groups of participants reported some negative impact; however, they were not able to entirely describe their functional status. Also, deficits to recognize the need for help with hygiene and general tasks were observed. Significant differences were found in awareness of need for help with general tasks and awareness of need for help with hygiene tasks. CONCLUSION People with mild and moderate AD may describe their aware of the disease better than specific functional deficits, and most of them can provide some reports concerning to the impact of the disease.
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Affiliation(s)
| | - Raquel Luiza Santos
- Center for Alzheimer’s Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Brazil
| | - Aud Johannessen
- Norwegian Advisory Unit for Aging and Health Vestfold Health Trust, Tønsberg, Norway
- University College of Southeast Norway
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Abstract
Objectives: Awareness is considered a heterogeneous and non-linear phenomenon in dementia. We aim to investigate patterns of change of different domains of awareness (awareness of cognitive functioning and health condition, activities of daily living, emotional state, social functioning, and relationships) in people with mild and moderate Alzheimer's disease (AD) and aspects related to each domain.Method: Cross-sectional assessment of dyads of people with AD (PwAD) and caregivers (n = 128; CDR1 = 74, CDR2 = 54). PwAD completed assessments about quality of life, cognition and their awareness of disease. Caregivers provided information about PwAD and received quality of life and burden of care assessments.Results: Mild AD group showed a mildly impaired awareness (n = 40; 54.05%), while moderate AD group, showed higher presence of moderately impaired awareness (n = 22; 40.74%). There was a significant difference between groups in awareness of cognitive functioning and health condition (p < 0.004), functional activity impairments (p < 0.001) and total score of awareness (p < 0.01). Conversely, awareness of emotional state (p = 0.22) and of social functioning and relationship (p = 0.44) presented no significant difference between groups. Unawareness of functional activity impairments showed higher discrepancy scores between PwAD and caregivers in both groups.Conclusions: Significant differences were found only in patterns of discrepancies in awareness of cognitive functioning and health condition, of ADL and socio-emotional functioning. Different factors are related to different domains in mild and moderate group, reinforcing the heterogeneity of awareness in dementia. ADL deficits have an important role in awareness phenomenon, independent of the severity of disease.
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Affiliation(s)
- Isabel B Lacerda
- Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raquel L Santos
- Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tatiana Belfort
- Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Pedro S Neto
- Sociology and Political Science Department, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Marcia C N Dourado
- Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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9
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Honjo Y, Ide K, Takechi H. Medical interventions suppressed progression of advanced Alzheimer's disease more than mild Alzheimer's disease. Geriatr Gerontol Int 2020; 20:324-328. [DOI: 10.1111/ggi.13883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 01/11/2020] [Accepted: 01/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Yasuyuki Honjo
- Department of Memory ClinicMiniren‐daini‐chou Hospital Kyoto Japan
- Department of Memory ClinicBiwako‐Yoikuin Hospital Otsu Japan
- Department of Memory ClinicKyoto‐Kaisei Hospital Kyoto Japan
- Department of Memory ClinicSeika‐cho National Health Insurance Hospital Kyoto Japan
| | | | - Hajime Takechi
- Department of Geriatrics and Cognitive DisordersFujita Health University School of Medicine Toyoake Japan
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Chapman KR, Spitznagel MB. Measurement of sexual disinhibition in dementia: A systematic review. Int J Geriatr Psychiatry 2019; 34:1747-1757. [PMID: 31489715 DOI: 10.1002/gps.5208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/31/2019] [Indexed: 11/07/2022]
Abstract
Sexual disinhibition in dementia is correlated with multiple negative care recipient and caregiver outcomes but remains largely overlooked in the literature. Its prevalence is not well understood, with studies reporting between 1.8% and 25% presence of sexual disinhibition in dementia samples. One reason for the variability in the reported presence of sexual disinhibition may be lack of standardized methods for assessment. Several widely used measures for neuropsychiatric symptoms do not include items to assess sexual disinhibition. When measures do include sexual disinhibition, it is not addressed in a consistent manner. Inconsistency in how questions about sexual disinhibition are phrased is problematic, given that recent work shows it can differentially influence endorsement. Working toward a gold standard of sexual disinhibition measurement in dementia is needed. To this end, a systematic review of the literature to identify potentially appropriate instruments for measurement of sexual disinhibition in this population was conducted through the Web of Science and PubMed databases between January 2019 and February 2019. An overview of the 20 measures identified in this search is provided. Each measure is evaluated for appropriateness of use in dementia samples through broad examination of psychometric properties, structure, and format and the extent to which measure content overlaps with current conceptualizations of sexual disinhibition in dementia. Five common content domains were identified: hypersexuality, lewd/aberrant sexual behavior, inappropriate sexual advances, inappropriate sexual comments, and socially disruptive sexual behavior. No single measure addressed all content domains. Directions for future research are identified and discussed.
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Affiliation(s)
- Kimberly R Chapman
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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Shaked D, Sunderaraman P, Piscitello J, Cines S, Hale C, Devanand D, Karlawish J, Cosentino S. Modification of everyday activities and its association with self-awareness in cognitively diverse older adults. PLoS One 2019; 14:e0222769. [PMID: 31697690 PMCID: PMC6837494 DOI: 10.1371/journal.pone.0222769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/06/2019] [Indexed: 01/05/2023] Open
Abstract
Cognitive impairment (CI) in older adults is frequently accompanied by difficulty performing complex everyday activities (e.g., managing finances). However, it is unclear if and how older adults with CI modify their activities (i.e., Do individuals continue, monitor, seek help with, change their approach to, or stop different activities?). In the current study, we examined if older adults with CI are concerned about their ability to carry out complex activities, if and how they modify activities based on their concern, and the factors associated with activity modification. We hypothesized that older adults with CI will more frequently be concerned about, and modify, everyday activities than cognitively healthy (HE) older adults, and that higher awareness of memory loss in the CI group would relate to more frequent modification. The sample included 81 older adults (51 HEs; mean age 70.02 (7.34) and 30 CI; mean age 75.97 (8.12)). Compared to HEs, the CI group reported having more concern about, F(3,77) = 5.50, p = 0.02, and modifying a greater number of activities, F(3,77) = 5.02, p = 0.03. Medication management (30%) and completing taxes (33.3%) were among the most frequently modified activities for the CI and HE groups, respectively. In the CI group, higher memory awareness was associated with more concern (r = .53, p = .005) and activity modification (r = 0.55, p = .003). Findings provide novel information about how cognitively diverse older adults navigate complex activities in daily life. We propose a preliminary theoretical model by which self-awareness may influence navigation of everyday activities in the context of CI.
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Affiliation(s)
- Danielle Shaked
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States of America
| | - Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
| | - Jennifer Piscitello
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
| | - Sarah Cines
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
| | - Christiane Hale
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
| | - Davangere Devanand
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
- Division of Geriatric Psychiatry, Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States of America
| | - Jason Karlawish
- Healthy Brain Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, United States of America
- Gertrude. H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States of America
- Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
- * E-mail:
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12
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Mayelle A, El Haj M, Antoine P. Awareness of Self and Disease Assessment: Development and Validation of a Subjective Measure in People with Alzheimer’s Disease. J Alzheimers Dis 2019; 71:841-850. [DOI: 10.3233/jad-190371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Amandine Mayelle
- Univ. Lille, CNRS, CHU Lille, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | - Mohamad El Haj
- Univ. Nantes, EA 4638 – LPPL – Laboratoire de Psychologie des Pays de la Loire, Nantes, France
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France
- Institut Universitaire de France, Paris, France
| | - Pascal Antoine
- Univ. Lille, CNRS, CHU Lille, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
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13
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Honjo Y, Takechi H. Japanese Old Stories Cognitive Scale: a screening test to detect cognitive disease and prompt visiting a memory clinic. Psychogeriatrics 2019; 19:363-369. [PMID: 30785221 DOI: 10.1111/psyg.12398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/22/2018] [Accepted: 12/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early detection and diagnosis is critical in enhancing treatment outcomes for those with cognitive disease. However, most Japanese patients are averse to visiting mental health clinics or taking cognitive screening examinations. A new simple screening test is needed that is acceptable to patients and encourages them to visit a memory clinic if indicated. METHODS We developed a brief screening examination, consisting of four common Japanese old stories, for detection of cognitive disease. A total of 311 patients at three outpatient memory clinics completed the screening test, responding to a 10-question, fill-in-the-blanks assessment. Questions were read aloud to patients with visual impairment, and we transcribed the spoken responses of patients who were physically incapable of writing. The Hasegawa Dementia Scale-Revised (HDS-R) and Mini-Mental State Examination (MMSE) were administered at the same time. RESULTS Using the developed Japanese Old Stories Cognitive Scale (JOSS), we found significant differences between dementia and control or mild cognitive impairment (MCI) groups. The JOSS was less affected by education level than the HDS-R or MMSE, possibly because Japanese old stories are usually learned from family members during preschool years. The JOSS may be able to detect remote memory disturbance in addition to other cognitive dysfunctions. CONCLUSIONS Most patients with AD, even in advanced stages, are averse to visiting a memory clinic because it can be difficult to accept any resulting diagnosis of cognitive disease. JOSS is a quick and simple screening tool to gather evidence of cognitive dysfunction and prompt a referral to a memory clinic. Patients with cognitive disease found the JOSS acceptable, and its high specificity could be useful in encouraging patients to visit already-crowded memory clinics for formal diagnosis and intervention.
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Affiliation(s)
- Yasuyuki Honjo
- Department of Memory Clinic, Miniren-daini-chou Hospital, Kyoto, Japan.,Department of Memory Clinic, Biwako-Yoikuin Hospital, Otsu, Japan.,Department of Memory Clinic, Kyoto-Kaisei Hospital, Kyoto, Japan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Toyoake, Japan
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Steward KA, Bull TP, Wadley VG. Differences in self-awareness of functional deficits between amnestic single- and multidomain mild cognitive impairment. J Clin Exp Neuropsychol 2019; 41:544-553. [PMID: 30870084 DOI: 10.1080/13803395.2019.1586839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Prior research examining self-awareness of deficits in those with mild cognitive impairment (MCI) has been inconsistent, suggesting that preservation of insight at this disease stage may be conditional on the domain(s) examined as well as individual characteristics. The current study is the first to examine differences in objective performance and self-awareness of difficulties between older adults with amnestic single- (MCI-ASD) and multidomain MCI (MCI-AMD) across six instrumental activities of daily living (IADLs). METHOD Seventy-five individuals (Mage = 73.9 years, range = 55-88 years; 56% female) with MCI-ASD (n = 30) and MCI-AMD (n = 45) were recruited primarily from a hospital-based memory disorders clinic. Participants were administered self-report and objective measures assessing six functional domains: financial management, driving, telephone use, nutrition evaluation, grocery shopping, and medication management. Self-awareness discrepancy scores were calculated for each of these IADLs, and participants were classified as either "overestimating ability" or "accurately/underestimating ability." RESULTS Individuals with MCI-AMD performed significantly worse on objective measures of financial management, driving, and nutrition evaluation than those with MCI-ASD. Across MCI subtypes, participants were most likely to lack awareness of their difficulties in nutrition evaluation (31%), financial management (25%), and driving (23%) domains. Individuals with MCI-AMD were significantly more likely than those with MCI-ASD to overestimate performance on driving and telephone use domains. CONCLUSION Individuals with MCI-AMD are more likely than those with MCI-ASD to have impairment in their everyday function and to lack awareness into their IADL difficulties. When possible, clinicians should obtain objective measures in combination with detailed informant reports of functional abilities in order to evaluate capacity to independently engage in various daily activities. Finally, level of self-awareness varies across IADL domains, providing further evidence that insight is not a unitary construct.
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Affiliation(s)
- Kayla A Steward
- a Department of Psychology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Tyler P Bull
- a Department of Psychology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Virginia G Wadley
- b Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
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Barrado-Martín Y, Heward M, Polman R, Nyman SR. Acceptability of a Dyadic Tai Chi Intervention for Older People Living With Dementia and Their Informal Carers. J Aging Phys Act 2019; 27:166-83. [PMID: 30160584 DOI: 10.1123/japa.2017-0267] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Exercise is effective in preventing falls among older adults. However, few studies have included people living with dementia and their carers and explored their experiences. The aim of this study is to explore what affects the acceptability of exercise interventions to better meet the needs of people with dementia and their carers as a dyad. Observations, field notes containing participant's and instructor's feedback, and focus groups with 10 dyads involved in Tai Chi classes for 3 or 4 weeks in two sites in the South of England were thematically analyzed to understand their experiences. Findings suggest that dyads' determination to achieve the benefits of Tai Chi facilitated their adherence, whereas a member of the dyad's low sense of efficacy performing the movements during classes was a barrier. Simplifying class content and enhancing the clarity of instructions for home-based practice will be key to support the design of future exercise interventions.
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Tsutsumimoto K, Doi T, Makizako H, Hotta R, Nakakubo S, Kim M, Kurita S, Suzuki T, Shimada H. Social Frailty Has a Stronger Impact on the Onset of Depressive Symptoms than Physical Frailty or Cognitive Impairment: A 4-Year Follow-up Longitudinal Cohort Study. J Am Med Dir Assoc 2018; 19:504-10. [DOI: 10.1016/j.jamda.2018.02.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/10/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
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Pillai JA, Bonner‐Jackson A, Floden D, Fernandez H, Leverenz JB. Lack of Accurate Self-appraisal is Equally Likely in MCI from Parkinson's Disease and Alzheimer's Disease. Mov Disord Clin Pract 2018; 5:283-289. [PMID: 30363404 PMCID: PMC6174380 DOI: 10.1002/mdc3.12606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/22/2018] [Accepted: 02/15/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND How accurate are mild cognitive impairment (MCI) patients in assessing their cognitive and functional deficit is often unclear to the clinician. The accuracy of patient self-appraisal in Parkinson's disease-MCI (PD-MCI) has received less attention than amnestic MCI (a-MCI) often associated with Alzheimer's disease. We evaluated if PD-MCI patients demonstrate accurate self-appraisal of their cognitive deficits compared to patients with amnestic a-MCI or non-amnestic MCI (na-MCI). METHODS This cross-sectional cohort study included, 30 PD-MCI, 33 a-MCI, and 17 na-MCI patients. Self-appraisal was assessed by comparing responses of caregivers and patients on a validated self-rating questionnaire of cognitive and functional impairments. All patients completed a full neuropsychological evaluation and depression screening measure. Univariate ANOVA, regression, and correlational analyses were employed to identify group differences in self-appraisal scores and relationships between cognitive and functional impairment, depression measures, and self-appraisal scores. RESULTS Self-appraisal scores for PD-MCI did not differ significantly from a-MCI and na-MCI. In the PD-MCI group, higher depression scores were associated with lower self-appraisal scores (i.e, patients assessed cognition as worse than caregivers). In a stepwise regression model with self-appraisal scores as the dependent variable, only the depression score was significant predictor among PD-MCI and accounted for 50% of the variance. CONCLUSIONS Our findings suggest that impaired patient self-appraisal is equally likely to occur in PD-MCI as in a-MCI and na-MCI patients. Among PD-MCI, depression was the strongest predictor of impaired patient self-appraisal. Impaired insight into cognitive impairment and depression should be considered in both care and research with PD patients.
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Affiliation(s)
- Jagan A. Pillai
- Lou Ruvo Center for Brain HealthCleveland ClinicClevelandOH
- Neurological InstituteCleveland ClinicClevelandOH
| | - Aaron Bonner‐Jackson
- Lou Ruvo Center for Brain HealthCleveland ClinicClevelandOH
- Neurological InstituteCleveland ClinicClevelandOH
| | - Darlene Floden
- Center for Neurological RestorationCleveland ClinicClevelandOH
- Neurological InstituteCleveland ClinicClevelandOH
| | - Hubert Fernandez
- Center for Neurological RestorationCleveland ClinicClevelandOH
- Neurological InstituteCleveland ClinicClevelandOH
| | - James B. Leverenz
- Lou Ruvo Center for Brain HealthCleveland ClinicClevelandOH
- Neurological InstituteCleveland ClinicClevelandOH
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18
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Abstract
Memory dysfunction and cognitive impairments due to Alzheimer’s disease can affect the selfhood and identity of afflicted individuals, causing distress to both people with Alzheimer’s disease and their caregivers. Recently, a number of case studies and clinical trials have been conducted to determine the potential of deep brain stimulation as a therapeutic modality for people with Alzheimer’s disease. Some of these studies have shown that deep brain stimulation could induce flashbacks and stabilize or even improve memory. However, deep brain stimulation itself has also been attributed as a potential threat to identity and selfhood, especially when procedure-related adverse events arise. We anticipate potential effects of deep brain stimulation for people with Alzheimer’s disease on selfhood, reconciling information from medical reports, psychological, and sociological investigations on the impacts of deep brain stimulation or Alzheimer’s disease on selfhood. A tripartite model of the self that extends the scope of Rom Harré’s and Steve Sabat’s social constructionist framework was used. In this model, potential effects of deep brain stimulation for Alzheimer’s disease on Self 1 or singularity through use of first-person indexicals, and gestures of self-reference, attribution, and recognition; Self 2 or past and present attributes, knowledge of these characteristics, and continuity of narrative identity; and Self 3 or the relational and social self are explored. The ethical implications of potential effects of deep brain stimulation for Alzheimer’s disease on the tripartite self are then highlighted, focusing on adapting informed consent procedures and care provided throughout the trial to account for both positive and negative plausible effects on Self 1, Self 2, and Self 3.
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Affiliation(s)
- John Noel M Viaña
- Wicking Dementia Research and Education Centre, College of Health and Medicine; Ethics, Policy and Public Engagement Program, Australian Research Council Centre of Excellence for Electromaterials Science; Philosophy and Gender Studies Program, School of Humanities, College of Arts, Law, and Education, University of Tasmania, Hobart, Australia
| | - Frederic Gilbert
- Center for Sensorimotor Neural Engineering and Department of Philosophy, University of Washington, Seattle, WA, USA; Ethics, Policy and Public Engagement Program, Australian Research Council Centre of Excellence for Electromaterials Science, University of Tasmania, Hobart, Australia
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Abstract
OBJECTIVES Subjective cognitive decline is considered to be a core feature of pre-Alzheimer's disease (AD) conditions, the vast majority of literature having focused on memory concerns. Neuropsychological studies have implicated executive dysfunction on objective performance measures in AD, but no research has evaluated whether individuals with AD have concerns about their executive functions and whether it differs from their caregiver's concerns. In the present study, we sought to evaluate self- and informant ratings of executive functioning in patients with mild AD. METHOD Participants were 23 patients with mild AD and 32 healthy elderly controls (HC) and their informants who completed the Behavior Rating Inventory of Executive Function - Adult version. RESULTS Patients with AD and their informants reported greater executive dysfunction than the HC group and their informants, respectively, and patients reported greater difficulty than their informants. The largest effect size for both self- and informant ratings was obtained for the Working Memory scale. CONCLUSIONS These findings indicate that subjective cognitive concerns in mild AD extend beyond the memory domain to executive functions. That greater difficulty was endorsed by patients than their informants suggests that at least in the mild stage of AD some awareness of executive dysfunction may be maintained in some patients. Implications for clinical care are discussed.
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Affiliation(s)
- Jennifer Fogarty
- a Department of Psychiatry and Division of Geriatric Medicine , Schulich School of Medicine & Dentistry, Western University , London , Ontario , Canada.,b Specialized Geriatric Services , Parkwood Institute , London , Ontario , Canada
| | - Erin Almklov
- c Neuropsychology Program, Department of Psychiatry , Geisel School of Medicine at Dartmouth , One Medical Center Drive, Lebanon , NH , USA
| | - Michael Borrie
- a Department of Psychiatry and Division of Geriatric Medicine , Schulich School of Medicine & Dentistry, Western University , London , Ontario , Canada.,b Specialized Geriatric Services , Parkwood Institute , London , Ontario , Canada
| | - Jennie Wells
- a Department of Psychiatry and Division of Geriatric Medicine , Schulich School of Medicine & Dentistry, Western University , London , Ontario , Canada.,b Specialized Geriatric Services , Parkwood Institute , London , Ontario , Canada
| | - Robert M Roth
- c Neuropsychology Program, Department of Psychiatry , Geisel School of Medicine at Dartmouth , One Medical Center Drive, Lebanon , NH , USA
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Hamdy RC, Lewis JV, Kinser A, Depelteau A, Copeland R, Kendall-Wilson T, Whalen K. Too Many Choices Confuse Patients With Dementia. Gerontol Geriatr Med 2017; 3:2333721417720585. [PMID: 28904992 PMCID: PMC5588787 DOI: 10.1177/2333721417720585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/22/2017] [Accepted: 06/09/2017] [Indexed: 12/02/2022] Open
Abstract
Choices are often difficult to make by patients with Alzheimer Dementia. They often become acutely confused when faced with too many options because they are not able to retain in their working memory enough information about the various individual choices available. In this case study, we describe how an essentially simple benign task (choosing a dress to wear) can rapidly escalate and result in a catastrophic outcome. We examine what went wrong in the patient/caregiver interaction and how that potentially catastrophic situation could have been avoided or defused.
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Affiliation(s)
- R C Hamdy
- East Tennessee State University, Johnson City, USA
| | - J V Lewis
- East Tennessee State University, Johnson City, USA
| | - A Kinser
- East Tennessee State University, Johnson City, USA
| | - A Depelteau
- East Tennessee State University, Johnson City, USA
| | - R Copeland
- East Tennessee State University, Johnson City, USA
| | - T Kendall-Wilson
- East Tennessee State University, Johnson City, USA.,Alzheimer's Tennessee, USA
| | - K Whalen
- East Tennessee State University, Johnson City, USA
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Yim SJ, Yi D, Byun MS, Choe YM, Choi HJ, Baek H, Sohn BK, Kim JW, Kim EJ, Lee DY. Screening Ability of Subjective Memory Complaints, Informant-Reports for Cognitive Decline, and Their Combination in Memory Clinic Setting. Psychiatry Investig 2017; 14:640-646. [PMID: 29042889 PMCID: PMC5639132 DOI: 10.4306/pi.2017.14.5.640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/06/2017] [Accepted: 06/03/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aimed to compare the accuracy of subjective memory complaints, informant-reports for cognitive declines, and their combination for screening cognitive disorders in memory clinic setting. METHODS One-hundred thirtytwo cognitively normal (CN), 136 mild cognitive impairment (MCI), and 546 dementia who visited the memory clinic in the Seoul National University Hospital underwent standardized clinical evaluation and comprehensive neuropsychological assessment. The Subjective Memory Complaints Questionnaire (SMCQ) and the Seoul Informant Report Questionnaire for Dementia (SIRQD) were used to assess subjective memory complaints and informant-reports for cognitive declines, respectively. RESULTS Both SMCQ and SIRQD showed significant screening ability for MCI, dementia, and overall cognitive disorder (CDall: MCI plus dementia) (screening accuracy: 60.1-94.6%). The combination of SMCQ and SIRQD (SMCQ+SIRQD) was found to have significantly better screening accuracy compared to SMCQ alone for any cognitive disorders. SMCQ+SIRQD also significantly improved screening accuracy of SIRQD alone for MCI and CDall, but not for dementia. CONCLUSION Our findings suggest that the combined information of both subjective memory complaints and informant-reports for cognitive declines can improve MCI screening by each individual information, while such combination appears not better than informant-reports in regard of dementia screening.
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Affiliation(s)
- Seon Jin Yim
- Department of Geriatric Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Dahyun Yi
- Department of Psychiatry and Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Soo Byun
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Min Choe
- Department of Neuropsychiatry, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Hyo Jung Choi
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyewon Baek
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bo Kyung Sohn
- Department of Psychiatry, Inje University College of Medicine, Busan, Republic of Korea
| | - Jee Wook Kim
- Department of Neuropsychiatry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Eui-Jung Kim
- Department of Psychiatry, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Dong Young Lee
- Department of Psychiatry and Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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Williams C, Tappen R, Wiese L, Newman D, Corbett M, Pinos S, Curtis B, Murray B. Stress in Persons with Dementia: Benefits of a Memory Center Day Program. Arch Psychiatr Nurs 2016; 30:531-8. [PMID: 27654233 DOI: 10.1016/j.apnu.2016.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/08/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
Most persons with dementia are cared for by family members who are so overwhelmed that their mental and physical health declines. Adult day care programs (ADC) are growing in number to meet caregivers' needs for respite but little is known about their effect on enrollee mental health. We examined mental health of enrollees (stress, anxiety, mood, emotions) and arousal (blood pressure and salivary cortisol) from day program enrollment to 3 months following enrollment. Results showed significant decreases in morning cortisol level at 1 and 3 months (p=.047). Perceived stress decreased at 1 and 3 months measured by Perceived Stress Scale (p=.03) and Index of Clinical Stress (p=.01). Results provide support for ADC as a stress-reducing environment for individuals with mild to moderate cognitive impairment. Future studies should be conducted to examine which elements of ADC are beneficial.
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Affiliation(s)
| | - Ruth Tappen
- Florida Atlantic University, Christine E Lynn College of Nursing
| | - Lisa Wiese
- Florida Atlantic University, Christine E Lynn College of Nursing
| | - David Newman
- Florida Atlantic University, Christine E Lynn College of Nursing
| | - Maria Corbett
- Florida Atlantic University, Department of Psychology
| | - Suzanne Pinos
- Florida Atlantic University, Christine E Lynn College of Nursing
| | - Barbara Curtis
- Florida Atlantic University, Christine E Lynn College of Nursing, Louis and Ann Greene Memory and Wellness Center
| | - Belinda Murray
- Florida Atlantic University, Christine E Lynn College of Nursing, Louis and Ann Greene Memory and Wellness Center
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Tappen RM, Elkins D, Worch S, Weglinski M. Modes of Decision Making Used by Nursing Home Residents and Their Families When Confronted With Potential Hospital Readmission. Res Gerontol Nurs 2016; 9:288-299. [PMID: 27665753 DOI: 10.3928/19404921-20160920-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/24/2016] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to characterize the decision-making processes used by nursing home (NH) residents and their families when confronted with an acute change in condition and the choice of transfer to the hospital or treatment in the NH. Using cognitive task analysis, 96 residents and 75 family members from 19 NHs were asked how they would make this choice. Fifty-one residents (53%) and 61 family members (81%) used a deliberative mode characterized by seeking information and weighing risks and benefits. Ten residents (10%) and five family members (7%) used a predominantly emotion-based mode characterized by references to feelings and prior experiences in these facilities. Thirty-six residents (38%) and nine family members (12%) delegated the decision to a family member or provider. Age and resident/family status were associated with mode used; transfer choice, gender, religion, education, and ethnic group were not. Although classic theories of information processing posit two modes of decision making, deliberative and affective, the current data suggest a third mode, that of delegating the decision to trusted others, particularly family members and providers. [Res Gerontol Nurs. 2016; 9(6):288-299.].
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Scherling CS, Wilkins SE, Zakrezewski J, Kramer JH, Miller BL, Weiner MW, Rosen HJ. Decreased Self-Appraisal Accuracy on Cognitive Tests of Executive Functioning Is a Predictor of Decline in Mild Cognitive Impairment. Front Aging Neurosci 2016; 8:120. [PMID: 27458368 PMCID: PMC4930951 DOI: 10.3389/fnagi.2016.00120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Mild cognitive impairment (MCI) in older individuals is associated with increased risk of progression to dementia. The factors predicting progression are not yet well established, yet cognitive performance, particularly for memory, is known to be important. Anosognosia, meaning lack of awareness of one's impaired function, is commonly reported in dementia and is often also a feature of MCI, but its association with risk of progression is not well understood. In particular, self-appraisal measures provide an autonomous measure of insight abilities, without the need of an informant. METHODS The present study examined the utility of self-appraisal accuracy at baseline for predicting cognitive decline in 51 patients using an informant-free assessment method. Baseline task performance scores were compared to self-assessments of performance to yield a discrimination score (DS) for tasks tapping into memory and executive functions. RESULTS Linear regression revealed that a larger DS for executive function tasks in MCI predicted functional decline, independent of age, education, and baseline memory and executive task scores. CONCLUSION These findings indicate that objective estimates of self-appraisal can be used to quantify anosognosia and increase predictive accuracy for decline in MCI.
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Affiliation(s)
- Carole S Scherling
- School of Psychology, University of San FranciscoSan Francisco, CA, USA; Memory and Aging Center, Department of Neurology, University of California San FranciscoSan Francisco, CA, USA
| | | | - Jessica Zakrezewski
- Memory and Aging Center, Department of Neurology, University of California San Francisco San Francisco, CA, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California San Francisco San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco San Francisco, CA, USA
| | - Michael W Weiner
- Memory and Aging Center, Department of Neurology, University of California San FranciscoSan Francisco, CA, USA; Department of Radiology, School of Medicine, University of California San FranciscoSan Francisco, CA, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California San Francisco San Francisco, CA, USA
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Weiler M, Northoff G, Damasceno BP, Balthazar MLF. Self, cortical midline structures and the resting state: Implications for Alzheimer's disease. Neurosci Biobehav Rev 2016; 68:245-55. [PMID: 27235083 DOI: 10.1016/j.neubiorev.2016.05.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 05/04/2016] [Accepted: 05/23/2016] [Indexed: 01/05/2023]
Abstract
Different aspects of the self have been reported to be affected in many neurological or psychiatric diseases such as Alzheimer's disease (AD), including mainly higher-level cognitive self-unawareness. This higher sense of self-awareness is most likely related to and dependent on episodic memory, due to the proper integration of ourselves in time, with a permanent conservation of ourselves (i.e., sense of continuity across time). Reviewing studies in this field, our objective is thus to raise possible explanations, especially with the help of neuroimaging studies, for where such self-awareness deficits originate in AD patients. We describe not only episodic (and autobiographical memory) impairment in patients, but also the important role of cortical midline structures, the Default Mode Network, and the resting state (intrinsic brain activity) for the processing of self-related information.
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Lacerda IB, Sousa MFB, Santos RL, Nogueira MML, Dourado MCN. Concepts and objects of awareness in Alzheimer’s disease: an updated systematic review. J bras psiquiatr 2016. [DOI: 10.1590/0047-2085000000110] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objectives To compare and discuss the objects of awareness in Alzheimer’s disease (AD): awareness of cognitive deficits, of functional activities, of social-emotional functioning and behavioral impairment. Methods A search in the PsycINFo, Pilots, PubMed/Medline and ISI electronic databases according to Prisma methodology was performed. We included studies about awareness in people with AD published between 2010 and 2015, with the combination of keywords: “Alzheimer AND awareness of deficits”, “Alzheimer AND anosognosia”, “Alzheimer AND insight”, “dementia AND awareness of deficits”, “dementia AND anosognosia”, “dementia AND insight”. The articles were categorized according to the specific object of awareness. Results Seven hundred and ten records were identified and, after application of the exclusion criteria, 191 studies were retrieved for potential use. After excluding the duplicates, 46 studies were included. Most studies assessed the cognitive domain of awareness, followed by the functional, social-emotional, and behavioral impairment domains. Memory deficits were not sufficient to explain impaired awareness in AD. Longitudinal studies did not find discrepancies between patients and caregivers’ reports, indicating that awareness is not related to cognition. Conflicting findings were observed, including the relation between awareness, mood, severity of disease, and personal characteristics. Conclusions The studies show lack of conceptual consensus and significant methodological differences. The inclusion of samples without differentiation of dementia etiology is associated to symptomatic differences, which affect awareness domains. Awareness in AD is a complex and multidimensional construct. Different objects elicit different levels of awareness.
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Piras F, Piras F, Orfei MD, Caltagirone C, Spalletta G. Self-awareness in Mild Cognitive Impairment: Quantitative evidence from systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 61:90-107. [DOI: 10.1016/j.neubiorev.2015.10.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 10/11/2015] [Accepted: 10/12/2015] [Indexed: 12/20/2022]
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Lautenschlager NT. Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer's disease and Parkinson's disease. Int Psychogeriatr 2015; 27:355-6. [PMID: 25640918 DOI: 10.1017/S1041610214002786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anosognosia or reduced awareness of cognitive and functional problems is a known clinical phenomenon in patients experiencing cognitive decline. It is common even in mild dementia syndromes and is often reported to increase with clinical disease progression (Aalten et al., 2006). More recently it also has been described in older adults with cognitive-impairment-no-dementia (CIND) and mild cognitive impairment (MCI) (Greenop et al., 2011; Maki et al., 2012). The clinical significance of awareness is a topic of controversy in the literature and determining its biological correlates in brain function and structure is an ongoing challenge (Zamboni et al., 2013; Ford et al., 2014).
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Lehrner J, Kogler S, Lamm C, Moser D, Klug S, Pusswald G, Dal-Bianco P, Pirker W, Auff E. Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer's disease and Parkinson's disease. Int Psychogeriatr 2015; 27:357-66. [PMID: 25382659 DOI: 10.1017/S1041610214002245] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Impaired awareness of memory deficits has been recognized as a common phenomenon in Alzheimer's disease (AD) and research is now increasingly focusing on awareness in groups at risk for future dementia. This study aimed to determine whether levels of awareness differ among healthy elderly people and patients with subjective cognitive decline (SCD), amnestic and non-amnestic subtypes of mild cognitive impairment (aMCI, naMCI), Alzheimer's disease (AD) and Parkinson's disease (PD), to explore correlates of awareness and to establish frequencies of memory over- and underestimation within each diagnostic group. METHODS 756 consecutive outpatients of a memory clinic and 211 healthy controls underwent thorough neuropsychological testing. Impairment of awareness was measured as the difference between subjective memory appraisals (16-item questionnaire on current memory-related problems in everyday life) and objective memory performance (15-item delayed recall task). Subgroups of over- and underestimators were classified using percentile ranks of controls. RESULTS At group level, awareness significantly decreased along the naMCI→aMCI→AD continuum, with naMCI patients showing a tendency towards overestimation of memory dysfunction. PD patients showed accurate self-appraisals as long as memory function was largely unaffected. However, there was a considerable between-group overlap in awareness scores. Furthermore, different correlates of awareness were observed depending on the diagnostic group. In general, unawareness seems to be associated with decreased cognitive performance in various domains (especially memory), higher age and lower levels of depression and self-reported functional impairment. CONCLUSION Impaired awareness is an important symptom in aMCI. Yet, given the considerable variability in awareness scores, longitudinal studies are required to evaluate their predictive power.
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Maki Y, Yamaguchi H. Early detection of dementia in the community under a community-based integrated care system. Geriatr Gerontol Int 2014; 14 Suppl 2:2-10. [PMID: 24650059 DOI: 10.1111/ggi.12259] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2014] [Indexed: 11/27/2022]
Abstract
Early detection of dementia is recommended in the stages from mild cognitive impairment to early dementia, excluding the asymptomatic stage. The advantages of early detection for patients and their caregivers include early receipt of pharmacological and non-pharmacological therapies, and early access to appropriate agencies and/or support networks. The disadvantages include psychological damage related to anxiety and depression, and risk of stigmatization and/or social exclusion. The possibility of false positive diagnoses is also problematic. For detection of dementia, various screening tests and questionnaires have been developed. However, none of these techniques are sensitive and specific enough to avoid false positives. Thus, these screening tools are recommended for assessment of the severity of functional decline after sufficient information has been gathered to suspect dementia. In terms of social services, early detection might delay institutionalization. However, implementation of early detection would add a heavy burden on social resources, especially human resources. For effective implementation of early diagnosis and management of dementia, measures are required to improve social and human resources, including the following: improvement of the diagnostic abilities of general practitioners, improvement of necessary care and support systems after diagnosis, and organizing volunteers to support local communities. Under a community-based integrated care system, each community will create a "tailored" system that meets the health needs, health status and values of the community. Promoting social participation and community involvement of the residents should be one of the key strategies to address the shortage of human resources.
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Affiliation(s)
- Yohko Maki
- Gunma University Graduate School of Health Sciences, Gunma, Japan
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Maki Y, Yamaguchi T, Yamagami T, Murai T, Hachisuka K, Miyamae F, Ito K, Awata S, Ura C, Takahashi R, Yamaguchi H. The impact of subjective memory complaints on quality of life in community-dwelling older adults. Psychogeriatrics 2014; 14:175-81. [PMID: 25142381 DOI: 10.1111/psyg.12056] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/10/2014] [Accepted: 06/16/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate the impact of memory complaints on quality of life (QOL) in elderly community dwellers with or without mild cognitive impairment (MCI). METHODS Participants included 120 normal controls (NC) and 37 with MCI aged 65 and over. QOL was measured using the Japanese version of Satisfaction in Daily Life, and memory complaints were measured using a questionnaire consisting of four items. The relevance of QOL was evaluated with psychological factors of personality traits, sense of self-efficacy, depressive mood, self-evaluation of daily functioning, range of social activities (Life-Space Assessment), social network size, and cognitive functions including memory. The predictors of QOL were analyzed by multiple linear regression analysis. RESULTS QOL was not significantly different between the NC and MCI groups. In both groups, QOL was positively correlated with self-efficacy, daily functioning, social network size, Life-Space Assessment, and the personality traits of extraversion and agreeableness; QOL was negatively correlated with memory complaints, depressive mood, and the personality trait of neuroticism. In regression analysis, memory complaints were a negative predictor of QOL in the MCI group, but not in the NC group. The partial correlation coefficient between QOL and memory complaints was -0.623 (P < 0.05), after scores of depressive mood and self-efficacy were controlled. Depressive mood was a common negative predictor in both groups. Positive predictors were Life-Space Assessment in the NC group and sense of self-efficacy in the MCI group. CONCLUSIONS Memory complaints exerted a negative impact on self-rated QOL in the MCI group, whereas a negative correlation was weak in the NC group. Memory training has been widely practised in individuals with MCI to prevent the development of dementia. However, such approaches inevitably identify their memory deficits and could aggravate their awareness of memory decline. Thus, it is critical to give sufficient consideration not to reduce QOL in the intervention for those with MCI.
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Affiliation(s)
- Yohko Maki
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
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Farrell MT, Zahodne LB, Stern Y, Dorrejo J, Yeung P, Cosentino S. Subjective word-finding difficulty reduces engagement in social leisure activities in Alzheimer's disease. J Am Geriatr Soc 2014; 62:1056-63. [PMID: 24890186 DOI: 10.1111/jgs.12850] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the influence of subjective word-finding difficulty on degree of engagement in social leisure activities among individuals with Alzheimer's disease (AD). DESIGN Analysis of data collected from the second cohort of the Multicenter Study of Predictors of Disease Course in Alzheimer's disease. SETTING Four study sites in the United States and France. PARTICIPANTS Individuals diagnosed with mild to moderate AD (N = 236). MEASUREMENTS On separate questionnaires, participants were asked to 1) report whether they had trouble finding the right word when speaking (subjective word-finding difficulty) and 2) rate their frequency and enjoyment of social and nonsocial leisure activities. Objective language measures included object naming and verbal fluency. Measures of dependence, depression, cognitive status, age, sex, and education were also included as covariates in regression analyses. RESULTS Fifty-two percent of the sample reported word-finding difficulty, and subjective complaints were correlated with poorer verbal fluency scores. Subjective word-finding difficulty was selectively related to social but not nonsocial activity measures. Endorsers of word-finding difficulty reported less frequency and enjoyment of social leisure activities, controlling for effects of covariates and objective word-finding ability. In contrast, lower engagement in nonsocial activities was associated with older age and higher depression scores but not with word-finding complaints. Caregivers' reports of study participants' activities corroborated these results. CONCLUSION Individuals with AD who are aware of increasing word-finding failures are less likely to participate in and enjoy socially oriented leisure activities. This finding may have significant implications for clinical and health outcomes in AD. Failure to evaluate subjective language complaints could result in social withdrawal symptoms, threatening the individual's quality of life and increasing caregiver burden. Reduced social interaction may ultimately exacerbate language symptoms over time.
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Affiliation(s)
- Meagan T Farrell
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York
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Maki Y, Yamaguchi T, Yamaguchi H. Evaluation of Anosognosia in Alzheimer's Disease Using the Symptoms of Early Dementia-11 Questionnaire (SED-11Q). Dement Geriatr Cogn Dis Extra 2013; 3:351-9. [PMID: 24403907 PMCID: PMC3884202 DOI: 10.1159/000355367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIMS The objective is to propose a brief method to evaluate anosognosia in Alzheimer's disease (AD) using the Symptoms of Early Dementia-11 Questionnaire (SED-11Q), a short informant-based screening questionnaire for identifying dementia. METHODS The participants were 107 elderly individuals: 13 with a Clinical Dementia Rating (CDR) of 0.5, 73 with mild AD of CDR 1, and 21 with moderate AD of CDR 2. The patients and caregivers answered the SED-11Q independently, and the degree of discrepancy indicated the severity of anosognosia. RESULTS THE SCORES WERE AS FOLLOWS: caregiver scores were 2.46 ± 1.85 (mean ± SD) in CDR 0.5, 6.36 ± 3.02 in CDR 1, and 9.00 ± 1.14 in CDR 2; patient scores were 2.00 ± 1.78, 2.55 ± 2.33, and 1.33 ± 2.46, respectively. Discrepancy was 0.46 ± 1.61, 3.81 ± 3.95, and 7.67 ± 2.87, respectively, and the caregiver assessments were significantly higher than the patient assessments in CDR 1 and CDR 2 (p < 0.001 in both groups). The SED-11Q for anosognosia was validated with the standardized Anosognosia Questionnaire for Dementia (AD-Q). The caregiver scores were moderately correlated with behavioral and psychological symptoms of dementia scores (r = 0.524), and the patient scores were moderately correlated with depression scores (r = 0.561). CONCLUSION The SED-11Q serves a dual purpose: caregiver assessment is useful for the screening of dementia, and any discrepancy between the patient and the caregiver assessment is considered as an indication of the severity of anosognosia; this can be informative for caregivers and essential for successful care.
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Affiliation(s)
- Yohko Maki
- Gunma University Graduate School of Health Sciences, Maebashi, Japan ; Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Tomoharu Yamaguchi
- Gunma University Graduate School of Health Sciences, Maebashi, Japan ; Department of Rehabilitation, Gunma University of Health and Welfare, Maebashi, Japan
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Belfort T, Sousa MFBD, Santos RL, Lima M, Torres B, Dias R, Dourado MCN. Consciência do déficit na doença de Alzheimer: diferenças entre os domínios cognitivo e funcional. J bras psiquiatr 2013. [DOI: 10.1590/s0047-20852013000300006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: Revisar sistematicamente desenhos de estudo, instrumentos de avaliação e fatores relacionados ao comprometimento dos domínios cognitivo e funcional da consciência do déficit em pessoas com doença de Alzheimer (DA). MÉTODO: Pesquisa nas bases de dados PubMed e ISI de estudos sobre consciência do déficit na DA publicados entre 2008 e 2013. As palavras-chave utilizadas foram: "dementia", "Alzheimer", "awareness", "awareness of memory" e "awareness of functioning", "deficits", "cognition". RESULTADOS: Os 10 artigos selecionados utilizaram os conceitos "falta de consciência do déficit", "anosognosia", "insight", "falta de consciência das dificuldades cognitivas" e "consciência limitada das deficiências". A etiologia do comprometimento da consciência do déficit foi relacionada a fatores biológicos como gravidade clínica da doença, associações neuroanatômicas, alterações neuropsiquiátricas e fatores psicológicos e sociais. O desenho de estudo mais utilizado foi o corte transversal. No domínio cognitivo, a memória e as funções executivas foram as duas principais funções investigadas. No domínio funcional, foram encontradas associações com a disfunção executiva, declínio da interação social, depressão e a influência do desempenho ocupacional. CONCLUSÕES: As distintas hipóteses etiológicas, a operacionalização variável do conceito e a falta de instrumentos de avaliação padronizados impossibilitam a obtenção de resultados homogêneos. Essas dificuldades comprometem a compreensão e a investigação dos domínios cognitivo e funcional.
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Abstract
BACKGROUND The purpose of the present study was to gain insight into Alzheimer's disease (AD) patients' perception of the world through the study of a few aspects of awareness. The aspects in focus of the study were disease awareness, metacognition, managing of everyday life, and as a complement, the agreement (calibration) between patients and their spouses on the studied aspects was considered. METHOD A mixed-method evaluation design was used involving 15 AD patients, their spouses, and 15 elderly healthy control subjects. The study comprised both a semistructured interview (AD patients and spouse) and a neuropsychological assessment (AD patients and control subjects). RESULTS The patients were aware of their disease and able to report on their illness. Despite this awareness, they were unable to realize and manage the practical and cognitive implications of their impairment. The results also indicate that patients and spouses were not well calibrated regarding thoughts about the disease and problems in handling the cognitive deterioration. CONCLUSIONS The findings of our study have relevance to patients' well being and how they manage everyday life. An open dialogue on these issues between spouses and in the care for AD patients would hopefully enhance quality of life for all parties involved.
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Maki Y, Yamaguchi T, Yamaguchi H. Symptoms of Early Dementia-11 Questionnaire (SED-11Q): A Brief Informant-Operated Screening for Dementia. Dement Geriatr Cogn Dis Extra 2013; 3:131-42. [PMID: 23687508 PMCID: PMC3656692 DOI: 10.1159/000350460] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to develop a brief informant-based questionnaire, namely the Symptoms of Early Dementia-11 Questionnaire (SED-11Q), for the screening of early dementia. 459 elderly individuals participated, including 39 with mild cognitive impairment in the Clinical Dementia Rating scale (CDR) 0.5, 233 with mild dementia in CDR 1, 106 with moderate dementia in CDR 2, and 81 normal controls in CDR 0. Informants were required to fill out a 13-item questionnaire. Two items were excluded after analyzing sensitivities and specificities. The final version of the SED-11Q assesses memory, daily functioning, social communication, and personality changes. Receiver operator characteristic curves assessed the utility to discriminate between CDR 0 (no dementia) and CDR 1 (mild dementia). The statistically optimal cutoff value of 2/3, which indicated a sensitivity of 0.84 and a specificity of 0.90, can be applied in the clinical setting. In the community setting, a cutoff value of 3/4, which indicated a sensitivity of 0.76 and a specificity of 0.96, is recommended to avoid false positives. The SED-11Q reliably differentiated nondemented from demented individuals when completed by an informant, and thus is practical as a rapid screening tool in general practice, as well as in the community setting, to decide whether to seek further diagnostic confirmation.
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Affiliation(s)
- Yohko Maki
- Gunma University School of Health Sciences, Gunma University of Health and Welfare, Maebashi, Japan ; Geriatrics Research Institute and Hospital, Gunma University of Health and Welfare, Maebashi, Japan
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