1
|
Read S, Hicks B, Budden E, Douglass J, Grahamslaw A, Herrero E, Joseph G, Kirkup C, Pusey M, Russell A, Sondh H, Sondh S, Storey B, Towson G, Baxter K, Birks Y, Brayne C, Colclough C, Dangoor M, Dixon J, Donaghy P, Gridley K, Harris PR, Hu B, King D, Knapp M, Miles E, Mueller C, Perach R, Robinson L, Rusted J, Thomas AJ, Wittenberg R, Banerjee S. Long-term impact of the COVID-19 pandemic on the quality of life of people with dementia and their family carers. Age Ageing 2024; 53:afad233. [PMID: 38275095 PMCID: PMC10811518 DOI: 10.1093/ageing/afad233] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Few studies have longitudinally mapped quality of life (QoL) trajectories of newly diagnosed people with dementia and their carers, particularly during coronavirus disease-2019 (COVID-19). METHODS In a UK cohort study, 261 newly diagnosed people with dementia and 206 family carers were assessed prior to the pandemic (July 2019-March 2020), followed up after the first lockdown (July-October 2020) and then again a year and 2 years later. Latent growth curve modelling examined the level and change of QoL over the four time-points using dementia-specific QoL measures (DEMQOL and C-DEMQOL). RESULTS Despite variations in individual change scores, our results suggest that generally people with dementia maintained their QoL during the pandemic and experienced some increase towards the end of the period. This contrasted with carers who reported a general deterioration in their QoL over the same period. 'Confidence in future' and 'Feeling supported' were the only carer QoL subscales to show some recovery post-pandemic. DISCUSSION It is positive that even during a period of global disruption, decline in QoL is not inevitable following the onset of dementia. However, it is of concern that carer QoL declined during this same period even after COVID-19 restrictions had been lifted. Carers play an invaluable role in the lives of people with dementia and wider society, and our findings suggest that, post-pandemic, they may require greater support to maintain their QoL.
Collapse
Affiliation(s)
- Sanna Read
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Ben Hicks
- Brighton and Sussex Medical School, Centre for Dementia Studies, University of Sussex, Brighton, UK
| | - Emily Budden
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | | | - Elena Herrero
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gregory Joseph
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Martha Pusey
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Alice Russell
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - Sharon Sondh
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Bryony Storey
- Gateshead Health NHS Foundation Trust, Gateshead, UK
| | | | - Kate Baxter
- Social Policy Research Unit, Faculty of Social Sciences, University of York, York, UK
| | - Yvonne Birks
- Social Policy Research Unit, Faculty of Social Sciences, University of York, York, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | | | - Margaret Dangoor
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Josie Dixon
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Paul Donaghy
- Kings College London, Institute of Psychiatry, London, UK
| | - Kate Gridley
- Social Policy Research Unit, Faculty of Social Sciences, University of York, York, UK
| | - Peter R Harris
- School of Psychology, University of Sussex, Brighton, UK
| | - Bo Hu
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Derek King
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Eleanor Miles
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Rotem Perach
- School of Psychology, University of Sussex, Brighton, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | | | - Alan J Thomas
- Institute for Ageing, Newcastle University, Newcastle, UK
| | - Raphael Wittenberg
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| |
Collapse
|
2
|
Colclough C, Miles E, Rusted J, Perach R, Hicks B, Dixon J, Dangoor M, Gridley K, Birks Y, Donaghy P, Mcardle R, Moseley E, Sondh HK, Banerjee S. Emotion-focused dyadic coping styles used by family carers of people with dementia during the COVID-19 pandemic. Dementia (London) 2023:14713012231173812. [PMID: 37147119 PMCID: PMC10164090 DOI: 10.1177/14713012231173812] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/07/2023]
Abstract
Emotional wellbeing of family carers and people with dementia is associated with not only how each individual copes with stress and conflict, but also by how they cope together. Finding ways to positively cope together was particularly important during COVID-19 lockdown restrictions, when other avenues of emotional support were less available. We explored how carers experienced and used emotion-focused dyadic coping styles during the COVID-19 pandemic. In-depth qualitative interviews were conducted during the pandemic with 42 family carers, supplemented by quality of life scores collected both pre- and during the pandemic and household status. Abductive thematic analysis identified five styles of emotion-focused dyadic coping: common, supportive, hostile, disengaged avoidance and protective. The COVID-19 pandemic left many dyads unsupported. While many carers adapted, reporting increases in quality of life and enjoying the extra time with the person with dementia, others experienced dyadic conflict and reductions in quality of life. This variation was associated with dyadic coping styles, including challenges in using 'positive' styles and the protective use of 'negative' disengaged avoidance in the right situations. Dyadic coping styles also differed as a function of whether the dyad lived together. As many people with dementia are supported by an informal carer, considering how they cope together could help us to better support them. We make suggestions for dyadic interventions tailored by co-residency status that could help dyads identify and communicate coping needs, reconnect following avoidance coping, and replenish their coping resources through social support.
Collapse
Affiliation(s)
| | - Eleanor Miles
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Rotem Perach
- School of Social Sciences, University of Westminster, London, UK
| | - Ben Hicks
- Brighton and Sussex Medical School, Brighton, UK
- University of Sussex, Brighton, UK
| | - Josie Dixon
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Margaret Dangoor
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Kate Gridley
- Social Policy Research Unit, University of York, York, UK
| | - Yvonne Birks
- Social Policy Research Unit, University of York, York, UK
| | - Paul Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Riona Mcardle
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Elen Moseley
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| |
Collapse
|
3
|
Perach R, Read S, Hicks B, Harris PR, Rusted J, Brayne C, Dangoor M, Miles E, Dixon J, Robinson L, Thomas A, Banerjee S. Predictors of loneliness during the Covid-19 pandemic in people with dementia and their carers in England: findings from the DETERMIND-C19 study. Aging Ment Health 2023; 27:521-532. [PMID: 35658781 DOI: 10.1080/13607863.2022.2080179] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To identify factors that predict the risk of loneliness for people with dementia and carers during a pandemic. METHODS People with dementia and their carers completed assessments before (July 2019-March 2020; 206 dyads) and after (July-October 2020) the first Covid-19 'lockdown' in England. At follow-up, the analytic sample comprised 67 people with dementia and 108 carers. We built a longitudinal path model with loneliness as an observed outcome. Carer type and social contacts at both measurements were considered. Other social resources (quality of relationship, formal day activities), wellbeing (anxiety, psychological wellbeing) and cognitive impairment were measured with initial level and change using latent growth curves. We adjusted for socio-demographic factors and health at baseline. RESULTS In carers, higher levels of loneliness were directly associated with non-spouse coresident carer type, level and increase of anxiety in carer, more formal day activities, and higher cognitive impairment in the person with dementia. In people with dementia, non-spouse coresident carer type, and higher initial levels of social resources, wellbeing, and cognitive impairment predicted the changes in these factors; this produced indirect effects on social contacts and loneliness. CONCLUSION Loneliness in the Covid-19 pandemic appears to be shaped by different mechanisms for people with dementia and their carers. The results suggest that carers of those with dementia may prioritize providing care that protects the person with dementia from loneliness at the cost of experiencing loneliness themselves. Directions for the promotion of adaptive social care during the Covid-19 pandemic and beyond are discussed.
Collapse
Affiliation(s)
- Rotem Perach
- School of Psychology, University of Sussex, Brighton, UK
| | - Sanna Read
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Ben Hicks
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Peter R Harris
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Margaret Dangoor
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Eleanor Miles
- School of Psychology, University of Sussex, Brighton, UK
| | - Josie Dixon
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Alan Thomas
- Institute for Ageing, Newcastle University, Newcastle, UK
| | - Sube Banerjee
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Faculty of Health, University of Plymouth, Plymouth, UK
| | | |
Collapse
|
4
|
Hicks B, Gridley K, Dixon J, Baxter K, Birks Y, Colclough C, Karim A, Perach R, Moseley E, Russell A, Sondh HK, Storey B, Tipping E, Ardle RM, Donaghy P, Dangoor M, Miles E, Robinson L, Rusted J, Waine H, Wheatley K, Banerjee S. Using digital technologies to facilitate social inclusion during the COVID-19 pandemic: Experiences of co-resident and non-co-resident family carers of people with dementia from DETERMIND-C19. Int J Geriatr Psychiatry 2023; 38:e5886. [PMID: 36734147 PMCID: PMC10947510 DOI: 10.1002/gps.5886] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic triggered rapid and unprecedented changes in the use of digital technologies to support people's social inclusion. We examined whether and how co-resident and non-co-resident family carers of people with dementia engaged with digital technologies during this period. METHODS Throughout November 2020-February 2021, we interviewed 42 family carers of people with dementia from our DETERMIND-C19 cohort. Preliminary analysis was conducted through Framework analysis, followed by an inductive thematic analysis. FINDINGS Digital technologies served as a Facilitator for social inclusion by enabling carers to counter the effects of the differing restrictions imposed on them so they could remain socially connected and form a sense of solidarity, access resources and information, engage in social and cultural activities and provide support and independence in their caring role. However, these experiences were not universal as carers discussed some Challenges for tech inclusion, which included preferences for face-to-face contact, lack of technological literacy and issues associated with the accessibility of the technology. CONCLUSION Many of the carers engaged with Information and Communication Technologies, and to a lesser extent Assistive Technologies, during the pandemic. Whilst carers experienced different challenges due to where they lived, broadly the use of these devices helped them realise important facets of social inclusion as well as facilitated the support they provided to the person with dementia. However, to reduce the 'digital divide' and support the social inclusion of all dementia carers, our findings suggest it is essential that services are attuned to their preferences, needs and technological abilities.
Collapse
Affiliation(s)
- Ben Hicks
- Brighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | - Kate Gridley
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Josie Dixon
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Kate Baxter
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Yvonne Birks
- Social Policy Research UnitUniversity of YorkYorkUK
| | | | - Anomita Karim
- Brighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | | | - Elen Moseley
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Alice Russell
- Brighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | | | | | - Eva Tipping
- Brighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | | | | | - Margaret Dangoor
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | | | | | | | - Harriet Waine
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | | | | |
Collapse
|
5
|
Steele OG, Stuart AC, Minkley L, Shaw K, Bonnar O, Anderle S, Penn AC, Rusted J, Serpell L, Hall C, King S. A multi-hit hypothesis for an APOE4-dependent pathophysiological state. Eur J Neurosci 2022; 56:5476-5515. [PMID: 35510513 PMCID: PMC9796338 DOI: 10.1111/ejn.15685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/31/2022] [Accepted: 04/25/2022] [Indexed: 01/01/2023]
Abstract
The APOE gene encoding the Apolipoprotein E protein is the single most significant genetic risk factor for late-onset Alzheimer's disease. The APOE4 genotype confers a significantly increased risk relative to the other two common genotypes APOE3 and APOE2. Intriguingly, APOE4 has been associated with neuropathological and cognitive deficits in the absence of Alzheimer's disease-related amyloid or tau pathology. Here, we review the extensive literature surrounding the impact of APOE genotype on central nervous system dysfunction, focussing on preclinical model systems and comparison of APOE3 and APOE4, given the low global prevalence of APOE2. A multi-hit hypothesis is proposed to explain how APOE4 shifts cerebral physiology towards pathophysiology through interconnected hits. These hits include the following: neurodegeneration, neurovascular dysfunction, neuroinflammation, oxidative stress, endosomal trafficking impairments, lipid and cellular metabolism disruption, impaired calcium homeostasis and altered transcriptional regulation. The hits, individually and in combination, leave the APOE4 brain in a vulnerable state where further cumulative insults will exacerbate degeneration and lead to cognitive deficits in the absence of Alzheimer's disease pathology and also a state in which such pathology may more easily take hold. We conclude that current evidence supports an APOE4 multi-hit hypothesis, which contributes to an APOE4 pathophysiological state. We highlight key areas where further study is required to elucidate the complex interplay between these individual mechanisms and downstream consequences, helping to frame the current landscape of existing APOE-centric literature.
Collapse
Affiliation(s)
| | | | - Lucy Minkley
- School of Life SciencesUniversity of SussexBrightonUK
| | - Kira Shaw
- School of Life SciencesUniversity of SussexBrightonUK
| | - Orla Bonnar
- School of Life SciencesUniversity of SussexBrightonUK
| | | | | | | | | | | | - Sarah King
- School of PsychologyUniversity of SussexBrightonUK
| |
Collapse
|
6
|
Hicks B, Read S, Hu B, Wittenberg R, Grahamslaw A, Karim A, Martin E, Nuzum E, Reichental J, Russell A, Siddle E, Storey B, Tipping E, Baxter K, Birks Y, Brayne C, Brimblecombe N, Dangoor M, Dixon J, Gridley K, Harris PR, Knapp M, Miles E, Perach R, Robinson L, Rusted J, Stewart R, Thomas AJ, Banerjee S. A cohort study of the impact of COVID-19 on the quality of life of people newly diagnosed with dementia and their family carers. Alzheimers Dement (N Y) 2022; 8:e12236. [PMID: 35509503 PMCID: PMC9060551 DOI: 10.1002/trc2.12236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/23/2021] [Accepted: 11/23/2021] [Indexed: 01/10/2023]
Abstract
Introduction COVID‐19 has impacted people with dementia and their family carers, yet little is known about effects on overall quality of life. Methods In a UK cohort study, pre‐ and post‐pandemic data were collected from 114 carers and 93 recently diagnosed people with dementia. Latent growth curve modeling examined change in quality of life. Results Carers reported significant decline in quality of life, although no change was demonstrated by people with dementia. In multivariable analyses, higher levels of cognitive impairment, deprivation, study site, and lower number of memory clinic contacts were associated with greater decline in carer quality of life. Discussion Maintaining life quality for people with dementia during the pandemic appears to have come at the expense of their family carers. This inequity has fallen hardest on those caring for people with more severe dementia, in deprived areas, and with least support from memory services. These effects may be prevented or reversed by post‐diagnostic care.
Collapse
Affiliation(s)
- Ben Hicks
- Brighton and Sussex Medical School University of Sussex Brighton UK
| | - Sanna Read
- Care Policy and Evaluation Centre London School of Economics and Political Science London UK
| | - Bo Hu
- Care Policy and Evaluation Centre London School of Economics and Political Science London UK
| | - Raphael Wittenberg
- Care Policy and Evaluation Centre London School of Economics and Political Science London UK
| | | | | | - Evelyn Martin
- South London and Maudsley NHS Foundation Trust London UK
| | - Eleanor Nuzum
- South London and Maudsley NHS Foundation Trust London UK
| | | | | | | | | | - Eva Tipping
- Sussex Partnership NHS Foundation Trust Worthing UK
| | - Kate Baxter
- Social Policy Research Unit University of York York UK
| | - Yvonne Birks
- Social Policy Research Unit University of York York UK
| | - Carol Brayne
- Cambridge Public Health University of Cambridge Cambridge UK
| | - Nicola Brimblecombe
- Care Policy and Evaluation Centre London School of Economics and Political Science London UK
| | - Margaret Dangoor
- Care Policy and Evaluation Centre London School of Economics and Political Science London UK
| | - Josie Dixon
- Care Policy and Evaluation Centre London School of Economics and Political Science London UK
| | - Kate Gridley
- Social Policy Research Unit University of York York UK
| | | | - Martin Knapp
- Care Policy and Evaluation Centre London School of Economics and Political Science London UK
| | - Eleanor Miles
- School of Psychology University of Sussex Brighton UK
| | - Rotem Perach
- School of Psychology University of Sussex Brighton UK
| | - Louise Robinson
- Population Health Sciences Institute Newcastle University Newcastle UK
| | | | - Rob Stewart
- Institute of Psychiatry Psychology and Neuroscience King's College London London UK
| | - Alan J Thomas
- Institute for Ageing Newcastle University Newcastle UK
| | - Sube Banerjee
- Faculty of Health University of Plymouth Plymouth UK
| |
Collapse
|
7
|
Balouch S, Dijk DA, Rusted J, Skene SS, Tabet N, Dijk D. Night‐to‐night variation in sleep associates with day‐to‐day variation in vigilance, cognition, memory, and behavioral problems in Alzheimer's disease. Alz & Dem Diag Ass & Dis Mo 2022; 14:e12303. [PMID: 35603140 PMCID: PMC9109375 DOI: 10.1002/dad2.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 11/05/2022]
Abstract
Introduction Sleep disturbances are commonly reported in people living with Alzheimer's disease (AD), but it is currently unknown whether night‐to‐night variation in sleep predicts day‐to‐day variation in vigilance, cognition, mood, and behavior (daytime measures). Methods Subjective and objective sleep and daytime measures were collected daily for 2 weeks in 15 participants with mild AD, eight participants with mild cognitive impairment (MCI), and 22 participants with no cognitive impairment (NCI). Associations between daytime measures and four principal components of sleep (duration, quality, continuity, and latency) were quantified using mixed‐model regression. Results Sleepiness, alertness, contentedness, everyday memory errors, serial subtraction, and behavioral problems were predicted by at least one of the components of sleep, and in particular sleep duration and continuity. Associations between variations in sleep and daytime measures were linear or quadratic and often different between participants with AD and those with NCI. Discussion These findings imply that daytime functioning in people with AD may be improved by interventions that target sleep continuity.
Collapse
Affiliation(s)
- Sara Balouch
- Centre for Dementia Studies Brighton & Sussex Medical School Brighton UK
- School of Humanities and Social Science University of Brighton Brighton UK
| | - Dylan A.D. Dijk
- Surrey Clinical Trials Unit Department of Clinical and Experimental Medicine University of Surrey Guildford UK
| | | | - Simon S. Skene
- Surrey Clinical Trials Unit Department of Clinical and Experimental Medicine University of Surrey Guildford UK
| | - Naji Tabet
- Centre for Dementia Studies Brighton & Sussex Medical School Brighton UK
| | - Derk‐Jan Dijk
- Surrey Sleep Research Centre Department of Clinical and Experimental Medicine University of Surrey Guildford UK
- UK Dementia Research Institute Care Research and Technology Centre Imperial College London and the University of Surrey Guildford UK
| |
Collapse
|
8
|
Henderson C, Knapp M, Martyr A, Gamble LD, Nelis SM, Quinn C, Pentecost C, Collins R, Wu YT, Jones IR, Victor CR, Pickett JA, Jones RW, Matthews FE, Morris RG, Rusted J, Thom JM, Clare L. The Use and Costs of Paid and Unpaid Care for People with Dementia: Longitudinal Findings from the IDEAL Cohort. J Alzheimers Dis 2021; 86:135-153. [PMID: 35001888 DOI: 10.3233/jad-215117] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The drivers of costs of care for people with dementia are not well understood and little is known on the costs of care for those with rarer dementias. OBJECTIVE To characterize use and costs of paid and unpaid care over time in a cohort of people with dementia living in Britain. To explore the relationship between cohort members' demographic and clinical characteristics and service costs. METHODS We calculated costs of health and social services, unpaid care, and out-of-pocket expenditure for people with mild-to-moderate dementia participating in three waves of the IDEAL cohort (2014- 2018). Latent growth curve modelling investigated associations between participants' baseline sociodemographic and diagnostic characteristics and mean weekly service costs. RESULTS Data were available on use of paid and unpaid care by 1,537 community-dwelling participants with dementia at Wave 1, 1,199 at Wave 2, and 910 at Wave 3. In models of paid service costs, being female was associated with lower baseline costs and living alone was associated with higher baseline costs. Dementia subtype and caregiver status were associated with variations in baseline costs and the rate of change in costs, which was additionally influenced by age. CONCLUSION Lewy body and Parkinson's disease dementias were associated with higher service costs at the outset, and Lewy body and frontotemporal dementias with more steeply increasing costs overall, than Alzheimer's disease. Planners of dementia services should consider the needs of people with these relatively rare dementia subtypes as they may require more resources than people with more prevalent subtypes.
Collapse
Affiliation(s)
- Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Claire Pentecost
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian R Jones
- Wales Institute for Social and Economic Research and Data, Cardiff University, Cardiff, UK
| | - Christina R Victor
- College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | | | - Roy W Jones
- The Research Institute for the Care of Older People (RICE), Bath, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Robin G Morris
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Jeanette M Thom
- School of Health Sciences, University of New South Wales, Kensington, Australia
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK.,National Institute of Health Research (NIHR) Applied Research Collaboration South-West Peninsula (PenARC), Exeter, UK
| | | |
Collapse
|
9
|
John A, Rusted J, Richards M, Gaysina D. Bidirectional relation between affective symptoms and cognitive function from middle to late adulthood: a population-based birth cohort study. Aging Ment Health 2021; 25:1642-1648. [PMID: 32363904 DOI: 10.1080/13607863.2020.1758916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES There is an association between affective symptoms and cognition. However, the direction of this association remains unclear. This study aimed to test bidirectional relationships between affective symptoms and cognition from middle to late adulthood. METHOD Data were available from the MRC National Survey of Health and Development (NSHD), a prospective birth cohort of 5362 people born in 1946. Affective symptoms and cognition were measured at ages 53, 60-64, and 69. Latent scores of affective symptoms were derived and cross-lagged models were fitted for affective symptoms with verbal memory and processing speed. RESULTS Results revealed an inverse cross-sectional association between affective symptoms and verbal memory (β=-0.18, SE=0.04, p<.001) and processing speed (β=-0.13, SE=0.06, p=.05) at age 53, but not at ages 60-64 or 69. Affective symptoms at age 53 predicted lower verbal memory at age 60-64 (β=-0.58, SE=0.27, p=.03), and affective symptoms at age 60-64 predicted lower verbal memory (β=-0.64, SE=0.29, p=.03) and processing speed (β=-1.27, SE=0.41, p=.002) at age 69. Verbal memory and processing speed did not predict subsequent affective symptoms. CONCLUSION Affective symptoms predict poorer verbal memory and processing speed over a period of 16 years, but not vice versa.
Collapse
Affiliation(s)
- Amber John
- EDGE Lab, School of Psychology, University of Sussex, Brighton, UK
| | | | | | - Darya Gaysina
- EDGE Lab, School of Psychology, University of Sussex, Brighton, UK
| |
Collapse
|
10
|
Abstract
BACKGROUND AND OBJECTIVES Emotion is integral to decision-making, and emotion regulation is associated with improved well-being in older age. Persons with dementia are likely to experience impairments in emotion regulation processes that can potentially contribute to differential decision-making and well-being outcomes. To promote the development of theoretical models of well-being in dementia, we review the quantitative evidence concerning the associations between emotion regulation and decision-making in dementia. METHODS Scoping review. RESULTS Seven studies of persons with dementia met our criteria. In persons with frontotemporal lobar degeneration, emotion regulation processes that precede the emotional experience were associated with decision-making in a moral (but not uncertainty) context. Independent of type of dementia, evidence concerning the associations between emotion regulation processes that occur after emotion is experienced and decision-making was mixed and drew on different methodologies. No studies relating to the associations between decision-making in dementia and several emotion regulation processes and strategies were found. CONCLUSIONS In this review, we sought to clarify the concept of everyday decision-making in dementia and map the current state of evidence concerning its associations with emotion regulation. Our findings show that emotion regulation processes are associated with decision-making in dementia, depending on type of decision-making assessment and emotional experience. We outline the gaps in the literature to set a research agenda for promoting our understanding of how emotion regulation processes can shape the various decisions that are made by persons with dementia on a daily basis.
Collapse
Affiliation(s)
- Rotem Perach
- School of Psychology, University of Sussex, Brighton, UK
| | | | | | - Eleanor Miles
- School of Psychology, University of Sussex, Brighton, UK
| | | |
Collapse
|
11
|
Clare L, Martyr A, Henderson C, Gamble L, Matthews FE, Quinn C, Nelis SM, Rusted J, Thom J, Knapp M, Hart N, Victor C. Living Alone with Mild-To-Moderate Dementia: Findings from the IDEAL Cohort. J Alzheimers Dis 2020; 78:1207-1216. [PMID: 33104029 DOI: 10.3233/jad-200638] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND A significant proportion of people with dementia live alone, but little is known about their specific needs. OBJECTIVE To understand the profile of people living alone with mild-to-moderate dementia in the UK and identify any systematic differences associated with living situation. METHODS We analyzed cross-sectional data from 1,541 people with mild-to-moderate dementia and 1,277 caregivers participating in the IDEAL cohort at the first wave of assessment. RESULTS There were 1,256 (81.5%) people with dementia living with others and 285 (18.5%) living alone, of whom 51 (3% of whole sample) reported little or no informal support. There were relatively few differences associated with living situation and odds ratios were generally small. People living alone were older on average, and more likely to be female, than those living with others. Those living alone were more likely to have higher cognitive ability and self-reported functional ability, and more social contact with those from other households. They were also lonelier, expressed less satisfaction with life, and used home care services and equipment more. There were no differences in symptoms, mood, quality of life, or well-being. CONCLUSION The findings support the view that it is possible to 'live well' with mild-to-moderate dementia while living alone, given appropriate support, including home care and equipment. Nevertheless, it is important to consider how those living alone may be supported to have a more satisfactory experience, and how health and social care services can best respond to their needs.
Collapse
Affiliation(s)
- Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, UK
| | - Catherine Henderson
- Personal Social Services Research Unit>, London School of Economics and Political Science, London, UK
| | - Laura Gamble
- Institute for Health and Society, Newcastle University, Newcastle, UK
| | - Fiona E Matthews
- Institute for Health and Society, Newcastle University, Newcastle, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, UK
| | | | - Jeanette Thom
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Martin Knapp
- Personal Social Services Research Unit>, London School of Economics and Political Science, London, UK
| | - Nicola Hart
- Research Development and Evaluation, Alzheimer's Society, London, UK
| | - Christina Victor
- College of Health and Life Sciences, Brunel University London, London, UK
| |
Collapse
|
12
|
Farina N, Hicks B, Baxter K, Birks Y, Brayne C, Dangoor M, Dixon J, Harris PR, Hu B, Knapp M, Miles E, Perach R, Read S, Robinson L, Rusted J, Stewart R, Thomas A, Wittenberg R, Banerjee S. DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers (DETERMIND): A protocol paper. Int J Geriatr Psychiatry 2020; 35:290-301. [PMID: 31876069 DOI: 10.1002/gps.5246] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/24/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) is designed to address fundamental, and, as yet unanswered questions about inequalities, outcomes and costs following diagnosis with dementia. These answers are needed to improve the quality of care and equity of access to care, and therefore the quality of life, of people with dementia and their carers. METHOD DETERMIND is a programme of research consisting of seven complementary workstreams (WS) exploring various components that may result in unequal dementia care: WS1: Recruitment and follow-up of the DETERMIND cohort-900 people with dementia and their carers from three geographically and socially diverse sites within six months following diagnosis, and follow them up for three years. WS2: Investigation of the extent of inequalities in access to dementia care. WS3: Relationship between use and costs of services and outcomes. WS4: Experiences of self-funders of care. WS5: Decision-making processes for people with dementia and carers. WS6: Effect of diagnostic stage and services on outcomes. WS7: Theory of Change informed strategy and actions for applying the research findings. OUTCOMES During the life of the programme, analysing baseline results and then follow-up of the DETERMIND cohort over 3 years, we will establish evidence on current services and practice. DETERMIND will deliver novel, detailed data on inequalities in dementia care and what drives positive and negative outcomes and costs for people with dementia and carers, and identify factors that help or hinder living well with dementia.
Collapse
Affiliation(s)
- Nicolas Farina
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Ben Hicks
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Kate Baxter
- Social Policy Research Unit, University of York, York, UK
| | - Yvonne Birks
- Social Policy Research Unit, University of York, York, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Margaret Dangoor
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Josie Dixon
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Peter R Harris
- School of Psychology, University of Sussex, Brighton, UK
| | - Bo Hu
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Eleanor Miles
- School of Psychology, University of Sussex, Brighton, UK
| | - Rotem Perach
- School of Psychology, University of Sussex, Brighton, UK
| | - Sanna Read
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | | | | | - Rob Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alan Thomas
- Institute for Ageing, Newcastle University, Newcastle, UK
| | - Raphael Wittenberg
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Sube Banerjee
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
- Faculty of Health, University of Plymouth, Plymouth, UK
| |
Collapse
|
13
|
John A, Rusted J, Richards M, Gaysina D. Accumulation of affective symptoms and midlife cognitive function: The role of inflammation. Brain Behav Immun 2020; 84:164-172. [PMID: 31785399 DOI: 10.1016/j.bbi.2019.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/23/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aim of the present study was to test whether C-Reactive Protein (CRP), a proxy measure of inflammation, is elevated in people with higher childhood and adulthood affective symptoms and whether elevated CRP predicts midlife cognitive function. METHODS Data were used from the National Child Development Study (n = 6276). Measures of memory, verbal fluency, information processing speed and accuracy were available in midlife (age 50). Affective symptoms were assessed in childhood (ages 7, 11, 16) and in adulthood (ages 23, 33, 42, 50). The level of plasma CRP was measured at age 44. Pathway models, unadjusted and fully adjusted for sex, education, childhood socioeconomic position, childhood cognitive ability and affective symptoms at age 50, were fitted to test direct associations between affective symptoms and midlife cognitive function, and indirect associations via the inflammatory pathway (CRP level). RESULTS In a fully adjusted model, there were significant indirect associations between adulthood affective symptoms and immediate memory (β = -0.01, SE = 0.003, p = .03) and delayed memory (β = -0.01, SE = 0.004, p = .03) via CRP. In addition, there were significant indirect associations between affective symptoms in childhood and immediate memory (β = -0.001, SE = 0.00, p = .03) and delayed memory (β = -0.001, SE = 0.001, p = .03), via adulthood affective symptoms and associated CRP. Independent of CRP, there was a significant direct association between adulthood affective symptoms and information processing errors (β = 0.47, SE = 0.21, p = .02). There were no direct or indirect associations between affective symptoms and verbal fluency or information processing speed. CONCLUSIONS CRP at age 44 is elevated in people with higher affective symptoms from age 7 to 42, and elevated CRP is associated with poorer immediate and delayed memory at age 50.
Collapse
Affiliation(s)
- Amber John
- EDGE Lab, School of Psychology, University of Sussex, Brighton, United Kingdom.
| | - Jennifer Rusted
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Darya Gaysina
- EDGE Lab, School of Psychology, University of Sussex, Brighton, United Kingdom
| |
Collapse
|
14
|
John A, James SN, Rusted J, Richards M, Gaysina D. Effects of affective symptoms in adolescence and adulthood on trajectories of cognitive function from middle to late adulthood. J Affect Disord 2019; 259:424-431. [PMID: 31610999 DOI: 10.1016/j.jad.2019.08.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/30/2019] [Accepted: 08/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the link between affective symptoms and cognitive function across the life course. This study aims to investigate whether affective symptoms in adolescence and adulthood predict trajectories of cognitive function from middle to late-adulthood. METHODS Data from the MRC National Survey of Health and Development (NSHD), a cohort of 5362 individuals born in mainland UK in 1946, were utilised. Linear mixed models were used to model cognitive trajectories (memory and processing speed) over a three-decade period (from 43 to 69) and to test effects of affective symptoms in adolescence (ages 13-15) and adulthood (ages 36 and 43) on cognitive function at first testing (age 43) and decline in cognitive function (from 43 to 69). Models were adjusted for sex, childhood cognition, childhood socioeconomic position, and education. RESULTS A quadratic model best fitted memory and processing speed data. Models revealed that adolescent affective symptoms were associated with lower memory (b = -1.11, SE = 0.53, p = .04) and processing speed (b = -18.17, SE = 7.53, p = .02) at first cognitive testing, but not with rates of decline from 43 to 69. There were no significant associations between adult affective symptoms and cognitive trajectories. LIMITATIONS Missing data is a potential limitation of this study. This was dealt with using maximum likelihood estimation and multiple imputation. CONCLUSIONS Findings suggest that adolescent, but not adult, affective symptoms are important predictors of cognitive function in midlife, but not rate of cognitive decline. This highlights the importance of early intervention to manage mental health in adolescence to protect later cognitive function.
Collapse
Affiliation(s)
- Amber John
- EDGE Lab, School of Psychology, University of Sussex, Pevensey 1 2C8, Brighton, United Kingdom.
| | - Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Jennifer Rusted
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Darya Gaysina
- EDGE Lab, School of Psychology, University of Sussex, Pevensey 1 2C8, Brighton, United Kingdom
| |
Collapse
|
15
|
John A, James SN, Patel U, Rusted J, Richards M, Gaysina D. Longitudinal associations of affective symptoms with mid-life cognitive function: evidence from a British birth cohort. Br J Psychiatry 2019; 215:675-682. [PMID: 30894229 DOI: 10.1192/bjp.2019.24] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND Affective disorders are associated with poorer cognition in older adults; however, whether this association can already be observed in mid-life remains unclear. AIMS To investigate the effects of affective symptoms over a period of 30 years on mid-life cognitive function. First, we explored whether timing (sensitive period) or persistence (accumulation) of affective symptoms predicted cognitive function. Second, we tested how different longitudinal trajectories of affective symptoms were associated with cognitive function. METHOD The study used data from the National Child Development Study. Memory, verbal fluency, information processing speed and accuracy were measured at age 50. Affective symptoms were measured at ages 23, 33, 42 and 50 and used to derive longitudinal trajectories. A structured modelling approach compared a set of nested models in order to test accumulation versus sensitive period hypotheses. Linear regressions and structural equation modelling were used to test for longitudinal associations of affective symptoms with cognitive function. RESULTS Accumulation of affective symptoms was found to be the best fit for the data, with persistent affective symptoms being associated with poorer immediate memory (b = -0.07, s.e. = 0.03, P = 0.01), delayed memory (b = -0.13, s.e. = 0.04, P < 0.001) and information processing accuracy (b = 0.18, s.e. = 0.08, P = 0.03), but not with information processing speed (b = 3.15, s.e. = 1.89, P = 0.10). Longitudinal trajectories of repeated affective symptoms were associated with poorer memory, verbal fluency and information processing accuracy. CONCLUSIONS Persistent affective symptoms can affect cognitive function in mid-life. Effective management of affective disorders to prevent recurrence may reduce risk of poor cognitive outcomes and promote healthy cognitive ageing. DECLARATION OF INTEREST None.
Collapse
Affiliation(s)
- Amber John
- PhD Student, EDGE Lab, School of Psychology, University of Sussex, UK
| | - Sarah-Naomi James
- Postdoctoral researcher, MRC Unit for Lifelong Health and Ageing at UCL, UK
| | - Urvisha Patel
- MSc Student, EDGE Lab, School of Psychology, University of Sussex, UK
| | - Jennifer Rusted
- Professor of Experimental Psychology, School of Psychology, University of Sussex, UK
| | - Marcus Richards
- Programme Leader, MRC Unit for Lifelong Health and Ageing at UCL, UK
| | - Darya Gaysina
- Senior Lecturer in Psychology, EDGE Lab, School of Psychology, University of Sussex, UK
| |
Collapse
|
16
|
Lancaster C, McDaniel MA, Tabet N, Rusted J. Prospective Memory: Age related change is influenced by APOE genotype. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2019; 27:710-728. [PMID: 31578124 DOI: 10.1080/13825585.2019.1671305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Non-focal prospective memory (PM) is sensitive to age-related decline; an additional impairment in focal PM is characteristic of mild stage Alzheimer's disease. This research explored whether, by mid-adulthood, the distinct demands of focal and non-focal PM expose differences in carriers of an APOE ε4 allele, a genetic risk factor for Alzheimer's disease. Thirty-three young and 55 mid-age adults, differentiated by APOE genotype, completed a category-decision task with a concurrent focal or non-focal PM demand. Only mid-age ε4 carriers showed a cost of carrying a focal PM intention. In addition, mid-age ε4 carriers showed a significantly greater cost of carrying a non-focal PM intention than young ε4 carriers, supporting a profile of accelerated aging. Consistency in the profile of cost differences observed in mid-age ε4 carriers and pathological aging may indicate premature vulnerability. Future research correlating a shift in PM performance with early genotype differences in brain-based markers of decline is important.
Collapse
Affiliation(s)
- Claire Lancaster
- School of Psychology, University of Sussex , Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Mark A McDaniel
- Department of Psychological and Brain Sciences, Washington University , St Louis, MI, USA
| | - Naji Tabet
- Brighton and Sussex Medical School, Centre for Dementia Studies , Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Jennifer Rusted
- School of Psychology, University of Sussex , Brighton, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
17
|
Nelis SM, Wu YT, Matthews FE, Martyr A, Quinn C, Rippon I, Rusted J, Thom JM, Kopelman MD, Hindle JV, Jones RW, Clare L. The impact of co-morbidity on the quality of life of people with dementia: findings from the IDEAL study. Age Ageing 2019; 48:361-367. [PMID: 30403771 PMCID: PMC6503940 DOI: 10.1093/ageing/afy155] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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: 04/25/2018] [Accepted: 09/12/2018] [Indexed: 12/26/2022] Open
Abstract
Background The aim was to investigate the co-morbidity profile of people with dementia and examine the associations between severity of co-morbidity, health-related quality of life (HRQoL) and quality of life (QoL). Methods The improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort consisted of 1,547 people diagnosed with dementia who provided information on the number and type of co-morbid conditions. Participants also provided ratings of their health-related and dementia-specific QoL. Results The majority of the sample were living with more than one chronic condition. Hypertension was commonly reported and frequently combined with connective tissue disease, diabetes and depression. The number of co-morbid conditions was associated with low QoL scores, and those with severe co-morbidity (≥5 conditions) showed the greatest impact on their well-being. Conclusions Co-morbidity is an important risk factor for poor QoL and health status in people with dementia. Greater recognition of the nature and impact of co-morbidity is needed to inform support and interventions for people with dementia and a multidisciplinary approach to care provision is recommended.
Collapse
Affiliation(s)
- Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
| | - Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
- King’s College London, Social Epidemiology Research Group, Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Fiona E Matthews
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
| | - Isla Rippon
- College of Health and Life Sciences, Brunel University London, London, UK
| | | | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Michael D Kopelman
- King’s College London, Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, UK
| | - John V Hindle
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
| | - Roy W Jones
- RICE (The Research Institute for the Care of Older People), Bath, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, UK
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| |
Collapse
|
18
|
John A, Patel U, Rusted J, Richards M, Gaysina D. Affective problems and decline in cognitive state in older adults: a systematic review and meta-analysis. Psychol Med 2019; 49:353-365. [PMID: 29792244 PMCID: PMC6331688 DOI: 10.1017/s0033291718001137] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 12/23/2022]
Abstract
Evidence suggests that affective problems, such as depression and anxiety, increase risk for late-life dementia. However, the extent to which affective problems influence cognitive decline, even many years prior to clinical diagnosis of dementia, is not clear. The present study systematically reviews and synthesises the evidence for the association between affective problems and decline in cognitive state (i.e., decline in non-specific cognitive function) in older adults. An electronic search of PubMed, PsycInfo, Cochrane, and ScienceDirect was conducted to identify studies of the association between depression and anxiety separately and decline in cognitive state. Key inclusion criteria were prospective, longitudinal designs with a minimum follow-up period of 1 year. Data extraction and methodological quality assessment using the STROBE checklist were conducted independently by two raters. A total of 34 studies (n = 71 244) met eligibility criteria, with 32 studies measuring depression (n = 68 793), and five measuring anxiety (n = 4698). A multi-level meta-analysis revealed that depression assessed as a binary predictor (OR 1.36, 95% CI 1.05-1.76, p = 0.02) or a continuous predictor (B = -0.008, 95% CI -0.015 to -0.002, p = 0.012; OR 0.992, 95% CI 0.985-0.998) was significantly associated with decline in cognitive state. The number of anxiety studies was insufficient for meta-analysis, and they are described in a narrative review. Results of the present study improve current understanding of the temporal nature of the association between affective problems and decline in cognitive state. They also suggest that cognitive function may need to be monitored closely in individuals with affective disorders, as these individuals may be at particular risk of greater cognitive decline.
Collapse
Affiliation(s)
- A. John
- EDGE Lab, School of Psychology, University of Sussex, Brighton, UK
| | - U. Patel
- EDGE Lab, School of Psychology, University of Sussex, Brighton, UK
| | - J. Rusted
- School of Psychology, University of Sussex, Brighton, UK
| | - M. Richards
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - D. Gaysina
- EDGE Lab, School of Psychology, University of Sussex, Brighton, UK
| |
Collapse
|
19
|
Fialho R, Pereira M, Gilleece Y, Rusted J, Whale R. A longitudinal study assessing depression in hepatitis C: Does gender play a role in the new-onset depression during interferon-alpha treatment? Women Health 2018; 59:181-195. [PMID: 29630491 DOI: 10.1080/03630242.2018.1449778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/14/2022]
Abstract
In this prospective study conducted from October 2013 to June 2015 in Brighton, England, we examined differences between men and women in new-onset major depressive disorder (MDD) during interferon-alpha-based (IFN-α) therapy for hepatitis C virus (HCV). We included 155 HCV-infected patients (47 women), eligible to receive HCV therapy, including direct-acting antivirals. The Semi-Structured Clinical Interview was used to assess MDD. Severity of depressive symptoms was assessed using the Hamilton Depression Rating Scale. Patients were assessed at baseline, during treatment and 6 months after treatment completion. A significant increase in depressive symptoms was observed in the total sample from baseline to week 4, and a significant decrease was observed from end of treatment (week 24) to the sustained virological response (SVR) end point at 6 months posttreatment. Women were more likely to have a MDD at week 24. In both men and women, neurovegetative and mood-cognitive syndromes increased significantly at the early stage of treatment but remitted by the end of HCV therapy. Proportions with SVR were similar among females and males (91.5 percent vs. 87 percent). Under an inflammatory condition, boosted by interferon-based treatments, these results suggest that female gender is not associated with increased vulnerability for developing depression during IFN-α therapy.
Collapse
Affiliation(s)
- Renata Fialho
- a School of Psychology , University of Sussex , Brighton , United Kingdom.,b Sussex Partnership NHS Foundation Trust , Brighton , United Kingdom
| | - Marco Pereira
- c Faculty of Psychology and Education Sciences , University of Coimbra , Coimbra , Portugal
| | - Yvonne Gilleece
- d Brighton & Sussex University Hospitals NHS Trust , Brighton , United Kingdom
| | - Jennifer Rusted
- a School of Psychology , University of Sussex , Brighton , United Kingdom
| | - Richard Whale
- b Sussex Partnership NHS Foundation Trust , Brighton , United Kingdom.,e Brighton and Sussex Medical School , Brighton , United Kingdom
| |
Collapse
|
20
|
Lancaster C, Forster S, Tabet N, Rusted J. Putting attention in the spotlight: The influence of APOE genotype on visual search in mid adulthood. Behav Brain Res 2017; 334:97-104. [PMID: 28750833 DOI: 10.1016/j.bbr.2017.07.015] [Citation(s) in RCA: 7] [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] [Received: 12/16/2016] [Revised: 05/31/2017] [Accepted: 07/15/2017] [Indexed: 01/10/2023]
Abstract
The Apolipoprotein E e4 allele is associated with greater cognitive decline with age, yet effects of this gene are also observed earlier in the lifespan. This research explores genotype differences (e2, e3, e4) in the allocation of visuospatial attention in mid-adulthood. Sixty-six volunteers, aged 45-55 years, completed two paradigms probing the active selection of information at the focus of attention (a dynamic scaling task) and perceptual capacity differences. Two methods of statistical comparison (parametric statistics, Bayesian inference) found no significant difference between e4 carriers and the homozygous e3 group on either the dynamic scaling or perceptual load task. E2 carriers, however, demonstrated less efficient visual search performance on the dynamic scaling task. The lack of an e4 difference in visuospatial attention, despite previous suggestion in the literature of genotype effects, indicates that select attentional processes are intact in e4 carriers in mid-adulthood. The association of e2 genotype with slower visual search performance complicates the premised protective effects of this allele in cognitive ageing.
Collapse
Affiliation(s)
- Claire Lancaster
- School of Psychology, University of Sussex, Brighton, East Sussex, BN1 9QG, UK.
| | - Sophie Forster
- School of Psychology, University of Sussex, Brighton, East Sussex, BN1 9QG, UK.
| | - Naji Tabet
- Brighton and Sussex Medical School, Centre of Dementia Studies, Brighton, East Sussex, BN1 9PH, UK.
| | - Jennifer Rusted
- School of Psychology, University of Sussex, Brighton, East Sussex, BN1 9QG, UK.
| |
Collapse
|
21
|
Fialho R, Pereira M, Harrison N, Rusted J, Whale R. Co-infection with HIV associated with reduced vulnerability to symptoms of depression during antiviral treatment for hepatitis C. Psychiatry Res 2017; 253:150-157. [PMID: 28365538 DOI: 10.1016/j.psychres.2017.03.049] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/03/2017] [Accepted: 03/20/2017] [Indexed: 12/11/2022]
Abstract
In this prospective study, we examined new-onset major depressive disorder (MDD) and the differential expression of depressive symptoms in a sample of 132 HCV mono-infected and 40 HIV/HCV co-infected patients initiating pegylated interferon-based treatment, including protease inhibitor therapy. The semi-structured clinical interview (SCID-I) was used to assess MDD. Severity of depressive symptoms was assessed using the Hamilton Depression Rating Scale. Of the total sample, 60 patients (34.9%) developed SCID-I defined MDD during antiviral treatment. The proportion of HCV mono- and HIV/HCV patients developing MDD during treatment was not significantly different (37.9% vs. 25%; p=0.185). In both groups, there was a significant increase in HAMD total score from baseline to week 4, and a significant decrease between week 24 and 6 months post-treatment cessation. The greatest increase was observed in the symptoms of the neurovegetative syndrome. HCV mono-infected patients reported higher scores than co-infected patients, particularly impaired activity and somatic symptoms, but the differences were only significant at week 12. The finding that co-infected patients appear less vulnerable to the development of depressive symptoms during HCV treatment than HCV mono-infected patients warrants further exploration, including a thorough analysis of the biological and psychosocial factors associated with this emergence.
Collapse
Affiliation(s)
- Renata Fialho
- School of Psychology, University of Sussex, Brighton, United Kingdom; Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom.
| | - Marco Pereira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Neil Harrison
- Clinical Imaging Science Centre, University of Sussex, Brighton, United Kingdom
| | - Jennifer Rusted
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Richard Whale
- Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom
| |
Collapse
|
22
|
Martyr A, Wu Y, Morris R, Hindle J, Rusted J, Thom J, Clarke R, Clare L. FACTORS ASSOCIATED WITH QUALITY OF LIFE IN DEMENTIA: A CORRELATIONAL META-ANALYSIS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A. Martyr
- University of Exeter, Exeter, United Kingdom,
| | - Y. Wu
- University of Exeter, Exeter, United Kingdom,
| | - R. Morris
- Kings College Hospital, London, United Kingdom
| | - J. Hindle
- Bangor University, Bangor, United Kingdom,
| | - J. Rusted
- University of Sussex, Brighton, United Kingdom,
| | - J. Thom
- University of New South Wales, Sydney, New South Wales, Australia,
| | - R. Clarke
- University of Sussex, Brighton, United Kingdom,
| | - L. Clare
- University of Exeter, Exeter, United Kingdom,
| |
Collapse
|
23
|
Butler K, Rusted J, Gard P, Jackson A. Performance monitoring in nicotine dependence: Considering integration of recent reinforcement history. Pharmacol Biochem Behav 2017; 156:63-70. [PMID: 28410978 DOI: 10.1016/j.pbb.2017.04.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/28/2017] [Accepted: 04/06/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Impaired monitoring of errors and conflict (performance monitoring; PM) is well documented in substance dependence (SD) including nicotine dependence and may contribute to continued drug use. Contemporary models of PM and complementary behavioural evidence suggest that PM works by integrating recent reinforcement history rather than evaluating individual behaviours. Despite this, studies of PM in SD have typically used indices derived from reaction to task error or conflict on individual trials. Consequently impaired integration of reinforcement history during action selection tasks requiring behavioural control in SD populations has been underexplored. METHODS A reinforcement learning task assessed the ability of abstinent, satiated, former and never smokers (N=60) to integrate recent reinforcement history alongside a more typical behavioural index of PM reflecting the degree of reaction time slowing following an error (post-punishment slowing; PPS). RESULTS On both indices there was a consistent pattern in PM data: Former smokers had the greatest and satiated smokers the poorest PM. Specifically satiated smokers had poorer reinforcement integration than former (p=0.005) and never smokers (p=0.041) and had less post-punishment slowing than former (p<0.001), never (p=0.003) and abstinent smokers (p=0.026). CONCLUSIONS These are the first data examining the effects of smoking status on PM that use an integration of reinforcement history metric. The concordance of the reinforcement integration and PPS data suggest that this could be a promising method to interrogate PM in future studies. PM is influenced by smoking status. As PM is associated with adapting behaviour, poor PM in satiated smokers may contribute towards continued smoking despite negative consequences. Former smokers show elevated PM suggesting this may be a good relapse prevention target for individuals struggling to remain abstinent however prospective and intervention studies are needed. A better understanding of PM deficits in terms of reinforcement integration failure may stimulate development of novel treatment approaches.
Collapse
Affiliation(s)
- Kevin Butler
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK; School of Psychology, University of Lincoln, Brayford Pool, Lincoln, UK.
| | | | - Paul Gard
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Anne Jackson
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| |
Collapse
|
24
|
Gard PR, Fidalgo S, Lotter I, Richardson C, Farina N, Rusted J, Tabet N. Changes of renin-angiotensin system-related aminopeptidases in early stage Alzheimer's disease. Exp Gerontol 2017; 89:1-7. [DOI: 10.1016/j.exger.2017.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 11/29/2022]
|
25
|
Abstract
The aim of this study was to carry out a systematic review and meta-analysis of the differences in the prevalence of depression and presence of depressive symptoms between HIV/HCV co-infection, HIV mono-infection, and hepatitis C virus (HCV) mono-infection. A systematic electronic search of bibliographic databases was performed to locate articles published from the earliest available online until December 2014. Outcomes of depression were based on clinical interviews and validated self-reported measures of depression/depressive symptoms. Of the 188 records initially screened, 29 articles were included in the descriptive systematic review and six were included in the meta-analysis. The meta-analytic results indicated that, as measured by self-reported measures of depression, HIV/HCV co-infected patients were significantly more likely to report depressive symptoms than either HIV (SMD = .24, 95% CI: .03-.46, p = .02) or HCV mono-infected (SMD = .55, 95% CI: .17-.94, p = .005) patients. The variability of the results of the reviewed studies, largely dependent on the samples' characteristics and the methods of assessment of depression, suggests that a clear interpretation of how depression outcomes are affected by the presence of HIV/HCV co-infection is still needed. Failing to diagnose depression or to early screen depressive symptoms may have a significant impact on patients' overall functioning and compromise treatments' outcomes.
Collapse
Affiliation(s)
- Renata Fialho
- a School of Psychology , University of Sussex , Brighton , UK.,b Sussex Partnership NHS Foundation Trust , Brighton , UK
| | - Marco Pereira
- c Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Jennifer Rusted
- a School of Psychology , University of Sussex , Brighton , UK
| | - Richard Whale
- b Sussex Partnership NHS Foundation Trust , Brighton , UK.,d Brighton and Sussex Medical School , Brighton , UK
| |
Collapse
|
26
|
Lancaster C, Tabet N, Rusted J. The APOE paradox: do attentional control differences in mid-adulthood reflect risk of late-life cognitive decline. Neurobiol Aging 2016; 48:114-121. [PMID: 27661410 DOI: 10.1016/j.neurobiolaging.2016.08.015] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/17/2016] [Accepted: 08/17/2016] [Indexed: 01/17/2023]
Abstract
Possession of an Apolipoprotein E (APOE) e4 allele is an established risk factor for Alzheimer's disease, whereas the less commonly studied e2 variant is premised to offer some protection. This research explores the purported deleterious-protective dichotomy of APOE variants on attentional control in mid-adulthood. Sixty-six volunteers, aged 45-55 years, completed 3 tasks that provided complementary measures of attentional control: prospective memory, sustained attention, and inhibition. Performance was compared between e2 carriers, e4 carriers, and e3 homozygotes (the population norm). Carriers of the e4 allele showed subtle disadvantages, compared with the e3 group, in accuracy of Stroop task and prospective memory performance. Contrary to expectations, e2 carriers showed performance disadvantages in sustained attention. The finding of detrimental effects in attentional control for both e4 and e2 complicates the current model that proposes opposing effects of these variants on later-life cognition. Future research is needed to understand how cognitive differences develop with increasing age, and the physiological mechanisms that underpin these changes.
Collapse
Affiliation(s)
- Claire Lancaster
- School of Psychology, University of Sussex, Brighton, East Sussex, UK
| | - Naji Tabet
- Brighton and Sussex Medical School, Institute of Postgraduate Medicine, Brighton, East Sussex, UK
| | - Jennifer Rusted
- School of Psychology, University of Sussex, Brighton, East Sussex, UK.
| |
Collapse
|
27
|
Abstract
The principal aim of this study is to evaluate the immediate and long-term effects of art therapy for older people with dementia, specifically to test the premise that participation in art therapy groups effects significant positive changes in mood and cognition both immediately within sessions and later outside the sessions to impact behaviour in the day care/residential care setting. The broader aim is to provide an evidence-based evaluation about the use of art therapy for older people with dementia. In order to isolate the impact of art therapy we compared art therapy groups with activity groups that do not have emotional expression as a central purpose.
Collapse
|
28
|
Fialho R, Pereira M, Bucur M, Fisher M, Whale R, Rusted J. Cognitive impairment in HIV and HCV co-infected patients: a systematic review and meta-analysis. AIDS Care 2016. [DOI: 10.1080/09540121.2016.1191614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
29
|
Abstract
APOE ϵ4 - one of three possible allelic variants (ϵ2, ϵ3 and ϵ4) of the polymorphic protein APOE - is well characterized in its role as the strongest risk factor (after old age) for sporadic Alzheimer's disease (AD). Perhaps less well known, and certainly less well characterized, is that this ϵ4 variant of the APOE gene also is a significant risk factor for age-related cognitive decline in nonclinical populations. This article considers APOE ϵ4 effects on cognition in people without dementia, the extent to which such effects may depend on age and on gender and other interactive biological systems that change across the lifespan.
Collapse
|
30
|
Abstract
Cognitive impairment has been well documented in HIV and hepatitis C virus (HCV) mono-infections. However, in the context of HIV/HCV co-infection the research is more limited. The aim of this systematic review was to describe the characteristics of cognitive impairment in HIV/HCV co-infection and to examine the differences in cognitive performance between HIV/HCV and HIV and HCV mono-infected patients. Of the 437 records initially screened, 24 papers met the inclusion criteria and were included in the systematic review. Four studies were included in the meta-analysis. Most studies indicated that HIV/HCV co-infected patients had a higher level of cognitive impairment than HIV mono-infected patients. Meta-analysis indicated, however, that HIV mono-infected patients had a significantly higher global deficit score than co-infected patients. The results also indicated that co-infected patients were more likely to be impaired in information processing speed than HIV mono-infected patients. These findings can be challenged by biasing factors such as the small number of studies, heterogeneity of the samples, and a large diversity of methodological procedures. Future research with consistent and comprehensive neuropsychological batteries and covering a greater diversity of risk factors is needed, in order to clarify the effects of both viruses on cognitive function and the mechanisms that underlie these effects. Because cognitive impairments may pose significant challenges to medication adherence, quality of life and overall functioning, such knowledge may have important implications to the planning and implementation of effective interventions aimed at optimising the clinical management of these infections.
Collapse
Affiliation(s)
- Renata Fialho
- a School of Psychology, University of Sussex , Brighton , UK.,b Sussex Partnership NHS Foundation Trust , Brighton , UK
| | - Marco Pereira
- c Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Mihaela Bucur
- b Sussex Partnership NHS Foundation Trust , Brighton , UK
| | - Martin Fisher
- d Elton John Centre , Brighton and Sussex University Hospitals NHS Trust , Brighton , UK.,e Brighton and Sussex Medical School , Brighton , UK
| | - Richard Whale
- b Sussex Partnership NHS Foundation Trust , Brighton , UK.,e Brighton and Sussex Medical School , Brighton , UK
| | - Jennifer Rusted
- a School of Psychology, University of Sussex , Brighton , UK
| |
Collapse
|
31
|
Richardson C, Rusted J, Tabet N. 74THE ACTION FOR HEALTH WITH EXERCISE IN ALZHEIMER'S DISEASE (AHEAD) FEASIBILITY STUDY. Age Ageing 2015. [DOI: 10.1093/ageing/afv115.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
32
|
Farina N, Tabet N, Rusted J. The relationship between habitual physical activity status and executive function in individuals with Alzheimer’s disease: a longitudinal, cross-lagged panel analysis. Aging, Neuropsychology, and Cognition 2015; 23:234-52. [DOI: 10.1080/13825585.2015.1080213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Abstract
BACKGROUND There is increasing evidence that physical activity supports healthy ageing. Exercise is helpful for cardiovascular, respiratory and musculoskeletal systems, among others. Aerobic activity, in particular, improves cardiovascular fitness and, based on recently reported findings, may also have beneficial effects on cognition among older people. OBJECTIVES To assess the effect of aerobic physical activity, aimed at improving cardiorespiratory fitness, on cognitive function in older people without known cognitive impairment. SEARCH METHODS We searched ALOIS - the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, the Cochrane Controlled Trials Register (CENTRAL) (all years to Issue 2 of 4, 2013), MEDLINE (Ovid SP 1946 to August 2013), EMBASE (Ovid SP 1974 to August 2013), PEDro, SPORTDiscus, Web of Science, PsycINFO (Ovid SP 1806 to August 2013), CINAHL (all dates to August 2013), LILACS (all dates to August 2013), World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch), ClinicalTrials.gov (https://clinicaltrials.gov) and Dissertation Abstracts International (DAI) up to 24 August 2013, with no language restrictions. SELECTION CRITERIA We included all published randomised controlled trials (RCTs) comparing the effect on cognitive function of aerobic physical activity programmes with any other active intervention, or no intervention, in cognitively healthy participants aged over 55 years. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data from included trials. We grouped cognitive outcome measures into eleven categories covering attention, memory, perception, executive functions, cognitive inhibition, cognitive speed and motor function. We used the mean difference (or standardised mean difference) between groups as the measure of the treatment effect and synthesised data using a random-effects model. We conducted separate analyses to compare aerobic exercise interventions with no intervention and with other exercise, social or cognitive interventions. Also, we performed analyses including only trials in which an increase in the cardiovascular fitness of participants had been demonstrated. MAIN RESULTS Twelve trials including 754 participants met our inclusion criteria. Trials were from eight to 26 weeks in duration.We judged all trials to be at moderate or high risk of bias in at least some domains. Reporting of some risk of bias domains was poor.Our analyses comparing aerobic exercise to any active intervention showed no evidence of benefit from aerobic exercise in any cognitive domain. This was also true of our analyses comparing aerobic exercise to no intervention. Analysing only the subgroup of trials in which cardiorespiratory fitness improved in the aerobic exercise group showed that this improvement did not coincide with improvements in any cognitive domains assessed. Our subgroup analyses of aerobic exercise versus flexibility or balance interventions also showed no benefit of aerobic exercise in any cognitive domain.Dropout rates did not differ between aerobic exercise and control groups. No trial reported on adverse effects.Overall none of our analyses showed a cognitive benefit from aerobic exercise even when the intervention was shown to lead to improved cardiorespiratory fitness. AUTHORS' CONCLUSIONS We found no evidence in the available data from RCTs that aerobic physical activities, including those which successfully improve cardiorespiratory fitness, have any cognitive benefit in cognitively healthy older adults. Larger studies examining possible moderators are needed to confirm whether or not aerobic training improves cognition.
Collapse
Affiliation(s)
- Jeremy Young
- University of SussexSchool of PsychologyBrightonUKBN1 9QH
| | - Maaike Angevaren
- University of Applied SciencesResearch Group Lifestyle and HealthBolognalaan 101UtrechtNetherlands3584 CJ
| | | | - Naji Tabet
- Brighton and Sussex Medical SchoolPostgraduate MedicineMayfield House, University of BrightonFalmerBrightonUKBN1 9PH
| | | |
Collapse
|
34
|
De Scalzi M, Rusted J, Oakhill J. Embodiment Effects and Language Comprehension in Alzheimer's Disease. Cogn Sci 2014; 39:890-917. [DOI: 10.1111/cogs.12187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 04/24/2014] [Accepted: 05/07/2014] [Indexed: 11/29/2022]
|
35
|
Austin AJ, Duka T, Rusted J, Jackson A. Effect of varenicline on aspects of inhibitory control in smokers. Psychopharmacology (Berl) 2014; 231:3771-85. [PMID: 24652107 DOI: 10.1007/s00213-014-3512-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 06/26/2013] [Accepted: 02/17/2014] [Indexed: 02/03/2023]
Abstract
RATIONALE Varenicline, a partial agonist at α4β2 nicotinic receptors (nAChRs) aids smoking cessation by reducing craving. Successful quitting may be associated with greater inhibitory control but the effectiveness of varenicline in this regard is unknown. OBJECTIVES This study aimed to investigate the effect of varenicline on aspects of inhibitory control in smokers. METHODS A double-blind, placebo-controlled study investigating the effect of varenicline 1 mg (or matched placebo) in satiated and abstinent smokers. Tests included Rapid Visual Information Processing (RVIP), Stop-Signal (SS), Prospective Memory (PM) and the Cambridge Gambling Task (CGT). RESULTS Smoking enhanced RVIP accuracy and latency to respond. Varenicline did not alter RVIP performance, nor the effect of smoking, suggesting that these effects were unrelated to α4β2 nAChRs. Smoking increased the number of errors during SS and increased the stop latency, indicating that smoking decreased inhibitory control. Varenicline partially mimicked this effect of smoking but also reduced the smoking-induced increase, indicating a role for α4β2 nAChRs. Likewise, smoking increased the number of points bet following a win during CGT and varenicline blocked this effect. There was no effect of smoking or varenicline on PM target detection per se. However, smoking protected the target detection rate in the ongoing task when a concurrent intention was introduced. Varenicline improved response speed in both satiated and abstinent smokers. CONCLUSIONS Some aspects of inhibitory control may be mediated by α4β2-related mechanisms and blockade of smoking-induced disinhibition may contribute towards the action of varenicline as an aid to smoking cessation.
Collapse
Affiliation(s)
- A J Austin
- Department of Pharmacology and Therapeutics, School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton, BN2 4GJ, UK
| | | | | | | |
Collapse
|
36
|
Farina N, Tabet N, Rusted J. Habitual physical activity (HPA) as a factor in sustained executive function in Alzheimer-type dementia: A cohort study. Arch Gerontol Geriatr 2014; 59:91-7. [DOI: 10.1016/j.archger.2014.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/21/2014] [Accepted: 03/28/2014] [Indexed: 11/15/2022]
|
37
|
Farina N, Young J, Tabet N, Rusted J. Prospective memory in Alzheimer-type dementia: exploring prospective memory performance in an age-stratified sample. J Clin Exp Neuropsychol 2013; 35:983-92. [PMID: 24131030 DOI: 10.1080/13803395.2013.844772] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Prospective memory (PM), the memory for future intentions, is an essential component of many day-to-day activities. PM accuracy has consistently been found to decline as a function of age and is further impaired in Alzheimer's disease (AD). In the present study, subjective PM failures, PM accuracy, and cost of carrying a PM were recorded in 42 healthy elderly, 34 younger old, and 45 older old AD participants. It was found that PM deficits across the AD cohort did not change as a function of age. In addition, while PM accuracy was impaired compared to age-matched controls, cost of carrying a PM intention did not differ across the three groups. Evidence that AD participants show a reaction time (RT) cost of PM intention alongside an impaired PM accuracy indicates that the PM intention is held, but is not implemented effectively. The fact that the cost is independent of age and dementia suggests that it may not index working memory (WM) resource. At a practical level, the study suggests that for a comprehensive evaluation of PM competence cost of carrying a PM intention should be measured alongside PM accuracy.
Collapse
Affiliation(s)
- Nicolas Farina
- a School of Psychology , University of Sussex , Brighton , UK
| | | | | | | |
Collapse
|
38
|
Davies K, Trimble R, Haynes R, Dowell N, Rusted J, Chan D. AB0681 The assessment of the cognitive and behavioural profiles in primary sjogren’s syndrome. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
39
|
Davies K, Haynes B, Trimble R, Rusted J, Dowell N. SAT0231 Diffusion tensor imaging and cogntive performance in NPSLE. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
40
|
Abstract
BACKGROUND Vitamin E is a dietary compound that functions as an antioxidant scavenging toxic free radicals. Evidence that free radicals may contribute to the pathological processes of cognitive impairment including Alzheimer's disease has led to interest in the use of vitamin E in the treatment of mild cognitive impairment (MCI) and Alzheimer's dementia (AD). OBJECTIVES To assess the efficacy of vitamin E in the treatment of AD and prevention of progression of MCI to dementia. SEARCH METHODS The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (ALOIS), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS as well as many trials databases and grey literature sources were searched on 25 June 2012 using the terms: "Vitamin E", vitamin-E, alpha-tocopherol. SELECTION CRITERIA All unconfounded, double-blind, randomised trials in which treatment with vitamin E at any dose was compared with placebo for patients with AD and MCI. DATA COLLECTION AND ANALYSIS Two review authors independently applied the selection criteria and assessed study quality and extracted and analysed the data. For each outcome measure data were sought on every patient randomised. Where such data were not available an analysis of patients who completed treatment was conducted. It was not possible to pool data between studies owing to a lack of comparable outcome measure. MAIN RESULTS Only three studies met the inclusion criteria: two in an AD population and one in an MCI population. In the first of the AD studies (Sano 1996) the authors reported some benefit from vitamin E (2000 IU/day) with fewer participants reaching an end point of death, institutionalisation, change to a Clinical Dementia Rating (CDR) of three, or loss of two basic activities of daily living within two years. Of patients completing treatment, 58% (45/77) on vitamin E compared with 74% (58/78) on placebo reached one of the end points (odds ratio (OR) 0.49; 95% confidence interval (CI) 0.25 to 0.96). The second AD treatment study (Lloret 2009) explored the effects of vitamin E (800 IU/day) on cognitive progression in relation to oxidative stress levels. Patients whose oxidative stress markers were lowered by vitamin E showed no significant difference in the percentage change in Mini-Mental State Examination (MMSE) score, between baseline and six months, compared to the placebo group. The primary aim of the MCI study (Petersen 2005) was to investigate the effect of vitamin E (2000 IU/day) on the time to progression from MCI to possible or probable AD. A total of 214 of the 769 participants progressed to dementia, with 212 being classified as having possible or probable AD. There was no significant difference in the probability of progression from MCI to AD between the vitamin E group and the placebo group (hazard ratio 1.02; 95% CI 0.74 to 1.41; P = 0.91). AUTHORS' CONCLUSIONS No convincing evidence that vitamin E is of benefit in the treatment of AD or MCI. Future trials assessing vitamin E treatment in AD should not be restricted to alpha-tocopherol.
Collapse
|
41
|
Ginani GE, Tufik S, Bueno OFA, Pradella-Hallinan M, Rusted J, Pompéia S. Acute effects of donepezil in healthy young adults underline the fractionation of executive functioning. J Psychopharmacol 2011; 25:1508-16. [PMID: 21262858 DOI: 10.1177/0269881110391832] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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] [Indexed: 11/17/2022]
Abstract
The cholinergic system is involved in the modulation of both bottom-up and top-down attentional control. Top-down attention engages multiple executive control processes, but few studies have investigated whether all or selective elements of executive functions are modulated by the cholinergic system. To investigate the acute effects of the pro-cholinergic donepezil in young, healthy volunteers on distinct components of executive functions we conducted a double-blind, placebo-controlled, independent-groups design study including 42 young healthy male participants who were randomly assigned to one of three oral treatments: glucose (placebo), donepezil 5 mg or donepezil 7.5 mg. The test battery included measures of different executive components (shifting, updating, inhibition, dual-task performance, planning, access to long-term memory), tasks that evaluated arousal/vigilance/visuomotor performance, as well as functioning of working memory subsidiary systems. Donepezil improved sustained attention, reaction times, dual-task performance and the executive component of digit span. The positive effects in these executive tasks did not correlate with arousal/visuomotor/vigilance measures. Among the various executive domains investigated donepezil selectively increased dual-task performance in a manner that could not be ascribed to improvement in arousal/vigilance/visuomotor performance nor working memory slave systems. Other executive tasks that rely heavily on visuospatial processing may also be modulated by the cholinergic system.
Collapse
Affiliation(s)
- G E Ginani
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
42
|
Rusted J. Developmental differences in the influence of orthographic and phonological information in visual word recognition. British Journal of Developmental Psychology 2011. [DOI: 10.1111/j.2044-835x.1989.tb00789.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
43
|
Pring L, Rusted J. Pictures for the blind: An investigation of the influence of pictures on recall of text by blind children. British Journal of Developmental Psychology 2011. [DOI: 10.1111/j.2044-835x.1985.tb00953.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
44
|
Nesic J, Rusted J, Duka T, Jackson A. Degree of dependence influences the effect of smoking on cognitive flexibility. Pharmacol Biochem Behav 2011; 98:376-84. [PMID: 21281663 PMCID: PMC3078331 DOI: 10.1016/j.pbb.2011.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/14/2011] [Accepted: 01/23/2011] [Indexed: 11/30/2022]
Abstract
Pre-frontal cortical (PFC) dysfunction has been put forward as the basis for development and maintenance of addiction. To explore this relationship, the present study investigated the effects of smoking on PFC-mediated cognitive flexibility and subjective states in low- (LD) and high-dependent (HD) smokers. Twenty-four LD and 24 HD smokers (Fagerström dependence scores ≤ 4 and ≥ 5, respectively) were randomly allocated to non-smoking or smoking condition (12 LD and 12 HD participants per condition). After abstaining from smoking for a minimum of two hours volunteers completed a battery of questionnaires [nicotine-specific Visual Analogue Scales (Nic-VAS), Questionnaire of Smoking Urges (QSU) and Profile of Mood States (POMS)] at baseline [T1] and again after smoking one cigarette or remaining abstinent [T2]. Cognitive flexibility was evaluated at T2 using the Intra-Extra Dimensional Set-Shift test. The Rapid Visual Information Processing test was performed as a control nicotine-sensitive task at several time points during the experiment. Compared to LD smokers, HD smokers had higher salivary cotinine and breath CO levels at baseline and reported more craving (QSU) and felt less stimulated (Nic-VAS), vigorous, friendly and elated (POMS) throughout the experiment. Smoking increased Nic-VAS ratings of 'Buzzed' and 'Dizzy' and decreased craving in all participants. Smoking selectively impaired cognitive flexibility in HD smokers since HD smokers allocated to the smoking condition made significantly more errors with the intra-dimensional set-shift than their counterparts in the abstinent condition. No effect of smoking on RVIP test was observed, most likely due to the practice effect which was significant in both groups of smokers. The practice effect, however, was more pronounced in LD smokers. This study demonstrates that PFC-mediated cognitive effects of smoking as well as subjective reports vary according to the degree of nicotine dependence.
Collapse
Affiliation(s)
- J. Nesic
- Department of Pharmacology and Therapeutics, School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton BN2 4GJ, UK
| | - J. Rusted
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QG, UK
| | - T. Duka
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QG, UK
| | - A. Jackson
- Department of Pharmacology and Therapeutics, School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton BN2 4GJ, UK
| |
Collapse
|
45
|
Rusted J, Ruest T, Gray MA. Acute effects of nicotine administration during prospective memory, an event related fMRI study. Neuropsychologia 2011; 49:2362-8. [PMID: 21530557 DOI: 10.1016/j.neuropsychologia.2011.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 02/17/2011] [Accepted: 04/11/2011] [Indexed: 11/30/2022]
Abstract
We previously demonstrated that stimulating neuronal nicotinic acetylcholine receptors modulates prospective memory (PM), the ability to remember and implement a prior intention. Here we used fMRI to explore the neuronal correlates of acute nicotinic (1mg) modulation during PM, employing a double blind, valence-matched placebo-controlled design, and a solely event-related analysis. Eight healthy adults completed on two occasions (1 week washout) a simple attentional task containing infrequent PM trials. PM activated bilateral parietal, prefrontal (BA10) and anterior cingulate, and deactivated genual cingulate and medial prefrontal regions. Further, acute nicotine administration decreased activity within a largely overlapping right parietal region. This data validates a purely event-related approach to exploring PM, and suggests procholinergic modulation of PM by parietal rather than BA10/frontal regions.
Collapse
Affiliation(s)
- Jennifer Rusted
- School of Psychology, University of Sussex, Brighton, East Sussex BN1 9QG, United Kingdom.
| | | | | |
Collapse
|
46
|
Thompson P, Rusted J, Tomlinson L, Ford M, Davies K, Wright J. P5.26 AMBULATORY BLOOD PRESSURE CORRELATES POSITIVELY WITH COGNITIVE SCORES IN ELDERLY PEOPLE WITH CHRONIC KIDNEY DISEASE (CKD) AND CARDIOVASCULAR DISEASE. Artery Res 2011. [DOI: 10.1016/j.artres.2011.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
47
|
Forde EME, Rusted J, Mennie N, Land M, Humphreys GW. The eyes have it: an exploration of eye movements in action disorganisation syndrome. Neuropsychologia 2010; 48:1895-900. [PMID: 20171234 DOI: 10.1016/j.neuropsychologia.2010.01.024] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 01/25/2010] [Accepted: 01/31/2010] [Indexed: 10/19/2022]
Abstract
We examined eye movements in a patient, FK, who has action disorganisation syndrome (ADS), as he performed the everyday task of making a cup of tea. We compared his eye movements with those of a person with Alzheimer's disease and with healthy volunteers. Despite showing very disorganised behaviour many aspects of FK's eye movements were relatively normal. However, unlike normal participants FK made no advance glances to objects that were about to be used, and he made increased numbers of fixations to irrelevant objects during the task. There were also differences in the durations of his eye movements during correct actions and during his perseverative and task-addition responses. We discuss the implications for understanding ADS and the cognitive processes required for correctly performing everyday tasks.
Collapse
Affiliation(s)
- E M E Forde
- Behavioural Brain Sciences, Department of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | | | | | | | | |
Collapse
|
48
|
Abstract
In this paper we report the results of a longitudinal study which examined memory for a single routine activity of daily living in people with dementia of the Alzheimer type. We assessed memory in a natural setting, visiting volunteers in their homes. We video-taped performance on the selected task and analysed the record for the presence or absence of each of its component actions over a period of 6 years. In this way, we obtained longitudinal data for a small group of people moving from the mild-moderate stages of dementia through to severe dysfunction. In the first section of this paper we examine the nature of the errors which are made in recall of a routine activity by volunteers with dementia of the Alzheimer type and what happens to that routine as the dementia erodes memory. In the second section we examine the consequence of moving the routine from a familiar setting to a novel setting. We observed large differences in the rate of decline of our volunteers, with substantial preservation of performed recall of the everyday task, even in the more severe phases of the disease. The pattern of decline suggests a benign degradation of the memory trace, with omissions comprising the most common category of errors, and this result is contrasted with the more dramatic action disorganization syndrome associated with frontal injury. The results have implications both for theoretical models of action-based memory and intervention programmes aimed at maintaining functional independence for people with dementia.
Collapse
Affiliation(s)
- Jennifer Rusted
- Laboratory of Experimental Psychology, University of Sussex, Brighton BN1 9QG, UK.
| | | |
Collapse
|
49
|
Grinstead K, Rusted J. Do people with Alzheimer's disease have a disproportionate deficit in functional knowledge? Verbal versus motoric access to semantic memory. Aging Ment Health 2001; 5:295-300. [PMID: 11575070 DOI: 10.1080/13607860120064989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Healthy elderly and Alzheimer's disease (AD) volunteers participated in four conditions in which they were asked to demonstrate the function and category of a series of objects either verbally or non-verbally. When responding verbally to category judgement questions, volunteers with mild-moderate AD showed levels of performance comparable with age and IQ-matched healthy elderly, but when responding verbally to questions about an item's function, they show marked deficits. This deficit was substantially reduced, however, when they were encouraged to provide the information motorically. Healthy elderly were able to use either mode of access without difficulty. The results of this study suggest that functional semantic knowledge may not be disproportionately degraded, but that when cognitive resources are compromised, retrieval may depend more critically upon mode of access. Functional information, for example, is usually acquired by actually using the object. Verbalizing such functions would require suppressing the direct (motoric) route and accessing information in a less familiar (verbal) form. In short, for people with AD, apparent deficits in semantic knowledge may reflect deficient use of unfamiliar routes of access to the information rather than degradation of semantic knowledge per se.
Collapse
Affiliation(s)
- K Grinstead
- Experimental Psychology, University of Sussex, Brighton BN1 9QG, UK
| | | |
Collapse
|
50
|
Abstract
The aim of this study was to determine the pattern of fixations during the performance of a well-learned task in a natural setting (making tea), and to classify the types of monitoring action that the eyes perform. We used a head-mounted eye-movement video camera, which provided a continuous view of the scene ahead, with a dot indicating foveal direction with an accuracy of about 1 deg. A second video camera recorded the subject's activities from across the room. The videos were linked and analysed frame by frame. Foveal direction was always close to the object being manipulated, and very few fixations were irrelevant to the task. The first object-related fixation typically led the first indication of manipulation by 0.56 s, and vision moved to the next object about 0.61 s before manipulation of the previous object was complete. Each object-related act that did not involve a waiting period lasted an average of 3.3 s and involved about 7 fixations. Roughly a third of all fixations on objects could be definitely identified with one of four monitoring functions: locating objects used later in the process, directing the hand or object in the hand to a new location, guiding the approach of one object to another (e.g. kettle and lid), and checking the state of some variable (e.g. water level). We conclude that although the actions of tea-making are 'automated' and proceed with little conscious involvement, the eyes closely monitor every step of the process. This type of unconscious attention must be a common phenomenon in everyday life.
Collapse
Affiliation(s)
- M Land
- Sussex Centre for Neuroscience, School of Biological Sciences, University of Sussex, Brighton, UK.
| | | | | |
Collapse
|