Introduction: A rapidly increasing number of patients with dementia present a serious social problem. Recently, the incidence of epilepsy in patients with Alzheimer's disease (AD) is increasing, drawing attention to the pathological relationship between the two conditions. Clinical studies have suggested the protective action of antiepileptic agents on dementia; however, the underlying mechanism remains unknown. We evaluated the effects of multiple antiepileptic drugs using tau aggregation assay systems to determine the effects of antiepileptic agents on tau aggregation, a major neuropathological finding associated with AD.
Methods: We evaluated the effects of seven antiepileptic agents on intracellular tau aggregation using a tau-biosensor cell-based high-throughput assay. Next, we tested these agents in a cell-free tau aggregation assay using thioflavin T (ThT).
Results: The assay results revealed that phenobarbital inhibited tau aggregation, whereas sodium valproate, gabapentin, and piracetam promoted tau aggregation. In the cell-free tau aggregation assay using ThT, we confirmed that phenobarbital significantly inhibited tau aggregation.
Conclusion: Antiepileptic drugs may modify the tau pathology in AD in a neural activity-independent manner. Our finding may provide an important insight into the optimization of antiepileptic drug therapy in older adults with dementia.
{"title":"Antiepileptic Drugs Modulate Alzheimer-Related Tau Aggregation in a Neuronal Activity-Independent Manner.","authors":"Yuki Ito, Shuko Takeda, Sayaka Moroi, Tsuneo Nakajima, Akane Oyama, Kunihiro Miki, Nanami Sugihara, Yoichi Takami, Yasushi Takeya, Munehisa Shimamura, Hiromi Rakugi, Ryuichi Morishita","doi":"10.1159/000529915","DOIUrl":"https://doi.org/10.1159/000529915","url":null,"abstract":"<p><strong>Introduction: </strong>A rapidly increasing number of patients with dementia present a serious social problem. Recently, the incidence of epilepsy in patients with Alzheimer's disease (AD) is increasing, drawing attention to the pathological relationship between the two conditions. Clinical studies have suggested the protective action of antiepileptic agents on dementia; however, the underlying mechanism remains unknown. We evaluated the effects of multiple antiepileptic drugs using tau aggregation assay systems to determine the effects of antiepileptic agents on tau aggregation, a major neuropathological finding associated with AD.</p><p><strong>Methods: </strong>We evaluated the effects of seven antiepileptic agents on intracellular tau aggregation using a tau-biosensor cell-based high-throughput assay. Next, we tested these agents in a cell-free tau aggregation assay using thioflavin T (ThT).</p><p><strong>Results: </strong>The assay results revealed that phenobarbital inhibited tau aggregation, whereas sodium valproate, gabapentin, and piracetam promoted tau aggregation. In the cell-free tau aggregation assay using ThT, we confirmed that phenobarbital significantly inhibited tau aggregation.</p><p><strong>Conclusion: </strong>Antiepileptic drugs may modify the tau pathology in AD in a neural activity-independent manner. Our finding may provide an important insight into the optimization of antiepileptic drug therapy in older adults with dementia.</p>","PeriodicalId":11126,"journal":{"name":"Dementia and Geriatric Cognitive Disorders","volume":"52 2","pages":"108-116"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9677702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01Epub Date: 2023-06-02DOI: 10.1159/000530911
Jonathan P Scott, Donnchadh F Murphy, Rupert F Noad
Introduction: Visual and spatial perception (VSP) are cognitive domains frequently assessed in the screening and neuropsychological assessment of dementia. Evidence suggests that VSP impairment is common in the early stages of Alzheimer's disease (AD). Despite this evidence, the ability of VSP tests to discriminate between healthy older adults and people with AD remains mixed. The purpose of this literature review was to employ a systematic search strategy to identify empirical evidence supporting the diagnostic utility of VSP tests which may be used in the screening and diagnosis of AD.
Methods: Specified criteria were used to perform a systematic literature search of the PsycINFO and PubMed databases with no date restrictions. Relevant data from the selected studies were extracted, and a published appraisal tool (the Quality Assessment of Diagnostic Accuracy Studies-2) was used to evaluate methodological quality.
Results: Of the 144 articles returned, six studies and 11 VSP tests met review inclusion criteria. Four tests demonstrated both sensitivity and specificity values above 80%. A computerised 3D Visual Task demonstrated the highest sensitivity and specificity values (90% and 95%, respectively). The quality of the identified studies was considered to be satisfactory. Identified limitations and the implications of issues relating to study methodology are discussed, and recommendations for future research are suggested.
Conclusion: The evidence from this review suggests that certain tests of VSP may be a useful addition to the routine screening of AD.
{"title":"The Utility of Visual and Spatial Perception Tests in Alzheimer's Disease: A Systematic Review.","authors":"Jonathan P Scott, Donnchadh F Murphy, Rupert F Noad","doi":"10.1159/000530911","DOIUrl":"10.1159/000530911","url":null,"abstract":"<p><strong>Introduction: </strong>Visual and spatial perception (VSP) are cognitive domains frequently assessed in the screening and neuropsychological assessment of dementia. Evidence suggests that VSP impairment is common in the early stages of Alzheimer's disease (AD). Despite this evidence, the ability of VSP tests to discriminate between healthy older adults and people with AD remains mixed. The purpose of this literature review was to employ a systematic search strategy to identify empirical evidence supporting the diagnostic utility of VSP tests which may be used in the screening and diagnosis of AD.</p><p><strong>Methods: </strong>Specified criteria were used to perform a systematic literature search of the PsycINFO and PubMed databases with no date restrictions. Relevant data from the selected studies were extracted, and a published appraisal tool (the Quality Assessment of Diagnostic Accuracy Studies-2) was used to evaluate methodological quality.</p><p><strong>Results: </strong>Of the 144 articles returned, six studies and 11 VSP tests met review inclusion criteria. Four tests demonstrated both sensitivity and specificity values above 80%. A computerised 3D Visual Task demonstrated the highest sensitivity and specificity values (90% and 95%, respectively). The quality of the identified studies was considered to be satisfactory. Identified limitations and the implications of issues relating to study methodology are discussed, and recommendations for future research are suggested.</p><p><strong>Conclusion: </strong>The evidence from this review suggests that certain tests of VSP may be a useful addition to the routine screening of AD.</p>","PeriodicalId":11126,"journal":{"name":"Dementia and Geriatric Cognitive Disorders","volume":" ","pages":"195-204"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9565368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emma G Johnson, Wytse Kuiper, R. Ahmed, G. Halliday, J. Burrell, J. Hodges, A. Guastella, O. Piguet, F. Kumfor
Introduction: Changes in social behavior and emotion processing are common in frontotemporal dementia (FTD) and semantic dementia (SD), and less so in Alzheimer’s disease (AD). Recent research has investigated oxytocin as a potential treatment for these symptoms; however, whether plasma oxytocin is associated with social-emotional symptoms of dementia remains underexplored. Methods: Thirty behavioral-variant FTD (bvFTD), 28 SD, 39 AD, and 24 controls underwent blood sampling to measure oxytocin. Participants completed an emotion processing battery. Carers completed the Cambridge Behavioral Inventory and the Neuropsychiatric Inventory. Results: Patients with bvFTD were severely impaired in emotion processing and behavioral ratings, with milder impairment in SD and AD. No difference in plasma oxytocin was observed between groups (p = 0.632). No significant associations were found between oxytocin and social behavior or emotion processing (r values between −0.241 and 0.227, all p values >0.099). Conclusion: Our results indicate that plasma oxytocin is not reduced in dementia and is unrelated to social, emotional, and behavioral features. We noted high interindividual variability in our data; hence, future investigations should consider methodological influences such as serum versus saliva and diurnal variation on oxytocin function. These results demonstrate that current measurement measures of plasma oxytocin have limited utility in determining the role of oxytocin in FTD. Alternative oxytocin measures may prove more sensitive and should be considered when conducting clinical trials.
{"title":"Plasma Oxytocin Is Not Associated with Social Cognition or Behavior in Frontotemporal Dementia and Alzheimer’s Disease Syndromes","authors":"Emma G Johnson, Wytse Kuiper, R. Ahmed, G. Halliday, J. Burrell, J. Hodges, A. Guastella, O. Piguet, F. Kumfor","doi":"10.1159/000525087","DOIUrl":"https://doi.org/10.1159/000525087","url":null,"abstract":"Introduction: Changes in social behavior and emotion processing are common in frontotemporal dementia (FTD) and semantic dementia (SD), and less so in Alzheimer’s disease (AD). Recent research has investigated oxytocin as a potential treatment for these symptoms; however, whether plasma oxytocin is associated with social-emotional symptoms of dementia remains underexplored. Methods: Thirty behavioral-variant FTD (bvFTD), 28 SD, 39 AD, and 24 controls underwent blood sampling to measure oxytocin. Participants completed an emotion processing battery. Carers completed the Cambridge Behavioral Inventory and the Neuropsychiatric Inventory. Results: Patients with bvFTD were severely impaired in emotion processing and behavioral ratings, with milder impairment in SD and AD. No difference in plasma oxytocin was observed between groups (p = 0.632). No significant associations were found between oxytocin and social behavior or emotion processing (r values between −0.241 and 0.227, all p values >0.099). Conclusion: Our results indicate that plasma oxytocin is not reduced in dementia and is unrelated to social, emotional, and behavioral features. We noted high interindividual variability in our data; hence, future investigations should consider methodological influences such as serum versus saliva and diurnal variation on oxytocin function. These results demonstrate that current measurement measures of plasma oxytocin have limited utility in determining the role of oxytocin in FTD. Alternative oxytocin measures may prove more sensitive and should be considered when conducting clinical trials.","PeriodicalId":11126,"journal":{"name":"Dementia and Geriatric Cognitive Disorders","volume":"51 1","pages":"241 - 248"},"PeriodicalIF":2.4,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45783303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takumi Takahashi, Saori Ekoyama, H. Tachikawa, Haruhiko Midorikawa, Y. Shiratori, Miho Ota, Sho Takahashi, T. Arai
Introduction: There have been numerous reports of cluster outbreaks of coronavirus disease 2019 (COVID-19) in hospitals and nursing homes. Healthcare workers fighting COVID-19 experience mental health issues. Caregivers in nursing homes experienced increased psychological distress and concern about deterioration of their mental health. We conducted a large-scale web-based survey exploring mental health among caregivers working in nursing homes during the COVID-19 pandemic with the aim of identifying their support needs. Methods: Survey participants were caregivers working at 284 nursing homes in Ibaraki prefecture, Japan. The survey period was from September 2020 to March 2021. Participants responded to a questionnaire covering gender, age, occupation, infections at facilities, infection protection, changes in nursing home users, cooperation with other medical institutions, and prejudice/discrimination. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate participants’ depression and anxiety. Results: In total, 676 participants completed the survey; 350 (52.5%) were with anxiety symptoms and 378 (56.7%) were with depressive symptoms (scores exceeding the HADS cut-off points). The risk for anxiety was associated with being care worker or social worker. The risk of anxiety or depression was high when family caregivers’ mental state changed. Discussion/Conclusion: This study found that caregivers working in nursing homes were exposed to high levels of stress during the COVID-19 pandemic and were at high risk for developing depression and anxiety.
{"title":"Mental Health of Caregivers Working in Nursing Homes during the COVID-19 Pandemic","authors":"Takumi Takahashi, Saori Ekoyama, H. Tachikawa, Haruhiko Midorikawa, Y. Shiratori, Miho Ota, Sho Takahashi, T. Arai","doi":"10.1159/000524953","DOIUrl":"https://doi.org/10.1159/000524953","url":null,"abstract":"Introduction: There have been numerous reports of cluster outbreaks of coronavirus disease 2019 (COVID-19) in hospitals and nursing homes. Healthcare workers fighting COVID-19 experience mental health issues. Caregivers in nursing homes experienced increased psychological distress and concern about deterioration of their mental health. We conducted a large-scale web-based survey exploring mental health among caregivers working in nursing homes during the COVID-19 pandemic with the aim of identifying their support needs. Methods: Survey participants were caregivers working at 284 nursing homes in Ibaraki prefecture, Japan. The survey period was from September 2020 to March 2021. Participants responded to a questionnaire covering gender, age, occupation, infections at facilities, infection protection, changes in nursing home users, cooperation with other medical institutions, and prejudice/discrimination. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate participants’ depression and anxiety. Results: In total, 676 participants completed the survey; 350 (52.5%) were with anxiety symptoms and 378 (56.7%) were with depressive symptoms (scores exceeding the HADS cut-off points). The risk for anxiety was associated with being care worker or social worker. The risk of anxiety or depression was high when family caregivers’ mental state changed. Discussion/Conclusion: This study found that caregivers working in nursing homes were exposed to high levels of stress during the COVID-19 pandemic and were at high risk for developing depression and anxiety.","PeriodicalId":11126,"journal":{"name":"Dementia and Geriatric Cognitive Disorders","volume":"51 1","pages":"233 - 240"},"PeriodicalIF":2.4,"publicationDate":"2022-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42488754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Dementia was caregivers experience tremendous difficulties both physically and psychologically, leading to high levels of depression and caregiver burden. The advantage of mobile interventions has been recognized due to its freedom from time and space restrictions. Objectives: A systematic review and meta-analysis was conducted to evaluate effectiveness of app-based mobile interventions for dementia caregivers. Method: We searched nine different databases including CINAHL, the Cochrane Library, Embase, MEDLINE, PsycINFO, the ACM digital library, IEEE Xplore, KoreaMed, and RISS for publications on app-based mobile interventions targeting dementia caregivers published in English or Korean. Meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) version 3.0. Standard mean difference (SMD) was used to estimate the effectiveness of the intervention on caregiver-related outcomes of caregiver burden, depression, stress, caregiving competency, and quality of life (QoL). Results: Five studies (three randomized controlled trials and two quasi-experimental studies) with a total of 230 participants were included. Using a mobile device, interventions were used to provide information and feedback, perform monitoring, and conduct skill training. Pooled analysis showed favorable effects of app-based mobile interventions for caregivers on caregiver burden (SMD = −0.315, 95% CI: −0.681 to 0.052), depression (SMD = −0.236, 95% CI: −0.517 to 0.046), stress (SMD = −0.295, 95% CI: −0.708 to 0.118), competency (SMD = 0.434, 95% CI: 0.093–0.775), and QoL (SMD = 0.794, 95% CI: 0.310–1.278). Conclusion: Types of mobile devices, lengths, and contents of interventions varied between included studies. Given that only five studies were included, the current meta-analysis could not confirm the effectiveness of app-based mobile interventions. However, this study suggests that app-based mobile interventions for dementia caregivers might have positive effects on diverse caregiving-related issues such as caregiver burden, depression, stress, competency, and QoL.
{"title":"Effects of App-Based Mobile Interventions for Dementia Family Caregivers: A Systematic Review and Meta-Analysis","authors":"Yunhee Shin, S. K. Kim, Y. Kim, Younghye Go","doi":"10.1159/000524780","DOIUrl":"https://doi.org/10.1159/000524780","url":null,"abstract":"Background: Dementia was caregivers experience tremendous difficulties both physically and psychologically, leading to high levels of depression and caregiver burden. The advantage of mobile interventions has been recognized due to its freedom from time and space restrictions. Objectives: A systematic review and meta-analysis was conducted to evaluate effectiveness of app-based mobile interventions for dementia caregivers. Method: We searched nine different databases including CINAHL, the Cochrane Library, Embase, MEDLINE, PsycINFO, the ACM digital library, IEEE Xplore, KoreaMed, and RISS for publications on app-based mobile interventions targeting dementia caregivers published in English or Korean. Meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) version 3.0. Standard mean difference (SMD) was used to estimate the effectiveness of the intervention on caregiver-related outcomes of caregiver burden, depression, stress, caregiving competency, and quality of life (QoL). Results: Five studies (three randomized controlled trials and two quasi-experimental studies) with a total of 230 participants were included. Using a mobile device, interventions were used to provide information and feedback, perform monitoring, and conduct skill training. Pooled analysis showed favorable effects of app-based mobile interventions for caregivers on caregiver burden (SMD = −0.315, 95% CI: −0.681 to 0.052), depression (SMD = −0.236, 95% CI: −0.517 to 0.046), stress (SMD = −0.295, 95% CI: −0.708 to 0.118), competency (SMD = 0.434, 95% CI: 0.093–0.775), and QoL (SMD = 0.794, 95% CI: 0.310–1.278). Conclusion: Types of mobile devices, lengths, and contents of interventions varied between included studies. Given that only five studies were included, the current meta-analysis could not confirm the effectiveness of app-based mobile interventions. However, this study suggests that app-based mobile interventions for dementia caregivers might have positive effects on diverse caregiving-related issues such as caregiver burden, depression, stress, competency, and QoL.","PeriodicalId":11126,"journal":{"name":"Dementia and Geriatric Cognitive Disorders","volume":"51 1","pages":"203 - 213"},"PeriodicalIF":2.4,"publicationDate":"2022-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45318465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Beauchet, M. Afilalo, G. Allali, Joshua Lubov, K. Galery, C. Launay
Introduction: Older people with major neurocognitive disorders (MNCDs) visiting the emergency department (ED) are at high risk of hospital admissions. The “Emergency Room Evaluation and Recommendations” (ER2) tool decreases the length of stay (LOS) in the hospital when older people visiting ED are hospitalized after an index ED visit, regardless of their cognitive status. Its effect on hospital admissions has not yet been examined in older people with MNCD visiting ED. This study aimed to examine whether ER2 recommendations were associated with incident hospital admissions and LOS in ED in older people with MNCD visiting ED. Methods: A total of 356 older people with MNCD visiting ED of the Jewish General Hospital (Montreal, Quebec, Canada) were recruited in this non-randomized, pre-post-intervention, single arm, prospective and longitudinal open label trial. ED staff and patients were blinded of the ER2 score, and patients received usual ED care during the observation period, whereas ED staff were informed about the ER2 score, and patients had ER2 tailor-made recommendations in addition to usual care during the intervention period. Hospital admissions and the LOS in ED were the outcomes. Results: There were less incident hospital admissions (odds ratio ≤ 0.61 with p ≤ 0.022) and longer LOS in ED (coefficient beta ≥4.28 with p ≤ 0.008) during the intervention period compared to the observation period. Discussion/Conclusion: ER2 recommendations have mixed effects in people with MNCD visiting ED. They were associated with reduced incident hospital admissions and increased LOS in ED, suggesting that they may have benefits in addition to usual ED care.
{"title":"“Emergency Room Evaluation and Recommendations” and Incident Hospital Admissions in Older People with Major Neurocognitive Disorders Visiting Emergency Department: Results of an Experimental Study","authors":"O. Beauchet, M. Afilalo, G. Allali, Joshua Lubov, K. Galery, C. Launay","doi":"10.1159/000524533","DOIUrl":"https://doi.org/10.1159/000524533","url":null,"abstract":"Introduction: Older people with major neurocognitive disorders (MNCDs) visiting the emergency department (ED) are at high risk of hospital admissions. The “Emergency Room Evaluation and Recommendations” (ER2) tool decreases the length of stay (LOS) in the hospital when older people visiting ED are hospitalized after an index ED visit, regardless of their cognitive status. Its effect on hospital admissions has not yet been examined in older people with MNCD visiting ED. This study aimed to examine whether ER2 recommendations were associated with incident hospital admissions and LOS in ED in older people with MNCD visiting ED. Methods: A total of 356 older people with MNCD visiting ED of the Jewish General Hospital (Montreal, Quebec, Canada) were recruited in this non-randomized, pre-post-intervention, single arm, prospective and longitudinal open label trial. ED staff and patients were blinded of the ER2 score, and patients received usual ED care during the observation period, whereas ED staff were informed about the ER2 score, and patients had ER2 tailor-made recommendations in addition to usual care during the intervention period. Hospital admissions and the LOS in ED were the outcomes. Results: There were less incident hospital admissions (odds ratio ≤ 0.61 with p ≤ 0.022) and longer LOS in ED (coefficient beta ≥4.28 with p ≤ 0.008) during the intervention period compared to the observation period. Discussion/Conclusion: ER2 recommendations have mixed effects in people with MNCD visiting ED. They were associated with reduced incident hospital admissions and increased LOS in ED, suggesting that they may have benefits in addition to usual ED care.","PeriodicalId":11126,"journal":{"name":"Dementia and Geriatric Cognitive Disorders","volume":"51 1","pages":"291 - 296"},"PeriodicalIF":2.4,"publicationDate":"2022-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45890038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anthony Martyr, Laura D. Gamble, S. Nelis, Rachel Collins, Catherine M. Alexander, R. Morris, C. Quinn, C. Pentecost, J. Rusted, C. Victor, J. Thom, F. Matthews, L. Clare
Introduction: Discrepancy scores reflecting the difference between parallel ratings made by people living with dementia (PwD) in the mild-to-moderate stages and by their informants provide a way to investigate awareness of functional ability in relation to activities of daily living (ADL). Methods: Two measures of ADL (Functional Activities Questionnaire; Dependence Scale) were completed by 1,227 PwD and their informants in the IDEAL cohort study baseline assessment. Self-rated and informant-rated scores were used to calculate discrepancies, which were used as an indicator of awareness of functional ability. Smaller discrepancy scores were considered to reflect greater awareness on the part of PwD. PwD completed questionnaires on depression, personality, comorbidities, neuropsychiatric symptoms, and completed a measure of cognition. Informants provided ratings of stress. Univariable and multiple regressions were used to investigate factors related to ADL discrepancy. Results: A similar pattern of associations were found for both ADL discrepancy scores. Smaller discrepancy scores were associated with higher levels of depression, higher neuroticism, fewer neuropsychiatric symptoms, higher comorbidity, lower carer stress, and receipt of less than 1 hour of care per day from the informant. Discussion/Conclusion: There was a clear pattern of factors that were associated with greater awareness for both measures of functional ability. These factors associated with smaller discrepancy scores could be used to identify PwD who might benefit from targeted interventions to support their independence.
{"title":"Predictors of Awareness of Functional Ability in People with Dementia: The Contribution of Personality, Cognition, and Neuropsychiatric Symptoms – Findings from the IDEAL Program","authors":"Anthony Martyr, Laura D. Gamble, S. Nelis, Rachel Collins, Catherine M. Alexander, R. Morris, C. Quinn, C. Pentecost, J. Rusted, C. Victor, J. Thom, F. Matthews, L. Clare","doi":"10.1159/000524607","DOIUrl":"https://doi.org/10.1159/000524607","url":null,"abstract":"Introduction: Discrepancy scores reflecting the difference between parallel ratings made by people living with dementia (PwD) in the mild-to-moderate stages and by their informants provide a way to investigate awareness of functional ability in relation to activities of daily living (ADL). Methods: Two measures of ADL (Functional Activities Questionnaire; Dependence Scale) were completed by 1,227 PwD and their informants in the IDEAL cohort study baseline assessment. Self-rated and informant-rated scores were used to calculate discrepancies, which were used as an indicator of awareness of functional ability. Smaller discrepancy scores were considered to reflect greater awareness on the part of PwD. PwD completed questionnaires on depression, personality, comorbidities, neuropsychiatric symptoms, and completed a measure of cognition. Informants provided ratings of stress. Univariable and multiple regressions were used to investigate factors related to ADL discrepancy. Results: A similar pattern of associations were found for both ADL discrepancy scores. Smaller discrepancy scores were associated with higher levels of depression, higher neuroticism, fewer neuropsychiatric symptoms, higher comorbidity, lower carer stress, and receipt of less than 1 hour of care per day from the informant. Discussion/Conclusion: There was a clear pattern of factors that were associated with greater awareness for both measures of functional ability. These factors associated with smaller discrepancy scores could be used to identify PwD who might benefit from targeted interventions to support their independence.","PeriodicalId":11126,"journal":{"name":"Dementia and Geriatric Cognitive Disorders","volume":"51 1","pages":"221 - 232"},"PeriodicalIF":2.4,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48169123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yeshin Kim, Jaekyung Chung, Jeong Yun Song, Hyemin Jang, Jae-Won Jang, S. Kim
Introduction: Ischemic stroke can cause impairment of daily function and cognitive function. Higher cognitive function is reported in many studies to be associated with better functional outcomes; however, evidence from longitudinal study is lacking. Therefore, in the present study, the association between cognitive function and longitudinal changes of functional outcome was investigated based on stroke severity. Furthermore, whether the effect of cognitive function remained consistent after controlling for depression was investigated. Methods: The data of 423 stroke patients (292 minor strokes, 93 moderate strokes, and 38 severe strokes) were collected. Baseline Mini-Mental State Examination (MMSE) score was considered a predictor, and change of modified Rankin Scale (mRS) score during 12 months of follow-up was the outcome. First, the association between the baseline MMSE score and longitudinal change in the mRS score was analyzed using linear mixed-effects models. Fixed effects were MMSE score group, time, and MMSE score group × time interaction. Additional adjustment was made for the Geriatric Depression Scale (GDS) score. Results: Among the 423 subjects, the mean age was 73.5 years, and 43.4% were female. In the minor stroke group, the high MMSE score group had a decreased mRS score, and the low MMSE score group had an increased mRS score (p < 0.001). This association remained after additional adjustment of the GDS score. Association was not observed between cognitive function and functional recovery in the moderate or severe stroke group. Conclusion: After ischemic stroke, higher baseline global cognitive function was a predictive factor for better functional recovery regardless of depression symptoms in the minor stroke group.
{"title":"Association between Baseline Cognitive Function and Longitudinal Functional Outcome Change after Ischemic Stroke","authors":"Yeshin Kim, Jaekyung Chung, Jeong Yun Song, Hyemin Jang, Jae-Won Jang, S. Kim","doi":"10.1159/000523981","DOIUrl":"https://doi.org/10.1159/000523981","url":null,"abstract":"Introduction: Ischemic stroke can cause impairment of daily function and cognitive function. Higher cognitive function is reported in many studies to be associated with better functional outcomes; however, evidence from longitudinal study is lacking. Therefore, in the present study, the association between cognitive function and longitudinal changes of functional outcome was investigated based on stroke severity. Furthermore, whether the effect of cognitive function remained consistent after controlling for depression was investigated. Methods: The data of 423 stroke patients (292 minor strokes, 93 moderate strokes, and 38 severe strokes) were collected. Baseline Mini-Mental State Examination (MMSE) score was considered a predictor, and change of modified Rankin Scale (mRS) score during 12 months of follow-up was the outcome. First, the association between the baseline MMSE score and longitudinal change in the mRS score was analyzed using linear mixed-effects models. Fixed effects were MMSE score group, time, and MMSE score group × time interaction. Additional adjustment was made for the Geriatric Depression Scale (GDS) score. Results: Among the 423 subjects, the mean age was 73.5 years, and 43.4% were female. In the minor stroke group, the high MMSE score group had a decreased mRS score, and the low MMSE score group had an increased mRS score (p < 0.001). This association remained after additional adjustment of the GDS score. Association was not observed between cognitive function and functional recovery in the moderate or severe stroke group. Conclusion: After ischemic stroke, higher baseline global cognitive function was a predictive factor for better functional recovery regardless of depression symptoms in the minor stroke group.","PeriodicalId":11126,"journal":{"name":"Dementia and Geriatric Cognitive Disorders","volume":"51 1","pages":"168 - 174"},"PeriodicalIF":2.4,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45265388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Huanqing Yu, Shufang Ding, Wei Wei, F. Guo, Zhongnan Li, Quan Yuan, Xin-Miao Zhao
Background and Objective: Pre-stroke dementia (PSD) and pre-stroke mild cognitive impairment (PSMCI) are important risk factors for stroke. The present meta-analysis aimed to investigate the impact of PSD or PSMCI on stroke outcomes. Methods: Electronic databases (PubMed, EMbase, Google Scholar, Cochrane Library, and TRIP) were screened for eligible studies published prior to March 31, 2021. Risk ratios (RR) and mean differences with 95% confidence intervals (CIs) using random or fixed effect models were used to calculate pooled estimates. Study quality was assessed using the Newcastle Ottawa Scale. Results: Fifteen studies were included in our meta-analysis. Pooled data from ten studies involving 3,107 PSD and 20,645 non-PSD subjects showed a higher risk of mortality in PSD patients (RR = 2.03; 95% CI: 1.40–2.91; I2 = 89%). Risk of recurrent stroke risk was observed more in patients with PSD compared to non-PSD patients (RR = 2.02; 95% CI: 1.40–2.91; I2 = 0%). Three studies involving 300 mild cognitive impairment (MCI) and 1,025 normal cognition subjects showed a significant increased risk of mortality in stroke patients with MCI (RR = 2.43; 95% CI: 1.81–3.27; I2 = 20%). However, elevated stroke severity was not observed in PSMCI patients. Conclusions: Our meta-analysis shows an increased risk of mortality in stroke patients with a history of PSD and PSMCI. Proper clinical management and increased attention are therefore required for the prevention and management of stroke in patients with cognitive deficits.
{"title":"Impact of Pre-Stroke Dementia or Mild Cognitive Impairment on Stroke Outcome: A Systematic Review and Meta-Analysis","authors":"Huanqing Yu, Shufang Ding, Wei Wei, F. Guo, Zhongnan Li, Quan Yuan, Xin-Miao Zhao","doi":"10.1159/000522302","DOIUrl":"https://doi.org/10.1159/000522302","url":null,"abstract":"Background and Objective: Pre-stroke dementia (PSD) and pre-stroke mild cognitive impairment (PSMCI) are important risk factors for stroke. The present meta-analysis aimed to investigate the impact of PSD or PSMCI on stroke outcomes. Methods: Electronic databases (PubMed, EMbase, Google Scholar, Cochrane Library, and TRIP) were screened for eligible studies published prior to March 31, 2021. Risk ratios (RR) and mean differences with 95% confidence intervals (CIs) using random or fixed effect models were used to calculate pooled estimates. Study quality was assessed using the Newcastle Ottawa Scale. Results: Fifteen studies were included in our meta-analysis. Pooled data from ten studies involving 3,107 PSD and 20,645 non-PSD subjects showed a higher risk of mortality in PSD patients (RR = 2.03; 95% CI: 1.40–2.91; I2 = 89%). Risk of recurrent stroke risk was observed more in patients with PSD compared to non-PSD patients (RR = 2.02; 95% CI: 1.40–2.91; I2 = 0%). Three studies involving 300 mild cognitive impairment (MCI) and 1,025 normal cognition subjects showed a significant increased risk of mortality in stroke patients with MCI (RR = 2.43; 95% CI: 1.81–3.27; I2 = 20%). However, elevated stroke severity was not observed in PSMCI patients. Conclusions: Our meta-analysis shows an increased risk of mortality in stroke patients with a history of PSD and PSMCI. Proper clinical management and increased attention are therefore required for the prevention and management of stroke in patients with cognitive deficits.","PeriodicalId":11126,"journal":{"name":"Dementia and Geriatric Cognitive Disorders","volume":"51 1","pages":"101 - 109"},"PeriodicalIF":2.4,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48003608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chuthiphun Panyawattanakit, Wadee Wongpradit, Ruankwan Kanhasing, P. Kulalert
Introduction: Thailand is a rapidly aging society. The percentage of older adults with diabetes has also been increasing. Since diabetes mellitus is documented as a risk factor for dementia, it is important to address cognitive impairment in older adults with diabetes. Thus, this study aimed to evaluate the prevalence and associated factors of cognitive impairment among older adults with diabetes in a suburban primary health center in Thailand. Methods: A cross-sectional study in 244 diabetic patients aged 60 years or older was conducted in a primary health care unit in Pathum Thani, Thailand. Cognitive function was assessed with the validated Thai version of the Mini-Addenbrooke’s Cognitive Examination Test. Sociodemographic and health characteristic data were obtained. Results: The prevalence of cognitive impairment was 54.5% (133 out of 244). Multivariate logistic regression disclosed that factors significantly associated with cognitive impairment were ages 70–79 years compared to ages 60–69 years (odds ratio [OR] 1.90, 95% confidence interval [CI]: 1.01–3.62, p value 0.048), ages ≥80 years compared to ages 60–69 years (OR 3.65, 95% CI: 1.19–11.24, p value 0.024), education ≤ primary school (OR 7.28, 95% CI: 3.56–14.89, p value <0.001), and medication managed by caregiver compared to self-management of medication (OR 13.40, 95% CI: 1.55–116.10, p value 0.019). Conclusion: We revealed that approximately half of older adults with diabetes had cognitive impairment. This finding strongly suggests the need to include cognitive assessment in a standard clinical practice guideline for diabetic patients and to focus more on individuals who are very old, have low education, or are unable to manage their drugs by themselves.
{"title":"Cognitive Impairment and Associated Factors among Older Adults with Diabetes in a Suburban Primary Health Center in Thailand","authors":"Chuthiphun Panyawattanakit, Wadee Wongpradit, Ruankwan Kanhasing, P. Kulalert","doi":"10.1159/000524132","DOIUrl":"https://doi.org/10.1159/000524132","url":null,"abstract":"Introduction: Thailand is a rapidly aging society. The percentage of older adults with diabetes has also been increasing. Since diabetes mellitus is documented as a risk factor for dementia, it is important to address cognitive impairment in older adults with diabetes. Thus, this study aimed to evaluate the prevalence and associated factors of cognitive impairment among older adults with diabetes in a suburban primary health center in Thailand. Methods: A cross-sectional study in 244 diabetic patients aged 60 years or older was conducted in a primary health care unit in Pathum Thani, Thailand. Cognitive function was assessed with the validated Thai version of the Mini-Addenbrooke’s Cognitive Examination Test. Sociodemographic and health characteristic data were obtained. Results: The prevalence of cognitive impairment was 54.5% (133 out of 244). Multivariate logistic regression disclosed that factors significantly associated with cognitive impairment were ages 70–79 years compared to ages 60–69 years (odds ratio [OR] 1.90, 95% confidence interval [CI]: 1.01–3.62, p value 0.048), ages ≥80 years compared to ages 60–69 years (OR 3.65, 95% CI: 1.19–11.24, p value 0.024), education ≤ primary school (OR 7.28, 95% CI: 3.56–14.89, p value <0.001), and medication managed by caregiver compared to self-management of medication (OR 13.40, 95% CI: 1.55–116.10, p value 0.019). Conclusion: We revealed that approximately half of older adults with diabetes had cognitive impairment. This finding strongly suggests the need to include cognitive assessment in a standard clinical practice guideline for diabetic patients and to focus more on individuals who are very old, have low education, or are unable to manage their drugs by themselves.","PeriodicalId":11126,"journal":{"name":"Dementia and Geriatric Cognitive Disorders","volume":"51 1","pages":"175 - 181"},"PeriodicalIF":2.4,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48590115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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