International Journal of Geriatric Psychiatry最新文献

Objective

With the increasing incidence of dementia, lifestyle interventions are key for long-term risk reduction. Understanding the psychological factors affecting lifestyle change motivation is crucial to developing effective policy strategies for dementia risk reduction. This study explores the moderating role of dementia-related fear on the relationship between perceived cognitive decline and engagement in dementia risk reduction behaviors.

Methods

A cross-sectional study was conducted among 200 Chinese community-dwelling middle-aged and older adults. Hierarchical regression and simple slope analysis were used to assess the moderating effect of dementia-related fear on the relationship between perceived cognitive decline and motivation to engage in dementia risk reduction behaviors.

Results

A significant correlation was found between perceived cognitive decline and increased motivation to engage in dementia risk reduction behaviors (r = 0.44). Dementia-related fear acted as a significant moderator; motivation was positively associated with low to moderate levels of fear, whereas this association diminished and became non-significant at higher levels of fear.

Conclusions

The findings suggest that while lower levels of dementia-related fear may be linked to increased motivation for engaging in risk reduction behaviors, elevated levels of fear do not appear to support such engagement. Rather than emphasizing the negative impacts of dementia, public health strategies should empower individuals with actionable messages to engage in dementia risk reduction behaviors.

Objectives

Interventions that enable people with dementia to retain some independence in activities of daily living (ADL) may delay transitions into residential care and offset sharp reductions in quality of life (QoL). The aim of this study was to estimate how effective a hypothetical intervention needs to be at preserving independence in home-dwelling people with dementia, to be cost-effective.

Methods

A decision-analytic model was constructed to compare costs and outcomes of a cohort of people with dementia in the United Kingdom and European Union over a 10-year period. At model entry, the cohort was distributed across low, moderate, or high levels of dependence. The impact of a hypothetical intervention that preserves independence was evaluated by reducing the proportion of people entering the model with moderate and high dependence. The model included costs for the intervention and health and social care resource use. Secondary analysis included estimated costs of informal care. Health benefit was measured as quality-adjusted life-years (QALYs).

Results

The cost of the intervention was £570/person. At this cost, an intervention that resulted in 7.5% of the sample entering the model in a lower level of dependence (compared with no intervention) was likely to be cost-effective (£8690/QALY). An intervention costing £250/person would only need a 2.5% effect and one costing £1000/person would need to have a 10% effect to be potentially cost-effective. Including informal care costs increased the size of the effect required for the intervention to be cost-effective because more of the care provided at lower levels of dependence is informal.

Conclusions

Preserving independence in people with dementia may be a cost-effective way to help them live well for longer. Our results provide a guide on costs and required effects for those developing interventions to preserve independence in people with dementia.

Introduction

Dementia is prevalent within Aboriginal and Torres Strait Islander communities but clients attending primary care often remain undiagnosed. This project aimed to develop a rapid dementia screen for primary care.

Methods

Logistic regression was used to identify candidate items from the Kimberley Indigenous Cognitive Assessment (KICA-Cog). The psychometric properties of different scales were assessed using receiver operating characteristic curve analysis and validated in a separate cohort.

Results

Four items in the KICA-Cog demonstrated high sensitivity (82.6%), specificity (83.2%) and area under the curve (AUC = 0.90; 95% CI: 0.87–0.94) for dementia at a cut-off point of 7/8 out of 10. This scale has favourable psychometrics (sensitivity 87.5%, specificity 80.9%, AUC = 0.92; 95% CI: 0.85–0.98) when validated in separate cohort.

Discussion

The proposed prototype tool, ready for community piloting and validation, may be useful in primary care to enable rapid cognitive screening as part of routine health care.

Background

Cognitive domains related to attention and executive functions (a set of cognitive processes that regulate, control, and manage other cognitive abilities) seem to influence the recognition of facial expressions in people with Alzheimer's disease (AD).

Purpose

We examined the relationship between facial expression recognition, global cognition and executive function in people with AD according to their cognitive level.

Research Design

In a cross-sectional design, we included 130 participants with AD divided into three groups based on their Mini-Mental State Examination (MMSE) scores: MMSE 1 (scores 23–28), MMSE 2 (scores 17–22), and MMSE 3 (scores 11–16). Facial expression recognition ability was analyzed using the Faces Test. Executive function was analyzed using the Trail Making Test (TMT), the Verbal Fluency Test (VFT), the Semantic Fluency Test (SFT), the Digit Span Forward (DSF) and Backward (DSB) tests, and the Clock Drawing Test (CDT).

Results

In MMSE 1 group difficulties in divided attention and cognitive flexibility impacted the accuracy of facial expression recognition. In the MMSE 2 group, facial expression recognition was related to impairment in working memory. In the MMSE 3 group, the impact on facial expression recognition was directly related to visuoconstructive abilities.

Conclusions

We observed that the executive resources involved in each evaluated group differed in terms of facial recognition task performance efficacy. Interventions at stimulating executive and visuoconstructive abilities in people with AD may contribute to better preservation of facial expression recognition.

Objectives

Latinos experience significant health disparities for Alzheimer's disease (AD) with an increased likelihood in developing the disease relative to non-Latino Whites. Our study sought to examine Latinos' beliefs about controlling the symptoms and progression of AD to identify gaps in community knowledge and improve understanding of culturally based perceptions of health and illness.

Methods

We conducted in-depth, semi-structured interviews in English or Spanish with 216 Latinos aged 40–60 years (average age 53 years) living in the neighborhoods of northern Manhattan. We asked them whether they believed there were interventions that could help control AD. The data was analyzed using content analysis.

Results

Most participants viewed medications as important in the management of AD, though they had limited specific knowledge about existing medications for AD. Some participants thought herbal and nutritional supplements could have some benefits. Many believed activities for mental stimulation could help enhance cognitive functioning. A few suggested that a healthy diet and exercise could help slow the progression of AD. Some participants believed that emotional wellness and degree of support influenced AD progression.

Conclusions

Limited knowledge of available medications and evidence-based non-medical approaches to control AD may adversely impact help-seeking behavior and use of effective management strategies among those with AD. Future interventions should strive to expand knowledge about ways to effectively manage and treat AD in Latino communities.

Trial Registration: The ClinicalTrials.gov ID is NCT04471779. The date registered was July 15, 2020

Objective

The objective of this study was to investigate the cost of care for patients with a primary diagnosis of dementia in Swiss hospitals under the new TARPSY reimbursement system.

Methods

We used a dataset of the Swiss hospital reimbursement system TARPSY from 2016 to 2019, including all relevant remuneration variables at the patient level, to investigate hospital costs. Costs were analyzed by geographic location and hospital type. Homogeneity coefficients were used to analyze case cost homogeneity.

Results

We identified 7090 cases in the TARPSY database who were treated in Swiss hospitals under the primary diagnosis of dementia from 2016 to 2019. Of these, 6747 cases were included in our analysis. The total case costs and daily costs increased from 2016 to 2019, whereas the length of stay decreased. The average total case cost in 2019 was CHF 34,917 (σ = 32,926), corresponding to a daily cost of CHF 946 (σ = 373.44). Patients were treated for an average of 39.7 (σ = 32.40) days. In 2019, the total costs billed according to TARPSY for 57,939 days of hospital care for dementia as the primary diagnosis were CHF 51.3 million. The case costs differed by region and hospital type. Overall, cost homogeneity for total case cost as a proxy for the quality of the cost calculation was “satisfactory, sufficient” and did not show a clear trend towards improvement during the introduction of TARPSY.

Discussion

Our analysis provides reliable, case-level cost data for dementia hospital treatment in Switzerland. The total cost of dementia treatment in psychiatric hospitals appears to be much lower than previous estimates had indicated. When correcting for changes in accounting practices, total case costs only increased modestly from 2016 to 2019.

Objective

A robust psychometric instrument is imperative to measure the devastating impact of self-stigma in dementia to adequately inform policy and practice. Our objective was to evaluate the psychometric properties of the Stigma Impact Scale in a global sample of people with dementia.

Method

Data were analysed from the World Alzheimer Report including 710 participants in 42 countries who completed the SIS. Detailed psychometric analyses of the SIS included estimating reliability, convergent validity with the Warwick-Edinburgh mental Well-being Scale (WEMWBS) and the Dementia Quality of Life instrument (DQoL), the factor structure of the measure (through both exploratory and confirmatory factor analysis).

Results

The SIS and its subscales had ‘good’ to ‘excellent’ internal consistency (Cronbach's Alpha: 0.883–0.943). However, convergent validity correlations were not in the predicted direction; no significant correlations were noted between the SIS and the WEMWBS and DQoL. Factor analysis suggested marginal improvements in global fit indices for the observed model compared to the theoretical model, though none met the thresholds for acceptable fit. The final proposed model had three factors: rejection and secrecy, loneliness and belonging and perceived social isolation. Most SIS items were strongly endorsed by participants.

Conclusion

The SIS is the most robustly tested instrument measuring self-stigma in dementia. The SIS has good to excellent reliability and relevance to the target population, however future work is required to improve the factor structure of the scale. Further the results of the validity testing pose a number of theoretical and empirical questions for future research.