Research Article
Patterns of executive dysfunction in amnestic mild cognitive impairment
- Nai-Ching Chen, Chiung-Chih Chang, Ker-Neng Lin, Chi-Wei Huang, Wen-Neng Chang, Ya-Ting Chang, Ching Chen, Yen-Chi Yeh, Pei-Ning Wang
-
- Published online by Cambridge University Press:
- 11 April 2013, pp. 1181-1189
-
- Article
- Export citation
-
Background: Executive dysfunction is not uncommon in patients with amnestic mild cognitive impairment (aMCI). This study aimed to investigate the applicability of executive function tests (EFTs) in aMCI as an aid in establishing the diagnosis of multi-domain MCI.
Methods: One hundred and twenty (120) aMCI patients, 126 Alzheimer's disease (AD) patients, and 100 normal controls were enrolled. The EFTs evaluated included the trail making test, digit backward span, Stroop color–word test, and design fluency and category fluency tests.
Results: Of the aMCI participants, 66% exhibited impairment in at least one EFT. Among the five selected EFTs, the category fluency test was the most discriminative in detecting executive dysfunction between patients with aMCI (standardized β = 0.264) or AD (standardized β = 0.361) with the controls, followed by the Stroop test. The performance of aMCI patients with two or more impaired EFTs was significantly different from those of controls but not from those of AD patients.
Conclusion: In the clinical setting, aMCI patients who fail in two or more EFTs may represent a unique population with multi-domain MCI that require close follow-up.
Caregiver rating bias in mild cognitive impairment and mild Alzheimer's disease: impact of caregiver burden and depression on dyadic rating discrepancy across domains
- Livia Pfeifer, Reinhard Drobetz, Sonja Fankhauser, Moyra E. Mortby, Andreas Maercker, Simon Forstmeier
-
- Published online by Cambridge University Press:
- 07 May 2013, pp. 1345-1355
-
- Article
- Export citation
-
Background: Caregivers of individuals with dementia are biased in their rating of mental health measures of the care receiver. This study examines caregiver burden and depression as predictors of this bias for mild cognitive impairment and mild Alzheimer's disease in different domains.
Methods: The sample consisted of 202 persons: 60 with mild cognitive impairment, 41 with mild Alzheimer's disease, and 101 caregivers. Discrepancy scores were calculated by subtracting the mean caregiver score from the respective mean patient score on the following assessment instruments: the Geriatric Depression Scale, Apathy Evaluation Scale, Bayer-Activities of Daily Living Scale, and Quality of Life-AD scale. Caregiver burden and depression were assessed by the Zarit Burden Interview and the Center for Epidemiologic Studies Depression Scale.
Results: Intraclass correlation coefficients were low for apathy (0.38), daily functioning (0.38), and quality of life (0.30) and moderate for depression (0.49). These domains showed negative rating discrepancies, which indicates caregiver rating bias for all four domains. Regression analyses revealed that caregiver burden significantly contributed to explaining these discrepancies in the domains apathy, daily functioning, and quality of life.
Conclusion: Caregiver rating bias can be attributed to caregiver burden. When caregiver burden is present, data based on caregiver ratings should therefore be interpreted with caution.
Comorbid cardiovascular disease and major depression among ethnic and racial groups in the United States
- Hector M. González, Wassim Tarraf
-
- Published online by Cambridge University Press:
- 07 January 2013, pp. 833-841
-
- Article
- Export citation
-
Background: To describe and examine the distribution, disability, and treatment associated with comorbid cardiovascular disease and major depressive disorder (CVD/MDD) among middle-aged and older ethnic/racial groups in the United States.
Methods: Cross-sectional data from a national probability sample of household resident adults (18 years and older; N = 16,423) living in the 48 coterminous United States were analyzed. We defined comorbid CVD/MDD as the presence of CVD (e.g. diabetes, hypertension, heart disease, and stroke) among adults who met MDD criteria at or after age 50 years.
Results: Two-thirds of middle-aged and older American adults meeting criteria major depression at or after age 50 years also reported a diagnosis of comorbid CVD. Blacks were most likely to meet our comorbid CVD/MDD (74.4%) criteria. The disease burden of depression was also highest among Black respondents. Differences in treatment due to race/ethnicity and comorbidity were not statistically significant.
Conclusions: Our findings indicate that among middle-aged and older US adults meeting MDD criteria more than half would also report a comorbid CVD. Comorbid CVD/MDD rates varied between the considered ethnic/race groups. Functional impairment associated with comorbid CVD/MDD was higher than MDD alone; however, depression care rates did not differ remarkably. Among middle-aged and older adults meeting MDD criteria, comorbid CVD may be the rule rather than the exception.
Consensus and variations in opinions on delirium care: a survey of European delirium specialists
- A. Morandi, D. Davis, J. K. Taylor, G. Bellelli, B. Olofsson, S. Kreisel, A. Teodorczuk, B. Kamholz, W. Hasemann, J. Young, M. Agar, S. E. de Rooij, D. Meagher, M. Trabucchi, A. M. MacLullich
-
- Published online by Cambridge University Press:
- 20 August 2013, pp. 2067-2075
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background:
There are still substantial uncertainties over best practice in delirium care. The European Delirium Association (EDA) conducted a survey of its members and other interested parties on various aspects of delirium care.
Methods:The invitation to participate in the online survey was distributed among the EDA membership. The survey covered assessment, treatment of hyperactive and hypoactive delirium, and organizational management.
Results:A total of 200 responses were collected (United Kingdom 28.6%, Netherlands 25.3%, Italy 15%, Switzerland 9.7%, Germany 7.1%, Spain 3.8%, Portugal 2.5%, Ireland 2.5%, Sweden 0.6%, Denmark 0.6%, Austria 0.6%, and others 3.2%). Most of the responders were doctors (80%), working in geriatrics (45%) or internal medicine (14%). Ninety-two per cent of the responders assessed patients for delirium daily. The most commonly used assessment tools were the Confusion Assessment Method (52%) and the Delirium Observation Screening Scale (30%). The first-line choice in the management of hyperactive delirium was a combination of non-pharmacological and pharmacological approaches (61%). Conversely, non-pharmacological management was the first-line choice in hypoactive delirium (67%). Delirium awareness (34%), knowledge (33%), and lack of education (13%) were the most commonly reported barriers to improving the detection of delirium. Interestingly, 63% of the responders referred patients after an episode of delirium to a follow-up clinic.
Conclusions:This is the first systematic survey involving an international group of specialists in delirium. Several areas of lack of consensus were found. These results emphasise the importance of further research to improve care of this major unmet medical need.
Do cerebral white matter lesions influence the rate of progression from mild cognitive impairment to dementia?
- Michael E. Devine, J. Andres Saez Fonseca, Zuzana Walker
-
- Published online by Cambridge University Press:
- 03 July 2012, pp. 120-127
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background: Cerebral white matter lesions (WML), evident on CT and MRI brain scans, are histopathologically heterogeneous but associated with vascular risk factors and thought mainly to indicate ischemic damage. There has been disagreement over their clinical prognostic value in predicting conversion from mild cognitive impairment (MCI) to dementia.
Methods: We scrutinised and rated CT and MRI brain scans for degree of WML in a memory clinic cohort of 129 patients with at least 1 year of follow-up. We examined the relationship between WML severity and time until conversion to dementia for all MCI patients and for amnestic (aMCI) and non-amnestic (naMCI) subgroups separately.
Results: Five-year outcome data were available for 87 (67%) of the 129 patients. The proportion of patients converting to dementia was 25% at 1 year and 76% at 5 years. Patients with aMCI converted to dementia significantly earlier than those with naMCI. WML severity was not associated with time to conversion to dementia for either MCI patients in general or aMCI patients in particular. Among naMCI patients, there was a tendency for those with a low degree of WML to survive without dementia for longer than those with a high degree of WML. However, this was not statistically significant.
Conclusions: MCI subtype is a significant independent predictor of conversion to dementia, with aMCI patients having higher risk than naMCI for conversion throughout the 5-year follow-up period. WML severity does not influence conversion to dementia for aMCI but might accelerate progression in naMCI.
Neuropsychiatric disorders secondary to neurosyphilis in elderly people: one theme not to be ignored
- Yan-Li Zeng, Wen-Jie Wang, Hui-Lin Zhang, Fu-Yi Chen, Song-Jie Huang, Gui-Li Liu, Ya Xi, Xiao-Jing Guo, Wei-Hong Zheng, Tian-Ci Yang
-
- Published online by Cambridge University Press:
- 21 June 2013, pp. 1513-1520
-
- Article
- Export citation
-
Background:
Neurosyphilis (NS) may present with neuropsychiatric disorders characterized by cognitive impairment, personality disorders, and confusion, among others. Very few studies have focused on neuropsychiatric disorders secondary to NS in elderly people.
Method:A retrospective chart review was performed to characterize the psychiatric findings, clinical signs and symptoms, laboratory findings, and brain magnetic resonance imaging results of ten elderly inpatients with NS.
Results:In these ten patients, the most common presenting symptoms included a wide variety of psychiatric manifestations. The serum rapid plasma regain (RPR) and Treponema pallidum particle agglutination assay (TPPA) of the ten patients were positive, with positive CSF TPPA and RPR rates of 100% and 60%, respectively. In addition, 90% of the patients demonstrated abnormal imaging, including cerebral atrophy, infarct ischemic stroke, and hydrocephalus.
Conclusions:Our findings support the importance of serological tests for syphilis as a routine component of the evaluation of patients with clinically evident neurological or psychiatric symptoms. If the serology is positive, all of the patients should be examined with a lumbar puncture. Moreover, psychiatric illnesses secondary to NS in the elderly also deserve medical attention.
Prevalence of delirium among outpatients with dementia
- N. Hasegawa, M. Hashimoto, S. Yuuki, K. Honda, Y. Yatabe, K. Araki, M. Ikeda
-
- Published online by Cambridge University Press:
- 22 July 2013, pp. 1877-1883
-
- Article
- Export citation
-
Background:
Delirium and dementia are highly interrelated. However, few comprehensive epidemiological studies have examined this altered state of consciousness superimposed on dementia. We investigated the frequency of delirium in patients with dementia, its prevalence in patients with each dementia type, and its association with cerebrovascular disease (CVD) in patients with neurodegenerative dementias.
Methods:We studied 261 consecutive outpatients in the memory clinic of a psychiatric hospital between April 2010 and September 2011. All patients underwent routine laboratory tests and computed tomography (CT), and their Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Physical Self-Maintenance Scale (PSMS), and Delirium Rating Scale – Revised 98 scores were recorded. The diagnosis of delirium was based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. CVD was detected by CT.
Results:Among the 206 patients with dementia, delirium was present in 40 (19.4%). The proportion of patients who experienced episodes of delirium was 14.7% in the Alzheimer's disease, 34.4% in the vascular dementia, 31.8% in the dementia with Lewy bodies, and none in frontotemporal lobar degeneration. Delirium was frequently observed in patients with dementia and CVD. The NPI total and agitation subscale scores were significantly higher in dementia patients with delirium than in those without delirium. PSMS scores were significantly lower for patients with delirium than for patients without delirium.
Conclusions:The frequency of delirium varies with each dementia type. In addition, delirium decreases activities of daily living, exaggerates behavioral and psychological symptoms dementia, and is associated with CVD in patients with neurodegenerative dementias.
Life satisfaction and frailty in community-based older adults: cross-sectional and prospective analyses
- Philip D. St John, Suzanne L. Tyas, Patrick R. Montgomery
-
- Published online by Cambridge University Press:
- 08 July 2013, pp. 1709-1716
-
- Article
- Export citation
-
Background:
Frailty may be associated with reduced life satisfaction (LS). The objectives of this paper are to determine if (1) frailty is associated with LS in community-dwelling older adults in cross-sectional analyses; (2) frailty predicts LS five years later; and (3) specific domains of LS are preferentially associated with frailty.
Methods:This paper presents analysis of an existing population-based cohort study of 1,751 persons aged 65+ who were assessed in 1991, with follow-up five years later. LS was measured using the terrible–delightful scale, which measures overall LS and LS in specific domains. Frailty was measured using the Brief Frailty Instrument. Analyses were adjusted for age, gender, education, and marital status.
Results:Frailty was associated with overall LS at time 1 and predicted overall LS at time 2. This was seen in unadjusted analyses and after adjusting for confounding factors. Frailty was associated with all domains of LS at time 1, and predicted LS at time 2 in all domains except housing and self-esteem. However, the effect was stronger for LS with health than with other domains for both times 1 and 2.
Conclusions:Frailty is associated with LS, and the effect is strongest for LS with health.
ADHD symptoms across the lifespan in a population-based Swedish sample aged 65 to 80
- Taina Guldberg-Kjär, Sally Sehlin, Boo Johansson
-
- Published online by Cambridge University Press:
- 14 December 2012, pp. 667-675
-
- Article
- Export citation
-
Background: The purpose of the study was to examine the attention deficit hyperactivity disorder (ADHD) symptomatology across the lifespan by comparing older individuals’ self-reports about current ADHD symptoms and symptoms in childhood.
Methods: The 25-item Wender Utah Rating Scale (WURS) was initially administered in a population-based sample of 1,599 persons aged 65–80 years. We also asked about current health, memory, and problems in childhood. Based on their WURS scores (below and above 36), we randomly drew two subsamples, each with 30 individuals. They were followed up by the Wender Riktad ADHD Symtom Skala (WRASS)-scale, a Swedish version of the Targeted Attention Deficit Disorder Rating Scale (TADDS).
Results: Our main finding was that higher WURS scores were significantly related to higher scores on the WRASS scale, indicating persistence of self-reported ADHD symptoms over the whole lifespan. Among those with a WURS score of 36 or more, 16 (53.3%) individuals scored 70 or more; the clinical cut-off used in Sweden. None of the individuals with a WURS score below 36 scored higher than 70 on the WRASS scale.
Conclusions: Our findings support the idea of a significant persistence of ADHD symptoms from childhood to old age. The results encourage studies of ADHD using a lifespan perspective, particularly in examining ADHD symptoms in old age.
Two types of squalor: findings from a factor analysis of the Environmental Cleanliness and Clutter Scale (ECCS)
- John Snowdon, Graeme Halliday, Glenn E. Hunt
-
- Published online by Cambridge University Press:
- 08 April 2013, pp. 1191-1198
-
- Article
- Export citation
-
Background: Most people who collect and hoard, and then have difficulty discarding items, do not live in squalor, even though accumulation of hoarded items can make cleaning very difficult. Commonly, people living in squalor accumulate garbage, but relatively few fulfill proposed criteria for “hoarding disorder.” We examined the overlap between hoarding and squalor among people referred because of unacceptable living conditions.
Methods: Ongoing collection of data by a Squalor Project team, including ratings on the Environmental Cleanliness and Clutter Scale (ECCS), allowed (1) description of characteristics of cases and (2) examination of ratings of uncleanliness, and of the effect of accumulation of items or material on access within dwellings. Principal component analysis was used to examine latent variables underlying the ECCS.
Results: The mean age of the referred occupants (108 male, 95 female) was 61.9 years. The mean ECCS score in 186 rated cases was 18.5. Factor analysis of ECCS data showed a two-factor solution as the most plausible. Factor 1, comprising seven squalor items, accounted for 33.7% of the variance. Factor 2 comprised reduced accessibility and accumulation of items of little value (variance 17.6%). Accumulation of garbage loaded equally on the two factors. High levels of squalor and/or accumulation were recorded in 105 (56%) of the 186 dwellings. One-third scored high on accumulation/hoarding, while 38% scored high on squalor; 15% scored high on both squalor and accumulation. A quarter of those scoring high on squalor scored low on hoarding/accumulation.
Conclusions: The ECCS is useful when describing whether referred cases show high levels of squalor, hoarding, or both.
Reliability and validity of the Attitudes to Ageing Questionnaire (AAQ) in older people in Spain
- Ramona Lucas-Carrasco, Ken Laidlaw, Juana Gómez-Benito, Michael J. Power
-
- Published online by Cambridge University Press:
- 15 November 2012, pp. 490-499
-
- Article
- Export citation
-
Background: As ageing is a personal experience, an attitude to ageing questionnaire is essential for capturing the most realistic appraisal of this important stage of life. Our aim was to study the psychometric properties of the Attitudes to Ageing Questionnaire (AAQ) in a sample of Spanish older people.
Methods: A total of 242 participants aged 60 years and older were recruited from community centers, primary care centers, and family associations for the mentally ill and dementia. In addition to the AAQ, participants provided information on demographics, self-perception of health, comorbidity, health status (SF-12), depressive symptoms (GDS-30), and quality of life (WHOQOL-BREF and WHOQOL-OLD). Analysis was performed using standard psychometric techniques with SPSS v15.0.
Results: No floor and ceiling effects were found, and missing data were low. The internal consistency measured by Cronbach's alpha for AAQ subscales were 0.59, 0.70, and 0.73. Exploratory Factor Analysis produced a three-factors solution accounting for 34% of the variance. A priori expected associations were found between some AAQ subscales with WHOQOL-BREF domains, with WHOQOL-OLD, SF-12, and the GDS-30 indicating good construct validity. In general, AAQ subscales differentiated between participants with lower and higher levels of education, and between a priori defined groups of older people (non-depressed vs. depressed; those with higher vs. lower physical comorbidities, and non-carers vs. carers).
Conclusions: The Spanish version of the AAQ questionnaire showed acceptable psychometric properties in a convenience sample of Spanish older people. It is a useful measure of attitude for use with older people in social and clinical services.
The neuropsychological sequelae of delirium in elderly patients with hip fracture three months after hospital discharge
- Joost Witlox, Chantal J. Slor, René W.M.M. Jansen, Kees J. Kalisvaart, Mireille F.M. van Stijn, Alexander P.J. Houdijk, Piet Eikelenboom, Willem A. van Gool, Jos F.M. de Jonghe
-
- Published online by Cambridge University Press:
- 07 May 2013, pp. 1521-1531
-
- Article
- Export citation
-
Background: Delirium is a risk factor for long-term cognitive impairment and dementia. Yet, the nature of these cognitive deficits is unknown as is the extent to which the persistence of delirium symptoms and presence of depression at follow-up may account for the association between delirium and cognitive impairment at follow-up. We hypothesized that inattention, as an important sign of persistent delirium and/or depression, is an important feature of the cognitive profile three months after hospital discharge of patients who experienced in-hosptial delirium.
Methods: This was a prospective cohort study. Fifty-three patients aged 75 years and older were admitted for surgical repair of acute hip fracture. Before the surgery, baseline characteristics, depressive symptomatology, and global cognitive performance were documented. The presence of delirium was assessed daily during hospital admission and three months after hospital discharge when patients underwent neuropsychological assessment.
Results: Of 27 patients with in-hospital delirium, 5 were still delirious after three months. Patients with in-hospital delirium (but free of delirium at follow-up) showed poorer performance than patients without in-hospital delirium on tests of global cognition and episodic memory, even after adjustment for age, gender, and baseline cognitive impairment. In contrast, no differences were found on tests of attention. Patients with in-hospital delirium showed an increase of depressive symptoms after three months. However, delirium remained associated with poor performance on a range of neuropsychological tests among patients with few or no signs of depression at follow-up.
Conclusion: Elderly hip fracture patients with in-hospital delirium experience impairments in global cognition and episodic memory three months after hospital discharge. Our results suggest that inattention, as a cardinal sign of persistent delirium or depressive symptomatology at follow-up, cannot fully account for the poor cognitive outcome associated with delirium.
Burden of caregivers for patients with mild cognitive impairment in Japan
- Satoshi Hayashi, Seishi Terada, Shigeto Nagao, Chikako Ikeda, Aki Shindo, Etsuko Oshima, Osamu Yokota, Yosuke Uchitomi
-
- Published online by Cambridge University Press:
- 19 April 2013, pp. 1357-1363
-
- Article
- Export citation
-
Background: Caregivers of patients with mild cognitive impairment (MCI) already experience a need for increased services comparable to that of individuals caring for Alzheimer's disease patients. However, there have been only a few studies on the MCI caregiver burden. In this study, we examined MCI caregiver burden in a larger number of consecutive outpatients in Japan.
Methods: One hundred and four consecutive caregivers of people with MCI participated in this study. The caregiver burden was evaluated by the short version of the Japanese version of the Zarit Burden Interview (sZBI).
Results: About 20% of the caregivers reported a clinically significant burden. The multiple linear regression analysis showed that the caregiver burden was significantly associated with neurobehavioral symptoms (p < 0.001) and memory problems (p = 0.022) of the patient.
Conclusions: The caregiver burden of MCI patients should be given more attention. The management of neurobehavioral symptoms may be important to reduce the burden on caregivers of MCI patients.
The efficacy of a multifactorial memory training in older adults living in residential care settings
- Andrea Vranić, Ana Marija Španić, Barbara Carretti, Erika Borella
-
- Published online by Cambridge University Press:
- 30 July 2013, pp. 1885-1897
-
- Article
- Export citation
-
Background:
Several studies have shown an increase in memory performance after teaching mnemonic techniques to older participants. However, transfer effects to non-trained tasks are generally either very small, or not found.
Methods:The present study investigates the efficacy of a multifactorial memory training program for older adults living in a residential care center. The program combines teaching of memory strategies with activities based on metacognitive (metamemory) and motivational aspects. Specific training-related gains in the Immediate list recall task (criterion task), as well as transfer effects on measures of short-term memory, long-term memory, working memory, motivational (need for cognition), and metacognitive aspects (subjective measure of one's memory) were examined. Maintenance of training benefits was assessed after seven months.
Fifty-one older adults living in a residential care center, with no cognitive impairments, participated in the study. Participants were randomly assigned to two programs: the experimental group attended the training program, while the active control group was involved in a program in which different psychological issues were discussed.
Results:A benefit in the criterion task and substantial general transfer effects were found for the trained group, but not for the active control, and they were maintained at the seven months follow-up.
Conclusion:Our results suggest that training procedures, which combine teaching of strategies with metacognitive–motivational aspects, can improve cognitive functioning and attitude toward cognitive activities in older adults.
Direct costs associated with depressive symptoms in late life: a 4.5-year prospective study
- Melanie Luppa, Hans-Helmut König, Dirk Heider, Hanna Leicht, Tom Motzek, Georg Schomerus, Steffi G. Riedel-Heller
-
- Published online by Cambridge University Press:
- 19 October 2012, pp. 292-302
-
- Article
- Export citation
-
Background: Depression in old age is common. Only few studies examined the association of depressive symptoms and direct costs in the elderly in a cross-sectional way. This study aims to investigate prospectively health service use and direct costs over a course of 4.5 years considering also different courses of depressive symptomatology.
Methods: 305 primary care patients aged 75+ were assessed face-to-face regarding depressive symptoms (Geriatric Depression Scale), and service use and costs at baseline and 4.5 years later. Resource utilization was monetarily valued using 2004/2005 prices. The association of baseline factors and direct costs after 4.5 years was analyzed by multivariate linear regression.
Results: Mean annual direct costs of depressed individuals at baseline and follow-up were almost one-third higher than of non-depressed, and highest for individuals with chronic depressive symptoms. Most relevant cost drivers were costs for inpatient care, pharmaceuticals, and home care. Costs for home care increased at most in individuals with chronic depressive symptoms. Baseline variables that were associated with direct costs after 4.5 years were number of medications as a measure of comorbidity, age, gender, and depressive symptoms.
Conclusions: Presence and persistence of depressive symptoms in old age seems to be associated with future direct costs even after adjustment for comorbidity. The findings deign a look to the potential economic consequences of depressive symptoms in the elderly for the healthcare system in the future.
Capgras syndrome in Dementia with Lewy Bodies
- Papan Thaipisuttikul, Iryna Lobach, Yael Zweig, Ashita Gurnani, James E. Galvin
-
- Published online by Cambridge University Press:
- 05 December 2012, pp. 843-849
-
- Article
- Export citation
-
Background: Capgras syndrome is characterized by the recurrent, transient belief that a person has been replaced by an identical imposter. We reviewed clinical characteristics of Dementia with Lewy Bodies (DLB) patients with Capgras syndrome compared to those without Capgras.
Methods: We identified 55 consecutive DLB patients (11 cases with Capgras syndrome (DLB-C) and 44 cases without evidence of Capgras (DLB). Semi-structured interviews with the patient and an informant, neurological exams, and neuropsychological testing were performed. Caregivers were assessed for caregiver burden and depression. Primary comparisons were made between DLB-C and DLB. Exploratory analyses using stepwise logistic regression and bootstrap analyses were performed to determine clinical features associated with Capgras.
Results: DLB-C patients experienced more visual hallucinations and self-reported anxiety, had higher scores on the Neuropsychiatric Inventory, and were less likely to be treated with cholinesterase inhibitors at time of initial evaluation. Extrapyramidal symptoms and depression were not associated with Capgras. Caregivers of DLB-C patients had higher caregiver burden. DLB-C was associated with self-reported anxiety (OR = 10.9; 95% CI = 2.6–47.6). In a bootstrap analysis, clinical findings that were predictors of Capgras included visual hallucinations (log(OR) = 18.3; 95% CI = 17.9–19.3) and anxiety (log(OR) = 2.9; 95% CI = 0.31–20.2).
Conclusions: Our study suggests that Capgras syndrome is common in DLB and usually occurs in the presence of anxiety and visual hallucinations, suggesting related etiopathogenesis. Early appreciation of Capgras syndrome may afford the opportunity to alleviate caregiver burden and improve patient and caregiver outcomes.
AwareCare: a pilot randomized controlled trial of an awareness-based staff training intervention to improve quality of life for residents with severe dementia in long-term care settings
- Linda Clare, Rhiannon Whitaker, Robert T Woods, Catherine Quinn, Hannah Jelley, Zoe Hoare, Joan Woods, Murna Downs, Barbara A. Wilson
-
- Published online by Cambridge University Press:
- 30 July 2012, pp. 128-139
-
- Article
- Export citation
-
Background: The extent to which care home residents with severe dementia show awareness is influenced by the extent to which the environment provides opportunities for engagement and by the way in which care staff interact with them. We aimed to establish whether training care staff to observe and identify signs of awareness in residents with severe dementia resulted in improved quality of life for residents.
Methods: In this pilot cluster randomized trial, care staff in four homes (n = 32) received training and supervision and carried out structured observations of residents using the AwareCare measure (n = 32) over an eight-week period, while staff in four control homes (n = 33) had no training with regard to their residents (n = 33) and no contact with the research team. The primary outcome was resident quality of life. Secondary outcomes were resident well-being, behavior and cognition, staff attitudes and well-being, and care practices in the home.
Results: Following intervention, residents in the intervention group had significantly better quality of life as rated by family members than those in the control group, but care staff ratings of quality of life did not differ. There were no other significant between-group differences. Staff participating in the intervention identified benefits in terms of their understanding of residents’ needs.
Conclusions: Staff were able to use the observational measure effectively and relatives of residents in the intervention homes perceived an improvement in their quality of life.
Role of severity and gender in the association between late-life depression and all-cause mortality
- Hyun-Ghang Jeong, Jung Jae Lee, Seok Bum Lee, Joon Hyuk Park, Yoonseok Huh, Ji Won Han, Tae Hui Kim, Ho Jun Chin, Ki Woong Kim
-
- Published online by Cambridge University Press:
- 21 December 2012, pp. 677-684
-
- Article
- Export citation
-
Background: Mortality associated with depression may be influenced by severity of depression and gender. We investigated the differential impacts on all-cause mortality of late-life depression by the type of depression (major depressive disorder, MDD; minor depressive disorder, MnDD; subsyndromal depression, SSD) and gender after adjusting comorbid conditions in the randomly sampled elderly.
Methods: One thousand community-dwelling elderly individuals were enrolled. Standardized face-to-face clinical interviews, neurological examination, and physical examination were conducted to diagnose depressive disorders and comorbid cognitive disorders. Depressive disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria and SSD to study-specific operational criteria. Five-year survivals were compared between groups using Cox proportional hazards models.
Results: By the end of 2010, 174 subjects (17.4%) died. Depressive disorder (p = 0.001) and its interaction term with gender (p < 0.001) were significant in predicting five-year survival. MDD was an independent risk factor for mortality in men (hazard ratio = 3.65, 95% confidence interval = 1.67–7.96) whereas MnDD and SSD were not when other risk factors were adjusted.
Conclusions: MDD may directly confer the risk of mortality in elderly men whereas non-major depression may be just an indicator of increased mortality in both genders.
Impact of a structured multidisciplinary intervention on quality of life of older adults with advanced cancer
- Megan M. Chock, Maria I. Lapid, Pamela J. Atherton, Simon Kung, Jeff A. Sloan, Jarrett W. Richardson, Matthew M. Clark, Teresa A. Rummans
-
- Published online by Cambridge University Press:
- 04 September 2013, pp. 2077-2086
-
- Article
- Export citation
-
Background:
Patients experience reductions in quality of life (QOL) while receiving cancer treatment and several approaches have been proposed to address QOL issues. In this project, the QOL differences between older adult (age 65+) and younger adult (age 18–64) advanced cancer patients in response to a multidisciplinary intervention designed to improve QOL were examined.
Methods:This study was registered on ClinicalTrials.gov, NCT01360814. Newly diagnosed advanced cancer patients undergoing radiation therapy were randomized to active QOL intervention or control groups. Those in the intervention group received six multidisciplinary 90-minute sessions designed to address the five major domains of QOL. Outcomes measured at baseline and weeks 4, 27, and 52 included QOL (Linear Analogue Self-Assessment (LASA), Functional Assessment of Cancer Therapy–General (FACT-G)) and mood (Profile of Mood States (POMS)). Kruskall–Wallis methodology was used to compare scores between older and younger adult patients randomized to the intervention.
Results:Of 131 patients in the larger randomized controlled study, we report data on 54 evaluable patients (16 older adults and 38 younger adults) randomized to the intervention. Older adult patients reported better overall QOL (LASA 74.4 vs. 62.9, p = 0.040), higher social well-being (FACT-G 91.1 vs. 83.3, p = 0.045), and fewer problems with anger (POMS anger–hostility 95.0 vs. 86.4, p = 0.028). Long-term benefits for older patients were seen in the anger–hostility scale at week 27 (92.2 vs. 84.2, p = 0.027) and week 52 (96.3 vs. 85.9, p = 0.005).
Conclusions:Older adult patients who received a multidisciplinary intervention to improve QOL while undergoing advanced cancer treatments benefited differently in some QOL domains, compared to younger adult patients. Future studies can provide further insight on how to tailor QOL interventions for these age groups.
The Sydney Centenarian Study: methodology and profile of centenarians and near-centenarians
- Perminder S. Sachdev, Charlene Levitan, John Crawford, Mamta Sidhu, Melissa Slavin, Robyn Richmond, Nicole Kochan, Henry Brodaty, Wei Wen, Kristan Kang, Karen A. Mather, the Sydney Centenarian Study Team
-
- Published online by Cambridge University Press:
- 19 March 2013, pp. 993-1005
-
- Article
- Export citation
-
Background: The study of exceptionally long-living individuals can inform us about the determinants of successful aging. There are few population-based studies of centenarians and near-centenarians internationally, but none in Australia.
Methods: Individuals 95 years and older were recruited from seven electoral districts in Sydney using the electoral roll, Medicare lists, and multiple other strategies to obtain a representative sample. Physical and mental health and cognitive status were assessed using standard instruments in multiple sessions, with assessments individually adapted. An informant was interviewed, and participants were invited to donate a blood sample, undergo an MRI scan, and enrol into the brain donation program.
Results: Preliminary data on the first 200 participants are reported. Mean age was 97.4 years (range 95–106), with 29.5% being men, and 58.5% living in a private dwelling. Rates of heart disease and diabetes were lower than in octogenarians, but hearing and visual deficits were common. The mean mini-mental state examination (MMSE) score was 21.1, with men performing better. Rates of psychological distress were low and satisfaction with life high (mean 5.91 out of a maximum of 7); 54% scored <24 on MMSE; 39.5% were impaired on both MMSE and a functional measure; and 20% had previous diagnosis of dementia.
Conclusions: This is a preliminary report describing the methodology of the study. It provides further evidence that dementia is not inevitable at this age and independent living is common. The study provides an excellent resource to determine the genetic and environmental contributions to long and successful cognitive aging.