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Potential impact of the COVID-19 pandemic on everyday preferences for persons with cognitive impairment
- James M. Wilkins, Joseph J. Locascio, Teresa Gomez-Isla, Bradley T. Hyman, Deborah Blacker, Brent P. Forester, Olivia I. Okereke
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- Journal:
- International Psychogeriatrics , First View
- Published online by Cambridge University Press:
- 25 August 2023, pp. 1-6
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The COVID-19 pandemic and subsequent social distancing guidelines and restrictions brought on changes in the everyday experiences of older adults. It is not clear, however, to what extent the pandemic has impacted the importance of everyday preferences for persons with cognitive impairment (CI) or the proxy ratings of those preferences. The sample of this study included 27 dyads of persons with CI and their care partners. The Preferences for Everyday Living Inventory was used to assess importance of preferences among persons with CI; care partners completed concurrent proxy assessments. Mixed random and fixed effects longitudinal models were used to evaluate changes in ratings and concordance levels between persons with CI and care partners prior to and during the COVID-19 pandemic. Persons with CI rated autonomous choice preferences as significantly more important during the COVID-19 pandemic than before; there was no association between the COVID-19 pandemic and change in other everyday preferences domains or discrepancy in proxy assessments of everyday preferences. Identifying avenues to support and provide for autonomy in the decision-making of older adults with CI may offer a way forward in mitigating the psychological and behavioral impacts of the COVID-19 pandemic in this population.
Predictors of the importance of everyday preferences for older adults with cognitive impairment
- James M. Wilkins, Joseph J. Locascio, Jeanette M. Gunther, Liang Yap, Teresa Gomez-Isla, Bradley T. Hyman, Deborah Blacker, Brent P. Forester, Olivia I. Okereke
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- Journal:
- International Psychogeriatrics / Volume 34 / Issue 3 / March 2022
- Published online by Cambridge University Press:
- 18 January 2021, pp. 287-294
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Objectives:
Among older people with cognitive impairment and mild dementia, relatively little is known about the factors that predict preferences for everyday living activities and experiences and that influence the relative importance of those activities and experiences.
Design:Cross-sectional study.
Setting:Participants were recruited from the Massachusetts Alzheimer’s Disease Research Center (MADRC) Clinical Core longitudinal cohort.
Participants:The sample included 62 community-dwelling older adults with cognitive impairment (Clinical Dementia Rating global score ≥ 0.5).
Measurements:We used the Preferences for Everyday Living Inventory (PELI) to assess preferences for activities and lifestyle experiences among persons with cognitive impairment. Within-subjects analysis of variance was used to test for significant differences in the mean ratings of importance for four domains of the PELI (“autonomous choice,” “social engagement,” “personal growth,” and “keeping a routine”). Multiple regression models were used to relate predictors, including neuropsychiatric symptoms, to importance ratings for each domain.
Results:Significant differences were noted in the mean importance ratings of the preferences domains: “social engagement” preferences were rated as most important, followed by “autonomous choice,” “personal growth,” and “keeping a routine.” For the “social engagement” preferences domain, female sex was significantly associated with higher importance of “social engagement,” while depressive symptoms (Geriatric Depression Scale-15 scores) were significantly associated with lower importance.
Conclusions:This study adds novel insight into the everyday preferences of community-dwelling older adults with cognitive impairment and highlights the impact of a number of factors, particularly level of depression, on how important various everyday experiences are perceived.
18 - Dementia with Lewy bodies
- from PART II - DISORDERS OF HIGHER FUNCTION
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- By Pamela J. McLean, Department of Neurology, Massachusetts General Hospital East, Charlestown, MA, USA, Estrella Gómez-Tortosa, Department of Neurology, Massachusetts General Hospital East, Charlestown, MA, USA, Michael C. Irizarry, Department of Neurology, Massachusetts General Hospital East, Charlestown, MA, USA, Bradley T. Hyman, Department of Neurology, Massachusetts General Hospital East, Charlestown, MA, USA
- Edited by Arthur K. Asbury, University of Pennsylvania School of Medicine, Guy M. McKhann, The Johns Hopkins University School of Medicine, W. Ian McDonald, University College London, Peter J. Goadsby, University College London, Justin C. McArthur, The Johns Hopkins University School of Medicine
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- Book:
- Diseases of the Nervous System
- Published online:
- 05 August 2016
- Print publication:
- 11 November 2002, pp 267-282
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Summary
History
The concept of the clinical syndrome of ‘dementia with Lewy bodies’ arose within the context of correlations with the pathological descriptions of Lewy body inclusions. These inclusions were first described by F. H. Lewy in 1912 in the dorsal motor nucleus of the vagus and substantia innominata (Lewy, 1912), and Lewy bodies in the substantia nigra were postulated to be specific for Parkinson's disease by Tretiakoff in 1919 (Tretiakoff, 1919). Cortical Lewy bodies were initially described in association with postencephalitic parkinsonism (Lipkin, 1959), in elderly with incidental nigral Lewy bodies (Forno, 1969), in severe dementia (Okazaki et al., 1961), and in institutionalized psychiatric patients (Woodward, 1962). From a clinicopathologic study of 20 cases in 1980, K. Kosaka proposed that the neuroanatomical spectrum of Lewy bodies ranged from isolated substantia nigra inclusions to widespread cortical inclusions; he coined the term ‘diffuse Lewy body disease’ to describe a clinical syndrome of parkinsonism, dementia, and/or psychosis associated pathologically with Lewy bodies in cortical and limbic regions in addition to subcortical nuclei (Kosaka et al., 1980). In more recent nomenclature, the clinicopathological syndrome has been termed ‘Dementia with Lewy bodies’ (DLB).
Epidemiology
DLB has been recognized as the second most common form of degenerative dementia, after Alzheimer's disease, occurring in 15–36% of pathological series of dementia (Hansen et al., 1990; Holmes et al., 1999; Perry et al., 1990), with an estimated prevalence of 10–25% in hospital and community elderly with dementia (Ballard et al., 1995; Shergill et al., 1994). Furthermore, cortical Lewy bodies are found in more than 25% of AD cases (Bergeron & Pollanen, 1989; Ditter & Mirra, 1987; Forno & Langston, 1993). In a review of autopsy-confirmed cases of DLB and AD, the frequency of males was greater in DLB (M:F 1.7 in DLB vs. 0.53 in AD), the average age of onset was similar (70 years old in DLB, 71 years old in AD), with a trend toward more rapidly progressive illness in DLB (duration 6.25 of years in DLB vs. 7.3 of years in AD) (McKeith & O'Brien, 1999).
Clinical features
The clinical features of DLB have been incorporated into consensus criteria for the clinical diagnosis of DLB (Table 18.1) (McKeith et al., 1996).