11 results
FC32: Neuropsychiatric symptoms: Disentangling the role of unmet needs using the Camberwell Assessment of Need for the Elderly (CANE) interview
- Ana Rita Ferreira, Mário R. Simões, Lia Fernandes
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, p. 95
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Objective:
As the world’s population ages, the number of people with dementia is expected to increase. In addition to progressive cognitive and functional deterioration, dementia comprises neuropsychiatric symptoms (NPS). NPS present significant management challenges based on their high frequency and disruptive nature. Against the prevailing guidelines, their treatment is often over-reliant on psychotropic drugs and other restrictive care approaches, frequently without a thorough assessment of underlying and potentially modifiable causes, such as over- and under-stimulating environments, untreated medical illnesses, drug interactions, or unidentified unmet needs. Consistent with the latter, the unmet needs model proposes that these neuropsychiatric phenomena are needs-driven and constitute indicators of identifiable unmet physical, psychological, emotional, or social needs. Despite this backdrop, few studies have investigated this association using standardized and replicable measures. In this context, the present study aims to put the unmet needs model into a practical context in order to disentangle the contribution of the unmet needs, assessed with the Camberwell Assessment of Need for the Elderly (CANE), to the presence of NPS.
Methods:A cross-sectional study was conducted. Participants were assessed with validated, accessible, and replicable measures, including the CANE interview and the Neuropsychiatric Inventory (NPI). Other variables collected included residents’ demographic characteristics, cognitive and functional impairment, and daily medication. Multivariate models were used to explore potential risk factors for NPS.
Results:Residents from four nursing homes entered the study. Results found that those with unmet needs assessed using CANE and those taking hypnotic/sedative medications had a higher risk of presenting at least one NPS, even after adjusting for other demographic and clinical-functional covariates.
Conclusion:Built on the main finding that unmet needs assessed with CANE can independently contribute to explaining the presence of NPS, a working model is proposed to find solutions for these symptoms based on uncovering unmet needs. The CANE, as a practical, low-cost, yet clinically relevant assessment of met and unmet needs may be used to signal need areas that can be useful for formulation and intervention purposes and may offer the first step towards individually-tailored non- pharmacological interventions for NPS.
307 - Exploratory Study on Healthcare Decision-Making Capacity Assessment
- Ana Saraiva Amaral, Rosa Marina Afonso, Mário R. Simões, Sandra Freitas
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- International Psychogeriatrics / Volume 32 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 04 November 2020, p. 65
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Mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) prevalence is expected to continue to increase, due to the population ageing. MCI and AD may impact patients’ decision-making capacities, which should be assessed through the disease course. These medical conditions can affect the various areas of decision-making capacity in different ways. Decision-making capacity in healthcare is particularly relevant among this population. Elders often suffer from multimorbidity and are frequently asked to make healthcare decisions, which can vary from consenting a routine diagnostic procedure to decide receiving highly risk treatments.
To assess this capacity in elders with MCI or AD, we developed the Healthcare Decision-Making Capacity Assessment Instrument (IACTD-CS - Instrumento de Avaliação da Capacidade de Tomada de Decisão em Cuidados de Saúde). This project is funded by Portuguese national funding agency for science, research and technology, FCT (SFRH/BD/139344/2018). IACTD-CS was developed based on Appelbaum and Grisso four abilities model, literature review and review of international assessment instruments. After IACTD-CS first version development, an exploratory study with focus groups was conducted. This study included focus groups with healthcare professionals and nursing homes’ professionals.
The focus groups main goals were: 1) understand the participants perception regarding healthcare decision-making capacity, 2) distinguish relevant aspects of decision-making, 3) discuss the abilities and items included in IACTD-CS and 4) identify new aspects or items to be added to IACTD-CS. A content analysis of the focus groups results, with resource to MAXQDA, was conducted afterwards. This exploratory study allowed to identify professionals’ perceptions on healthcare decision-making and its results were a significant contribute to IACTD-CS development. The proposed communication aims to describe the methodology used and present the results of content analysis.
Delirium in elderly patients: association with educational attainment
- Sónia Martins, José Artur Paiva, Mário R. Simões, Lia Fernandes
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- Acta Neuropsychiatrica / Volume 29 / Issue 2 / April 2017
- Published online by Cambridge University Press:
- 09 August 2016, pp. 95-101
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Objective
Among cognitive reserve markers, educational attainment is the most widely studied, with several studies establishing a strong association with risk of dementia. However, it has not yet been fully examined in delirium. This study aims to analyse the relationship between educational attainment and delirium.
MethodsThe study included elderly hospitalised patients admitted (≥48 h) into an intermediate care unit (IMCU) of Intensive Care Medicine Service. Exclusion criteria were as follows: Glasgow Coma Scale (total≤11), blindness/deafness, inability to communicate or to speak Portuguese. The European Portuguese Version of the Confusion Assessment Method (CAM) was used for delirium assessment.
ResultsThe final sample (n=157) had a mean age of 78.8 (SD=7.6) the majority being female (52.2%), married (51.5%) and with low educational level (49%). According to CAM, 21% of the patients had delirium. The delirium group presented the fewest years of education (median 1 vs. 4), with statistical significance (p=0.003). Delirium was more frequent among male patients [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.12–0.86; p=0.023], as well as those patients with lower education (OR 0.76; 95% CI 0.62–0.95; p=0.016), and with respiratory disease (OR 3.35; 95% CI 1.20–9.33; p=0.020), after controlling for age and medication.
ConclusionSimilar to previous studies, these findings point to a negative correlation between education and delirium. This study appears as an attempt to contribute to the knowledge about the role of cognitive reserve in risk of delirium, particularly because is the first one that has been carried out in an IMCU, with lower educated elderly patients. Further studies are needed to clarify this relationship considering other markers (e.g. cognitive activities), which can contribute to the definition of preventive strategies.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
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- 05 August 2015
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- 27 April 2015, pp ix-xxx
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Validation study of the European Portuguese version of the Confusion Assessment Method (CAM)
- Sónia Martins, Carla Lourenço, João Pinto-de-Sousa, Filipe Conceição, José Artur Paiva, Mário R. Simões, Lia Fernandes
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- International Psychogeriatrics / Volume 27 / Issue 5 / May 2015
- Published online by Cambridge University Press:
- 02 October 2014, pp. 777-784
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Background:
The Confusion Assessment Method (CAM) is the most widely used delirium screening instrument. The aim of this study was to evaluate the reliability and validity of the European Portuguese version of CAM.
Methods:The sample included elderly patients (≥65 years), admitted for at least 48 h, into two intermediate care units (ICMU) of Intensive Medicine and Surgical Services in a university hospital. Exclusion criteria were: score ≤11 on the Glasgow Coma Scale (GCS), blindness/deafness, inability to communicate and to speak Portuguese. For concurrent validity, a blinded assessment was conducted by a psychiatrist (DSM-IV-TR, as a reference standard) and by a trained researcher (CAM). This instrument was also compared with other cognitive measures to evaluate convergent validity. Inter-rater reliability was also assessed.
Results:In this sample (n = 208), 25% (n = 53) of the patients had delirium, according to DSM-IV-TR. Using this reference standard, the CAM had a moderate sensitivity of 79% and an excellent specificity of 99%. The positive predictive value was 95%, indicating a strong ability to confirm delirium with a positive test result, and the negative predictive value was lower (93%). Good convergent validity was also found, in particular with Mini-Mental State Examination (MMSE) (rs = −0.676; p ≤0.01) and Digit Span Test (DST) forward (rs = −0.605; p ≤0.01), as well as a high inter-rater reliability (diagnostic k = 1.00; single items’ k between 0.65 and 1.00).
Conclusion:Robust results on concurrent and convergent validity and good reliability were achieved. This version was shown to be a valid and reliable instrument for delirium detection in elderly patients hospitalized in intermediate care units.
Pilot study on the European Portuguese version of the Confusion Assessment Method
- Sónia Martins, Patrícia Moldes, João Pinto-de-Sousa, Filipe Conceição, José Artur Paiva, Mário R. Simões, Lia Fernandes
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- Journal:
- Acta Neuropsychiatrica / Volume 26 / Issue 5 / October 2014
- Published online by Cambridge University Press:
- 20 June 2014, pp. 321-324
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Objective
To present the pilot study on the European Portuguese validation of the Confusion Assessment Method (CAM).
MethodsThe translation process was carried out according to International Society Pharmacoeconomics and Outcomes Research guidelines with trained researchers and inter-rater reliability assessment. The study included 50 elderly patients, admitted (≥24 h) to two intermediate care units. Exclusion criteria were: Glasgow Coma Scale (total score ≤11), blindness/deafness, inability to communicate and not able to speak Portuguese. The sensitivity and specificity of CAM were assessed, with DSM-IV-TR criteria of delirium used as a reference standard.
ResultsFindings revealed excellent inter-rater reliability (k>0.81), moderate sensitivity (73%) and excellent specificity (95%).
ConclusionThese preliminary results suggested that this version emerges as a promising diagnostic instrument for delirium.
Financial and testamentary capacity evaluations: procedures and assessment instruments underneath a functional approach
- Liliana B. Sousa, Mário R. Simões, Horácio Firmino, Carmelle Peisah
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- International Psychogeriatrics / Volume 26 / Issue 2 / February 2014
- Published online by Cambridge University Press:
- 14 November 2013, pp. 217-228
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Background:
Mental health professionals are frequently involved in mental capacity determinations. However, there is a lack of specific measures and well-defined procedures for these evaluations. The main purpose of this paper is to provide a review of financial and testamentary capacity evaluation procedures, including not only the traditional neuropsychological and functional assessment but also the more recently developed forensic assessment instruments (FAIs), which have been developed to provide a specialized answer to legal systems regarding civil competencies.
Methods:Here the main guidelines, papers, and other references are reviewed in order to achieve a complete and comprehensive selection of instruments used in the assessment of financial and testamentary capacity.
Results:Although some specific measures for financial abilities have been developed recently, the same is not true for testamentary capacity. Here are presented several instruments or methodologies for assessing financial and testamentary capacity, including neuropsychological assessment, functional assessment scales, performance based functional assessment instruments, and specific FAIs.
Conclusions:FAIs are the only specific instruments intended to provide a specific and direct answer to the assessment of financial capacity based on legal systems. Considering the need to move from a diagnostic to a functional approach in financial and testamentary capacity evaluations, it is essential to consider both general functional examination as well as cognitive functioning.
Rapid Naming Tests: Developmental Course and Relations with Neuropsychological Measures
- Cristina P. Albuquerque, Mário R. Simões
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- The Spanish Journal of Psychology / Volume 13 / Issue 1 / May 2010
- Published online by Cambridge University Press:
- 10 January 2013, pp. 88-100
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A Digits Rapid Automatized Naming (RAN) test and a Colors and Shapes Rapid Alternating Stimulus (RAS) test were administered to 904 Portuguese, normally achieving children (ages 7 to 15), in order to examine these tests scores developmental course. The results showed that the two tests have slightly different developmental trajectories. In addition, the two tests associations with a large number of neuropsychological measures were determined in three age groups (7-9 years, n = 301; 10-12 years, n = 299; 13-15 years, n = 304). The neuropsychological measures addressed attention/executive functions, motor behavior, verbal memory, visual memory and language. The results indicated that each one of the rapid naming tests brings into play not entirely coincident processes. Although, they converge in terms of their associations with language and attention measures, Colors and Shapes RAS test is more demanding in cognitive and linguistic terms. In addition, while Digits RAN test has little in common with short-term memory, Colors and Shapes RAS test relates moderately with short-term memory, due to the increased demands in terms of effort, access and retrieval of the phonological labels that correspond to the different stimuli categories. The need to differentiate between the two rapid naming tests is supported.
Montreal Cognitive Assessment (MoCA): Validation Study for Vascular Dementia
- Sandra Freitas, Mário R. Simões, Lara Alves, Margarida Vicente, Isabel Santana
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- Journal:
- Journal of the International Neuropsychological Society / Volume 18 / Issue 6 / November 2012
- Published online by Cambridge University Press:
- 08 June 2012, pp. 1031-1040
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The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment, having surpassed the well-known limitations of the MMSE. The aim of the present study was to validate the MoCA as well as its short version, which was proposed by the NINDS-CSN VCI Harmonization Standards for screening Vascular Dementia (VaD) patients. The results, based on a homogeneous sample of 34 VaD patients, indicate that the MoCA is a psychometrically valid and reliable instrument for cognitive screening in VaD patients, showing excellent discriminant validity. Both the full and short versions of the MoCA had excellent diagnostic accuracy in discriminating VaD patients, exhibiting an area under curve (AUC) higher than the MMSE [AUC(MoCA full version) = .950; 95% IC = .868–.988; AUC(MoCA short version) = .936; 95% IC = .849–.981; AUC(MMSE) = .860; 95% IC = .754–.932]. With a cutoff below 17 on the MoCA full version and 8 on the short version, the results for sensitivity, specificity, positive and negative predictive values, and classification accuracy were superior compared to the MMSE. In conclusion, both versions of the MoCA are valid, reliable, sensitive and accurate screening instruments for VaD patients. (JINS, 2012, 18, 1–10)
Construct Validity of the Montreal Cognitive Assessment (MoCA)
- Sandra Freitas, Mário R. Simões, João Marôco, Lara Alves, Isabel Santana
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- Journal:
- Journal of the International Neuropsychological Society / Volume 18 / Issue 2 / March 2012
- Published online by Cambridge University Press:
- 24 November 2011, pp. 242-250
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The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment. The present study aims to assess the construct related validity of the MoCA through the establishment of the factorial, convergent, and discriminant related validities, and the reliability of data. In a Portuguese sample of 830 participants, several models were tested using Confirmatory Factor Analysis. Although all tested models showed a good fit, the six-factor model based on the conceptual model proposed by the MoCA's authors showed a significantly better fit. The results allowed us to establish the factorial, convergent, and discriminant validity of this six-dimensional structure. An overall psychometric adequacy of the items, and a good reliability were also found. This study contributes to overcome an important gap in the construct related validity of this instrument. The present findings corroborate the six-dimensional structure of the MoCA and provide good evidence of the construct related validity. The MoCA has proved to be an appropriate measure for cognitive screening taking into account different cognitive domains, which will enable clinicians and researchers to use this test and its six latent dimensions to achieve a better understanding of the individuals’ cognitive profile. (JINS, 2012, 18, 242–250)
Geropsychology and psychogeriatrics in Portugal: research, education and clinical training
- Oscar Ribeiro, Lia Fernandes, Horácio Firmino, Mário R. Simões, Constança Paúl
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- Journal:
- International Psychogeriatrics / Volume 22 / Issue 6 / September 2010
- Published online by Cambridge University Press:
- 29 July 2010, pp. 854-863
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Background: In response to the global challenges of population aging in Portugal, it is crucial to improve research, education and clinical training in old age in order to meet the growing demands placed on psychogeriatric care services.
Methods: An overview is provided on the status of old age psychology and psychiatry as part of the multidisciplinary care delivery system for the elderly in Portugal. Available educational offerings and clinical training in geriatric mental health at both undergraduate and postgraduate level are described, as well as primary research associations and initiatives within Portugal.
Results: Important issues raised include the need for more educational and clinical training programs for specialists, a broader commitment to aging research and the need to increase interest in working with older adults among students across disciplines. The recent movement towards multidisciplinary work conducted by researchers, psychiatrists, psychologist and other health professionals in Portugal points to the urgent need for specialist education for all health professionals working in geriatrics. This educational initiative must focus not only on the transmission of knowledge on aging-related topics, but also on the training of specific skills and competencies. Improving geriatric mental health service delivery and connecting research with clinical practice constitute other significant steps forward.
Conclusions: An effective intervention in psychogeriatrics should involve a strategy with the participation of a multidimensional network that includes the commitment of researchers, educators, clinicians, health policy-makers and older adults. Several recommendations to improve late life mental health care are presented.