Search results for ‘Subject term:"cognitive impairment"’ Sort:
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Alcohol, dementia and cognitive decline in the elderly: a systematic review
- Authors:
- PETERS Ruth, et al
- Journal article citation:
- Age and Ageing, 37(5), September 2008, pp.505-512.
- Publisher:
- Oxford University Press
Evidence from the review and meta-analysis of results from 23 longitudinal studies of people aged 65 and older suggests that small amounts of alcohol may be protective against unspecified incident dementia (risk ratio 0.63) and Alzheimer’s disease (RR 0.57) but not vascular dementia (RR 0.82) or cognitive decline (RR 0.89). However, studies varied, with differing lengths of follow-up, measurement of alcohol intake, inclusion of true abstainers and assessment of potential confounders. The results should therefore be interpreted with caution and, given the ethical objections to randomised placebo-controlled trials in this area, it may never be possible to know for certainty the relationship between alcohol intake and dementia.
The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: a meta-analysis
- Author:
- MITCHELL Alex J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(11), November 2008, pp.1191-1202.
- Publisher:
- Wiley
A meta-analysis was conducted for all studies examining subjective memory complaints (SMC) and either concurrent dementia or mild cognitive impairment (MCI). Eight studies reported the rate of SMC in dementia, seven studies reported the rate of SMC in MCI and of these four compared the rate of SMC in dementia and MCI head-to-head. SMC were present in 42.8% of those with dementia and 38.2% of those with MCI. Across all levels of cognitive impairments 39.8% of people had SMC compared with 17.4% in healthy elderly controls (Relative Risk 2.3). In head-to-head studies there was a significantly higher rate of SMC in dementia vs MCI (48.4% vs 35.1%). Examining the diagnostic value of SMC in dementia, the meta-analytic pooled sensitivity was 43.0% and specificity was 85.8%. For MCI, meta-analytic pooled sensitivity was 37.4% and specificity was 86.9%. In community studies with a low prevalence the positive and negative predictive values were 18.5% and 93.7% for dementia and 31.4% and 86.9% for MCI. The clinical utility index which calculates the value of a diagnostic method suggested poor value for ruling in a diagnosis of dementia but good value for ruling out a diagnosis. When assessed by simple questions, SMC appear to be present in the minority of those with mild cognitive impairment and dementia. In cross-sectional community settings, even when people agree that they have SMC there is only a 20% or 30% chance that dementia or MCI are present, respectively. Despite this, the absence of SMC may be a reasonable method of excluding dementia and MCI and could be incorporated into short screening programs for dementia and MCI but replication is required in clinical settings.
Alcohol-related dementia: a 21st-century silent epidemic?
- Authors:
- GUPTA Susham, WARNER James
- Journal article citation:
- British Journal of Psychiatry, 193(11), November 2008, pp.351-353.
- Publisher:
- Cambridge University Press
Evidence suggests a J-shaped relationship between alcohol consumption and cognitive impairment and other health indicators, with low levels of consumption having better outcomes than abstention or moderate to heavy drinking. Most research to date has focused on the protective effects of drinking small amounts of alcohol. As alcohol consumption is escalating rapidly in many countries, the current cohort of young and middle-aged people may face an upsurge of alcohol-related dementia. The dangers of heavy drinking and its effect on cognition require further attention.
A predictive depression pattern in mild cognitive impairment
- Authors:
- HOUDE Michele, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(10), October 2008, pp.1028-1033.
- Publisher:
- Wiley
This Canadian study aimed to evaluate the prognostic utility of the presence, persistence, and patterns of depression in subjects with amnesic Mild Cognitive Impairment (MCI). Sixty amnesic MCI patients were assessed cognitively and for presence of depression using the 30 item Geriatric Depression Scale (GDS). They were followed annually for an average period of 4.3 years. Simple presence or absence of depression at referral did not predict progression of MCI to AD. Positive answers to specific GDS questions referring to melancholic affect as well as the persistence of depression over two to three years significantly predicted cognitive deterioration leading to AD. The affective characteristics of depression at referral and the persistence of depression were better predictors of conversion to AD than the simple presence or absence of depression measured at referral time.
Referral patterns and acetylcholinesterase inhibitor prescribing for cognitive impairment (1999-2007): impact of NICE guidelines
- Authors:
- GANGESHALINGAM Yogesh, et al
- Journal article citation:
- Psychiatric Bulletin, 32(7), July 2008, pp.265-267.
- Publisher:
- Royal College of Psychiatrists
The proportion of people referred to two outer London mental healthcare services for older people with cognitive impairment increased after the 2001 National Institute for Health and Clinical Excellence (NICE) guidelines for acetylcholinesterase (AChE) inhibitor use in Alzheimer’s disease, but declined after the amended 2006 guidelines. There were the reviewed case notes for 546 individuals referred between 1999 and 2007. The proportion of individuals with cognitive impairment referred increased between 1999 (56.1%) and 2005 (70.5%, 2=5.4, P=0.02), as did the proportion prescribed AChE inhibitor (0.8% to 16.1%, 2=27.5, P<0.001). There were no significant changes between 2005 and 2007 The 2006 NICE amendment may have curbed the increase in psychiatric referrals and AChE inhibitor prescribing rates for people with cognitive impairment but so far these rates have not decreased.
Neuropsychiatric symptoms in the community-based patients with mild cognitive impairment and the influence of demographic factors
- Authors:
- MUANGPAISAN W., INTALAPAPORN S., ASSANTACHAI P.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(7), July 2008, pp.699-703.
- Publisher:
- Wiley
The objective of this study was to investigate the pattern of neuropsychiatric symptoms of mild cognitive impairment (MCI) patients in the Thai population and the influence of demographic factors on the symptoms. One hundred and seven participants aged 50 and over, 77 diagnosed with MCI and 30 normal were recruited from a community-based unit. The Neuropsychiatric Inventory (NPI) was used to assess behavioural disturbances in the subjects. Compared to normal subjects, MCI patients had higher incidence of anxiety (53% vs 27%), dysphoria (46% vs 17%) and sleep problem (45% vs 23%. Although marginally significant, apathy was more common in MCI patients (12% vs 0%). The mean total NPI score and NPI distress score were higher in the MCI group (6.8 vs 1.9 and 2.9 vs 0.6 respectively). The MCI patients aged over 65 had higher incidence of hallucinations (18.9% vs 0%). Males and patients of poor financial status had a higher percentage of dysphoria compared to females and patients with better financial status (65% vs 38.5% and 75% vs 37.9% respectively). Patients with poor financial status also had a higher percentage of anxiety (81.3% vs 44.5%). It was concluded that MCI is associated with significant neuropsychiatric symptoms which caused caregiver distress. In this study, the pattern of neuropsychiatric symptoms in a Thai MCI population was similar to those reported in western countries. Age, sex, educational level and financial status influenced the neuropsychiatric symptoms of MCI patients.
Prevalence of clinically significant depressive symptoms in an epidemiologic sample of community-dwelling elders with milder forms of cognitive impairment in Hong Kong SAR
- Authors:
- CHAN Sandra S. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(6), June 2008, pp.611-617.
- Publisher:
- Wiley
Depression and cognitive impairment in later-life have great bearings on public health. The two conditions often co-occur and have mutual implications on short-term risk and long-term prognosis. A two-phase epidemiologic survey on the prevalence of dementia in elders aged 60 and over was conducted in Hong Kong in 2005-06. In the first phase, 6,100 randomly selected community dwelling elders were assessed with a Cantonese version of Mini-Mental State Examination (C-MMSE) and Abbreviated Memory Inventory for Chinese (AMIC), of whom 2,073 were screened positive and invited for second phase cognitive and psychiatric assessment. 35.5% of screen-positive subjects participated in Phase 2 assessment conducted by psychiatrists for diagnosis of dementia. Severity of dementia was determined using Clinical Dementia Rating Scale (CDR). Cornell Scale for Depression in Dementia (CSDD) and a structured bedside cognitive battery were also administered to each subject. The results showed that 1.7% of subjects with CDR 0.5 and 5.9% of subjects with CDR 1 had clinically significant depressive symptoms. Score on CSDD correlated positively with duration of cognitive symptoms, scores on CIRS and CMMSE in linear regression model. In a logistic regression model, male gender, duration of cognitive symptoms, CIRS and CMMSE was associated with increased risk for clinically significant depressive symptoms. It was concluded that in the sample, milder forms of cognitive impairment were associated with increased risk for depression in the presence of other risk factors such as male gender, higher physical illness burden and longer duration of cognitive symptoms.
Clinical referral patterns and cognitive profile in mild cognitive impairment
- Authors:
- LONIE Jane A., et al
- Journal article citation:
- British Journal of Psychiatry, 192(1), January 2008, pp.59-64.
- Publisher:
- Cambridge University Press
There is current interest in exploring the different subtypes of mild cognitive impairment (MCI), in terms of both their epidemiology and their cognitive profile. Consecutive tertiary referrals (n=187) were psychiatrically evaluated; 45 patients met criteria for amnestic mild cognitive impairment (aMCI). A subgroup of 33 patients with aMCI as well as 21 healthy controls took part in a thorough neuropsychological examination. Of the patients who were examined in greater neuropsychological detail, ten had pure aMCI (none with visual memory impairment only). Fifteen met criteria for non-amnestic MCI. Fifteen had normal neuropsychological profiles. Using more than one test increased sensitivity to detect episodic memory impairment. Amnestic MCI is an important diagnosis in secondary and tertiary memory clinics. There is scope to improve the efficacy and sensitivity of the clinical assessment of this impairment.
Evaluation of effect of cognitive intervention programs for the community-dwelling elderly with subjective memory complaints
- Authors:
- TSAI Athena Yi-jung, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(11), November 2008, pp.1172-1174.
- Publisher:
- Wiley
This study compared the efficacy of cognitive training (CT) and cognitive stimulation (CS) programs for the community elderly with subjective memory complaints (SMC). The single-blind non-randomized controlled study was applied. The numbers of CT and CS participants were 14 and 11. The mean ages of CT and CS participants were 68.71 and 70.36. Memory training and problem solving strategies were applied in the CT group. There were ten 2-hourly sessions of CT, held twice weekly. CS group met once weekly in a 1.5-h class for eight classes. Cognitive performance tests of general cognitive performance, verbal memory and executive function were measured before/after the training and at 6 months follow-up. In both training conditions, the general cognitive performance were enhanced. The CT group showed improvement in the verbal memory test. The CS group did not trigger any training effect in the verbal memory test but the executive function. All cognitive progresses remained at follow-up. Both cognitive training and cognitive stimulation programs showed training effects and remained until 6 months.
Anxiety symptoms and cognitive performance in later life: results from the longitudinal aging study Amsterdam
- Authors:
- BIERMAN Ellis J.M., et al
- Journal article citation:
- Aging and Mental Health, 12(4), July 2008, pp.517-523.
- Publisher:
- Taylor and Francis
This study investigates whether, and if so how, anxiety symptoms are related to cognitive decline in elderly persons and whether anxiety symptoms precede cognitive decline. Data were obtained from the Longitudinal Aging Study Amsterdam. Anxiety symptoms were measured with the Hospital Anxiety and Depression Scale. General cognitive functioning was measured with the Mini-Mental State Examination, episodic memory with the Auditory Verbal Learning Test, fluid intelligence with the Raven's Coloured Progressive Matrices and information processing speed with the coding task. Multilevel analyses were performed to investigate the relationship between anxiety symptoms and cognitive decline over 9 years, taking into account confounding variables. Although not consistent across all dimensions of cognitive functioning, a curvilinear effect of anxiety on cognitive performance was found. Furthermore, we found that previous measurement of anxiety symptoms were not predictive of cognitive decline at a later time-point. This study suggests that the effect of anxiety on cognition depends on the severity of the present anxiety symptoms with mild anxiety associated with better cognition, whereas more severe anxiety is associated with worse cognition. The effect of anxiety symptoms on cognitive functioning seems to be a temporary effect, anxiety is not predictive of cognitive decline.