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Longitudinal differences in everyday preferences: comparisons between people with cognitive impairment and their care partners
- Authors:
- WILKINS James M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 37(1), 2022,
- Publisher:
- Wiley
Objectives: Persons with progressive cognitive impairment (CI) increasingly rely on surrogate decision-makers for everyday activities. Yet, little is known about changes in everyday preferences over time or about concordance between persons with CI and their care partners regarding longitudinal changes. Methods: The sample included 48 dyads of persons with CI (Clinical Dementia Rating Scale score ≥0.5) and their care partners. The Preferences for Everyday Living Inventory was used to assess importance of preferences among persons with CI at baseline and follow-up (mean 486 days). Care partners separately 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. Results: There were significant gender differences regarding importance ratings of “autonomous choice” and “social engagement” preferences over time: women with CI rated these preferences as more important across time as a whole. Higher levels of neuropsychiatric symptoms were associated with less importance of “social engagement” preferences across time as a whole for persons with CI and a more negative discrepancy between persons with CI and care partner proxy assessments as time went on. Conclusion: This study yields new insights into predictors of longitudinal change in everyday preferences among persons with CI and their care partners. Although preferences were largely stable over time, there is increasing support for the relationship between differences in “social engagement” preferences and neuropsychiatric symptoms, which may have implications for monitoring and/or treatment in the context of cognitive impairment. (Edited publisher abstract)
Anxiety disorders, depressive episodes and cognitive impairment no dementia in community-dwelling older men and women
- Authors:
- POTVIN Olivier, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(10), October 2011, pp.1080-1088.
- Publisher:
- Wiley
Anxiety symptoms are highly prevalent in elders with mild cognitive disorders. The examination of anxiety disorders in older people with cognitive impairment no dementia (CIND) could provide a better comprehension of the psychiatric symptomatology that arises in these persons at high risk of dementia. The aim of this study was to identify the clinical and subclinical anxiety disorders associated with CIND and to determine whether these associations differ depending on sex and concomitant depressive episodes. Data was collected through the Enquête sur la santé des aînés (ESA study), a population based study conducted in 2005-2006. The participants were a random sample of 2414 community-dwelling adults aged 65–96 years who underwent semi-structured at-home interviews and provided access to their medical records. The anxiety disorders investigated included specific phobia, social phobia, agoraphobia, panic disorder, obsessive–compulsive, and generalised anxiety disorder (GAD). The findings showed that in men, after adjusting for confounding variables, CIND was associated with subclinical GAD. Further analyses showed that in men, CIND was related to clinical/subclinical GAD whether MDE/MD was present or absent. In women, CIND was not linked to any clinical or subclinical anxiety disorder. These results suggest that GAD is the main anxiety disorder associated with poor global cognitive functioning. This association is modified by sex, but not by the presence of depressive episodes.
Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity
- Authors:
- ZUIDEMA Sytse, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(10), October 2009, pp.1079-1086.
- Publisher:
- Wiley
This study aimed to assess the influence of dementia severity and gender on neuropsychiatric symptoms in demented nursing home patients. It assessed a sample of Dutch nursing home patients using the Cohan-Mansfield Agitation Inventory and the Neuropsychiatric Inventory-Nursing Home version. The influence of gender and severity of cognitive decline, assessed with the Global Deterioration Scale (GDS), was investigated with correction for factors such as age, duration of institutionalisation, and psychoactive medication use. The results showed that while physically aggressive behaviour was more common in patients with very severe cognitive deterioration, disinhibition, irritability, physically non-aggressive and verbally agitated behaviour were more common in patients with moderately severe and severe cognitive decline. Physically aggressive behaviour was more common in men, whereas female patients demonstrated more verbally agitated behaviour. The study concluded that neuropsychiatric symptoms were associated with the severity of dementia, with most symptoms occurring in patients showing moderately severe cognitive decline, that only physical aggression, anxiety and apathy were more common in patients with very severe cognitive decline and that dementia severity and gender were important predictors of neuropsychiatric symptoms in this patient cohort.
Stress affects carers before patient’s first visit to a memory clinic
- Authors:
- ROSNESS Atle, ULSTEIN Ingun, ENGEDAL Knut
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(10), October 2009, pp.1143-1150.
- Publisher:
- Wiley
The objective of this study was to measure and compare the burden on spousal carers of patients with and without dementia who were consulting a memory clinic for the first time. The burden of care was measured with the Relative Stress Scale (RSS). The gender of patients and their spouses was recorded and measures of cognition, depression and functional capacity of the patients were included in the analysis. The findings were that spouses of patients referred to a memory clinic for an initial assessment report a considerable amount of stress regardless of whether the patient fulfilled the criteria for dementia or not. 27.6% of all carers had a score on RSS above 23 indicating a moderate to severe level of distress at their first contact with a memory clinic. The most important predictor of the burden of care at the time of the diagnostic assessment is impaired function in activities of daily living in patients, followed by female gender of the spousal carer and depression in the patient. Carers of Cognitive Impairment No Dementia patients already experienced distress on an initial visit to a memory clinic, but less overall distress than the carers of dementia patients.
Socioeconomic factors and the risk of cognitive decline among the elderly population in Japan
- Author:
- OKAMOTO Shohei
- Journal article citation:
- International Journal of Geriatric Psychiatry, 34(2), 2019, pp.265-271.
- Publisher:
- Wiley
Aim: In Japan, with the largest percentage of population aged 65 years or over, a dementia strategy is needed not only from a medical perspective, but also from a social policy viewpoint. This study aimed to verify the association between socioeconomic factors and cognitive decline among Japanese elderly people. Methods: Cognitive decline was assessed over a 15‐year follow‐up period using memory tests or through identifying missing/proxy responses to survey questions due to cognitive dysfunction. The author analysed 1886 men and 2102 women in Japan, using competing risk models for cognitive decline, to consider survival effects. Survival effects have not been considered so far although those who live longer may be more likely to experience cognitive decline. Results: Men with higher income had a lower risk of cognitive decline (sub‐hazard ratio [SHR]: 0.997, 95% confidence interval (CI): 0.995‐0.999). Women with higher education had a lower risk of cognitive decline: 8 to 9 years (SHR: 0.646, 95% CI: 0.457‐0.914) and ≥12 years (SHR: 0.360, 95% CI: 0.164‐0.794) than women with 0 to 7 years of education. Conclusion: This study suggests that cognitive decline among the elderly Japanese population is associated with socioeconomic factors, such as income and education, even after taking survival effects into account. (Edited publisher abstract)
The influence of spouse lower cognitive function on partner health and well-being among community-dwelling older couples: moderating roles of gender and marital problems
- Authors:
- STRAWBRIDGE William Joseph, et al
- Journal article citation:
- Aging and Mental Health, 13(4), July 2009, pp.530-536.
- Publisher:
- Taylor and Francis
This study analyzed longitudinal relationships between older spouses' lower cognitive function and the health and well-being of their partners five years later and to assess the moderating roles of gender and marital problems. Subjects were 404 community-dwelling older couples from the Alameda County Study. Baseline cognitive function was measured with a scale assessing problems remembering names, finding the right word, misplacing things and paying attention. Follow-up measures included five health and well-being outcomes. Statistical models adjusted for paired data and included spouse and partner cognitive function as well as partner baseline values for each outcome. Interaction terms assessed gender differences; stratified models assessed the moderating roles of marital problems. Husbands' lower cognitive function was associated with subsequent poorer health and well-being for their wives; however, these associations were significant only for the 52% reporting few or no marital problems. Wives' lower cognitive function was not associated with any outcomes for their husbands. The findings support early identification of cognitive decline and development of assistive strategies for wives dealing with relationship changes associated with lower cognitive function in their husbands. Although the finding that associations were limited to wives in marriages with few or no problems is consistent with a communication framework, further research is necessary to better understand this strong gender difference.
Risk factors of cognitive decline in residential care in Hungary
- Authors:
- VINCZE Gabor, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(12), December 2007, pp.1208-1216.
- Publisher:
- Wiley
The incidence of dementia is known to vary between nations due to population specific interactions of genetic and epigenetic risk factors. Since this type of data was missing from the Central-Eastern part of Europe, especially from Hungary, an ongoing prospective multicentre study was initiated 3 years ago to determine the impact of some well-known social and biological dementia risk factors and the prevalences and conversion rates of dementia and depression syndromes. As part of this work, the effects of age, gender, education, smoking and alcohol consumption were investigated in residential homes-based cohort of more than 2,100 elderly. Forty-eight percent of the entire population showed clinical signs of cognitive decline. Eighteen percent, 22%, 16% and 10% were classified as mild cognitive impairment, mild, moderate and severe stages of cognitive decline, respectively. Considered individually, all the examined dementia risk factors were significantly related to the presence of the cognitive decline. Age, female gender and regular drinking increased the risk, while smoking, higher level of education and occasional or former history of alcohol consumption were protective factors. The male gender associated regular alcohol consumption represented the strongest risk, especially with low education levels. When the different severity subgroups were compared, similar risk tendencies have been observed, but the most robust effects were associated with the most severe stages. The well-known dementia risk and protective factors are confirmed in this study. Taking these variables into consideration, the Hungarian cohort is similar to other ethnic groups in Europe.
Salience of self-identity roles in persons with dementia: differences in perceptions among elderly persons, family members and caregivers
- Authors:
- COHEN-MANSFIELD Jiska, PAPURA-GILL Alexsandra, GOLANDER Hava
- Journal article citation:
- Social Science and Medicine, 62(3), February 2006, pp.745-757.
- Publisher:
- Elsevier
The authors explored perceptions of the salience of self-identity in persons suffering from dementia as perceived by the participants themselves, by family, and by staff caregivers. Four types of role-identity were explored: professional, family role, hobbies/leisure activities, and personal attributes. Participants were 104 persons with dementia, 48 of whom attended six adult day care centers while 56 resided in two nursing homes in the Washington, DC metropolitan area. Participants, relatives, and staff members were interviewed to obtain information about past and present self-identity roles of participants and attitudes toward these roles. Findings demonstrate that the importance of role identities decreases over time and with the progression of dementia. The family role was found to be the most important and salient role identity according to all the informant groups. The professional role was the one that showed the steepest decline in importance from past to present. Gender differences were detected for the importance of professional role identity. Participants rated their roles in the past as less important and those in the present as more important compared to family members. Family members reported greater decline in the importance of role identities for those participants with greater cognitive impairment. Participants with moderate cognitive impairment reported greater decline in the importance of role identities than did the participants with severe cognitive impairment. Understanding the past and present self-identities of persons with diminished cognitive abilities is crucial in the effort to provide individualized care and enhance participant experiences.
No association between subjective memory complaints and apolipoprotein E genotype in cognitively intact elderly
- Authors:
- HARWOOD Dylan G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(12), December 2004, pp.1131-1139.
- Publisher:
- Wiley
This cross-sectional study examined the relationship between subjective memory complaints and the apolipoprotein epsilon 4 allele (4), a genetic risk factor for Alzheimer's disease (AD), among cognitively normal subjects identified from a community memory screening. The sample comprised 232 consecutive white non-Hispanic older adults who presented to a free community-based memory-screening program at a University affiliated memory disorders center. Participants were classified as cognitively normal based on scores on the age and educated adjusted Folstein Mini-Mental Status Exam (MMSAdj) and a brief Delayed Verbal Recall Test (DRT). Subjects were assessed for APOE genotype, subjective memory complaints (Memory Questionnaire, MQ), depressive symptoms (Hamilton Depression Rating Scale, HDRS), and history of four major medical conditions that have been associated with memory loss (stroke/transient ischemic attack [TIA], atherosclerotic heart disease, hypertension, and diabetes). A hierarchical regression analysis was performed to examine the association between APOE genotype and memory complaints after controlling for a host of potential confounding factors. The APOE 4 allele frequency for cognitively normal subjects was 0.13. Subjective memory complaints were predicted by depressive symptoms and a history of stroke/TIA. They were not associated with APOE genotype, MMSAdj score, DRT score, age, education, gender, and reported history of atherosclerotic heart disease, hypertension, or diabetes. The results did not suggest an association between subjective memory complaints and the APOE 4 allele in this sample of cognitively intact subjects. This indicates that memory complaints may confer risk for future dementia through pathways independent of APOE genotype. The results also show that older adults with memory complaints are at increased risk for underlying depression
Age at onset and cognitive functioning in schizophrenia
- Authors:
- TUULO-HENRICKSSON Annamari, et al
- Journal article citation:
- British Journal of Psychiatry, 185(9), September 2004, pp.215-219.
- Publisher:
- Cambridge University Press
Impairments in cognitive functioning are common in schizophrenia, and the degree of impairment may be associated with the individual’s age at onset of the disorder. The aim was to examine the effect of age at onset on cognitive functioning using the California Verbal Learning Test, sub-tests from the Wechsler Memory Scale – Revised and sub-scales from the Wechsler Adult Intelligence Scale – Revised among families with schizophrenia. The effect of age at onset on cognitive function in 237 people with schizophrenia from a population-based sample was examined using linear mixed effects models with family as the random effect, and age, gender, chronicity of the illness and number of affected first-degree relatives as fixed effects. Impairment in verbal learning and memory was associated with earlier disease onset. No association was found for working memory or IQ. In patients with early-onset schizophrenia, verbal memory functions in particular should be taken into account in neuropsychological evaluation and efforts at remediation.