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Mild cognitive impairment: a ‘hardening of the categories’?
- Authors:
- WHITEHOUSE Peter J., MOODY Harry R.
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 5(1), February 2006, pp.11-25.
- Publisher:
- Sage
Mild cognitive impairment (MCI) is a controversial label for forms of age-related, intellectual difficulties unassociated with impairments in activities of daily living. The principal issue is whether this arbitrary, heterogeneous and unreliable term is appropriate to use clinically. Persons with the label MCI may progress to different types of dementia, stay stable, or even improve. In this article we offer a philosophical analysis of MCI from epistemological, ethical and semantic perspectives. The authors believe that the term should currently not be used clinically.
A new approach to the qualitative evaluation of functional disability in dementia
- Authors:
- KURZ X., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(11), November 2003, pp.1050-1055.
- Publisher:
- Wiley
Dementia patients suffer from the progressive deterioration of cognitive and functional abilities. Instrumental disabilities usually appear in the earlier stages of the disease while basic disabilities appear in the more advanced stages. In order to differentiate between mild, moderate and severe patients both instrumental and basic functional disabilities should be taken into account simultaneously. The objective of this study was to find a new method for classifying dementia patients based on their disabilities by using a basic and an instrumental Activities of Daily Living (ADL) scale. Functional disability was assessed in a Belgian cohort of dementia patients using the Katz and Lawton Instrumental Activities of Daily Living (IADL) scales. A k-means derived clustering method allocated patients to disability clusters according to their Katz and Lawton scores. In order to validate the classification, we compared socio-demographic, clinical and costs parameters between the groups. The clustering method allocated patients between three clusters: dependent, non-dependent with instrumental functional disability (ND-IFD) and non-dependent. Dependence, as defined by these clusters, significantly correlates with age, residential setting, MMSE, patient's quality of life and costs. This new classification of patients suffering from dementia will provide better understanding of functional disabilities and will complement the evaluation of disease severity based on cognitive function.
Resource pack for carers of adults with Down's Syndrome and dementia
- Authors:
- DODD Karen, TURK Vicky, CHRISTMAS Michelle
- Publisher:
- British Institute of Learning Disabilities
- Publication year:
- 2002
- Pagination:
- 146p.
- Place of publication:
- Kidderminster
People with Down's syndrome are far more likely to develop dementia than the general population, and at a younger age - the average age of dementia onset is just 52 years, with death likely to occur within just six years . This new resource for family carers, staff and other professionals supporting people with Down syndrome, to help them with practical day to day issues, including: supporting a person to maintain skills and independence as long as possible; treating treatable conditions; understanding and responding appropriately to changes in behaviour, at early, middle and late stages of dementia; providing emotional reassurance for carers; improving the confidence of carers to look after individuals; iIdentifying local supports and resources; and being open to the problems that may arise, and help with tips and solutions to cope.
Caregiving and institutionalisation of cognitively impaired older people: utilising dynamic predictors of change
- Authors:
- GAUGLER Joseph E., et al
- Journal article citation:
- Gerontologist, 43(2), April 2003, pp.219-229.
- Publisher:
- Oxford University Press
The purpose of this study was to identify reliable predictors of nursing home entry over a 3-year period in a sample of 3,944 persons with dementia who resided in a home setting at baseline. Strengths of the analysis include a multiregional recruitment strategy, incorporation of salient caregiver characteristics, and a 3-year prospective design that allows for the modeling of change in important variables (e.g., care recipient functional status or caregiving indicators) when time to institutionalization is predicted. Data were derived from the control sample of the Medicare Alzheimer's Disease Demonstration Evaluation (MADDE). A Cox proportional hazards model was used to predict time to institutionalization among individuals with dementia (baseline was enrollment into MADDE). Predictors included care recipient demographics, caregiver demographics, and time-varying measurements of care recipient functional status, caregiving indicators, and service utilization. Indicators of change were also incorporated to capitalize on the prospective data available. Although several results were consistent with prior findings, caregiving indicators (i.e., burden and self-rated health) and community-based service use were significant predictors of earlier placement. Change in caregiver instrumental activities of daily living and care recipient activities of daily living were also related to expedited institutionalization. The findings emphasize the importance of incorporating both care recipient and caregiver function and service use patterns when targeting programs designed to prevent or delay institutionalization for people with dementia.