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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.
Dignity in care: communication
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2014
- Pagination:
- 16 minutes 7 seconds
- Place of publication:
- London
Good communication can help people to maintain their dignity. It is vital that staff develop other ways of communicating with people who have a cognitive impairment or limited speech. This film provides an example of communicating with Matthew, a young man with Down's Syndrome Matthew is encouraged to use a diary so that he knows what he's going to be doing on any particular week. It's a good way for staff to find out what's been happening in Matthew's life. The film also shows how, for older people, past memories of being at the beach can be used as a useful communication tool. Communication in practice can mean asking people how they prefer to be addressed and to respect their wishes; giving people information about the service in advance and in a suitable format; and not assuming that you know what people want because of their culture, ability or any other factor. (Edited publisher abstract)
Duration of stay and outcome for inpatients on an basement ward for elderly patients with cognitive impairment
- Authors:
- BALL Sue, et al
- Journal article citation:
- Quality in Ageing, 5(2), October 2004, pp.12-20.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
Reports a prospective study of a consecutive group of 101 patients who died on or were discharged from an acute assessment ward for elderly patients with cognitive impairment. Clinical characteristics were recorded according to an in-patient dementia care pathway, including mini-MOUSEPAD, Crichton activities of daily living, Mini-Mental State Examination and the Burvill physical health score evaluations. Outcome measures were duration of stay, destination on discharge or death on the ward. Mean duration of stay was 7.9 weeks. Self-funding status and lack of behaviourial and psychological complications were associated with reduced duration of. Discharge home was strongly predicted by having a spouse at home, and the need for nursing home other than residential care was related to severity of cognitive impairment. Concludes that patients can expect to stay in hospital for 8 weeks but 2 areas of concern are highlighted: the importance of community rehabilitation funding for patients with memory disorders and the importance of a spouse at home to look after the patient.
The neuropsychological assessment of age related cognitive deficits in adults with Down's Syndrome
- Authors:
- CRAYTON Lissa, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 11(3), 1998, pp.255-272.
- Publisher:
- Wiley
There is substantial evidence that older adults who have Down's Syndrome are at risk for developing Alzheimer's disease. In this study, adults with Down's Syndrome were assessed using a battery of neuropsychological tests, some of which had been used to assess dementia arising from Alzheimer's Disease in the general population. The results of a pre-existing global cognitive comparison, showed no difference between age groups on neuropsychological deficits which may indicate advanced dementia. However, the older age groups showed significantly impaired performance on memory tests in comparison to the younger age group. It is concluded that the more subtle cognitive impairments which associate to Alzheimer's Disease can be identified in the presence of a global cognitive impairment with sufficiently sensitive tests.
Dementia and memory: a handbook for students and professionals
- Author:
- THOMPSON Simon B.N.
- Publisher:
- Ashgate
- Publication year:
- 2006
- Pagination:
- 235p., bibliog.
- Place of publication:
- Aldershot
Intended for students and trained healthcare and medical professionals, this book focuses on treatment of people suffering from dementia and memory problems. It looks at ageing and ageism, definition of dementia, different types of dementia, memory disorders, learning disability and dementia, and coping with memory problems and dementia. It includes information about how to treat memory problems, advanced memory strategies, assessing dementia, treating and managing dementia, and future directions for people with dementia. Case studies on memory, dementia, and dementia and learning disability, and a memory test are included.
A systematic review of cognitive decline in the general elderly population
- Authors:
- PARK Helen L., O'CONNELL Janice O., THOMSON Richard G.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(12), December 2003, pp.1121-1134.
- Publisher:
- Wiley
The aim was to establish the rate of age-related cognitive decline in the general elderly population. Systematic review of studies of cognitive decline in the general elderly population. Medline, Embase and PsycINFO databases were searched using an adapted version of McMaster's aetiology, causation and harm strategies and the Cochrane Dementia and Cognitive Impairment Group strategy. Grey literature was explored and experts contacted. A second observer was involved at all stages and quality appraisal of included studies was performed. Included studies were representative, community-based, cohort studies of people aged over 60, incorporating individuals with dementia. Identification of 5990 abstracts and retrieval of 163 full texts led to inclusion of 19 papers. Heterogeneity made narrative review the appropriate method of data synthesis. Some degree of cognitive impairment with increasing age was found in all studies, although the extent varied. The prevalence of cognitive impairment and the rate of decline increased with age. Studies were of variable quality. Cognitive decline is almost universal in the general elderly population and increases with age. Improved communication between researchers and between clinicians to identify a core minimum data set of neuropsychological tests that could be used in different populations would support consistent study design and meta-analysis, helping to quantify the true rate of cognitive decline in the elderly and assisting diagnosis in clinical practice.
A longitudinal study of neuropsychological change in individuals with Parkinson's disease
- Authors:
- AZUMA Tamiko, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(12), December 2003, pp.1115-1120.
- Publisher:
- Wiley
Neuropsychological changes in individuals with Parkinson's disease (PD) were studied longitudinally. Sixty-nine idiopathic PD patients, with Mini-Mental State Examination (MMSE) scores falling within normal range, and 37 elderly control participants were given neuropsychological tests twice approximately two years apart. The PD group performed poorer than the control group on Semantic Fluency, Letter Fluency, Modified Wisconsin Card Sorting Task, and Block Design at test time 1. Two years later, the PD group showed significant decline in Semantic and Letter Fluency. A subset of 12 PD patients declined in mental status by second testing (>4 MMSE points). Cox proportional-hazards models were used to see if any baseline measures were associated with relative risk of decline in mental status. In the final model, Repetition performance and Age were significantly associated with cognitive decline. Consistent with previous studies, executive function tasks were those most susceptible to disease progression.
Neuropsychiatric symptoms in Latino elders With dementia or cognitive impairment without dementia and factors that modify their association with caregiver depression
- Authors:
- HINTON Ladson, et al
- Journal article citation:
- Gerontologist, 43(5), October 2003, pp.669-677.
- Publisher:
- Oxford University Press
The purpose of this study was to determine neuropsychiatric symptom frequency and intensity in cognitively impaired but not demented Latino elderly persons, evaluate whether overall neuropsychiatric symptom intensity is associated with higher levels of caregiver depression, and identify factors that modify the relationship between neuropsychiatric symptoms and caregiver depression. Ninety-five elderly Latinos with dementia or cognitive impairment but not dementia (CIND), all of whom were identified through an ongoing epidemiological cohort study, and their informal caregivers participated in the study. Caregivers were interviewed in their homes, in either Spanish or English. The Neuropsychiatric Inventory was used to assess neuropsychiatric disturbances. For most neuropsychiatric symptoms, prevalence and intensity were significantly higher in the demented group compared with the CIND group. The overall neuropsychiatric symptom intensity score was significantly associated with caregiver depression. The strength and direction of the association of neuropsychiatric symptoms with caregiver depression was found to vary by three factors: whether the caregiver was the care recipient's spouse, whether the care recipient had dementia or CIND, and the care recipient's age. Neuropsychiatric symptoms may play a significant role in caregiver depression among Latino families. However, the impact of neuropsychiatric disturbances on Latino caregivers may differ depending on characteristics of both the caregiver and care recipient. The adverse impact of neuropsychiatric symptoms on caregivers of elderly persons with CIND has not been previously reported and deserves further study.
Cognitive decline in high-functioning older adults: reserve or ascertainment bias?
- Authors:
- TUOKKO H., et al
- Journal article citation:
- Aging and Mental Health, 7(4), July 2003, pp.259-270.
- Publisher:
- Taylor and Francis
The detection of mild cognitive impairment and dementia in high-functioning older adults can be difficult. It has also been observed that high-functioning persons show a lower prevalence of dementia than low-functioning persons. Three alternative explanations for this observation have been proposed in the literature: brain reserve capacity (BRC), cognitive reserve, and ascertainment bias. With data from a prospective, population-based study of incident dementia, the Canadian Study of Health and Aging (CSHA), we classified participants as being high- (HF) or low-functioning (LF) in three ways: educational and occupational attainment, and estimated premorbid IQ. We observed that fewer HF older adults were diagnosed with dementia after five years, which is in accordance with both the BRC and cognitive reserve models. Contrary to expectations, no difference on rate of memory deterioration was observed between those HF and LF persons who exhibited mild cognitive impairment at CSHA-1. However, HF persons who subsequently were diagnosed with dementia (CSHA-2) showed more rapid decline on five of the six memory measures over time than did LF persons diagnosed with dementia at CSHA-2. When performance on measures of memory functioning at CSHA-1 was examined for highly educated older adults, significantly more of those with dementia at CSHA-2 (n¼59) had scores falling within or below the average range in comparison to normative standards than those who continued to show no cognitive impairment (n¼145). Our findings suggest that the lower incidence of dementia for HF persons may be primarily the result of ascertainment bias, not underlying differences in brain or cognitive reserve.
The detection of mild cognitive impairment in the general practice setting
- Authors:
- ATERO S, RITCHIE K.
- Journal article citation:
- Aging and Mental Health, 7(4), July 2003, pp.251-258.
- Publisher:
- Taylor and Francis
Results from a general practice study of cognitive impairment are used to construct guidelines for the detection of mild cognitive impairment (MCI) in general practice. The role of the general practitioner in the diagnosis of MCI is discussed and the potential feasibility of general practice screening is evaluated with data from a two-year prospective study conducted in the Montpellier region of France. Neuropsychological tests with the highest predictive value for dementia conversion and suitable for use in general practice, were determined by logistic regression modelling. An examination comprising three tests (delayed auditory verbal recall, verbal fluency and visuospatial construction), were found to give a specificity of 99% and sensitivity of 73%. Reports from other research centres suggest that MCI detection should not be limited to cognitive performance alone. It is suggested that proxy observations of behavioural change and information relating to loss of ability to perform activities of daily living should also be used to improve sensitivity and also to provide information needed in patient management. It may be potentially feasible for the family practitioner to verify cognitive complaints and to screen for MCI with a high degree of accuracy using a brief test battery derived from empirical observations in population studies.