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Anxiety symptoms bias memory assessment in older adults
- Authors:
- WILLIAMS M.W., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(9), 2017, pp.983-990.
- Publisher:
- Wiley
Background: Older adults with anxiety and/or depression experience additional memory dysfunction beyond that of the normal ageing process. However, few studies have examined test bias in memory assessments due to anxiety and/or depressive symptoms. The current study investigated the influence of self-reported symptoms of anxiety and depression on the measurement equivalence of memory tests in older adults. Method: This is a secondary analysis of the Advanced Cognitive Training for Independent and Vital Elderly dataset, a randomized controlled trial of community-dwelling older adults. Baseline data were included in this study (n = 2802). Multiple indicators multiple causes modeling was employed to assess for measurement equivalence, differential item functioning (DIF), in memory tests. Results: The DIF was present for anxiety symptoms but not for depressive symptoms, such that higher anxiety placed older adults at a disadvantage on measures of memory performance. Analysis of DIF impact showed that compared with participants scoring in the bottom quartile of anxious symptoms, participants in the upper quartile exhibited memory performance scores that were 0.26 standard deviation lower. Conclusion: Anxious but not depressive symptoms introduce test bias into the measurement of memory in older adults. This indicates that memory models for research and clinical purposes should account for the direct relationship between anxiety symptoms and memory tests in addition to the true relationship between anxiety symptoms and memory construct. These findings support routine assessments of anxiety symptoms among older adults in settings in which cognitive testing is being conducted. (Edited publisher abstract)
Quality of diagnosis and treatment plans after using the ‘diagnostic guideline for anxiety and challenging behaviours’ in people with intellectual disabilities: a comparative multiple case study design
- Authors:
- PRUIJSSERS Addy, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 29(4), 2016, pp.305-316.
- Publisher:
- Wiley
Background: People with intellectual disabilities often have a multitude of concurrent problems due to the combination of cognitive impairments, psychiatric disorders (particularly anxiety) and related challenging behaviours. Diagnoses in people with intellectual disabilities are complicated. This study evaluates the quality of the diagnoses and treatment plans after using a guideline that was developed to support professionals in their diagnostic tasks. Materials and Methods: A comparative multiple case study with an experimental and control condition, applying deductive analyses of diagnoses and treatment plans. Results: The analyses revealed that the number of diagnostic statements and planned treatment actions in the experimental group was significantly larger and more differentiated than in the control condition. In the control group, consequential harm and protective factors were hardly mentioned in diagnoses and treatment plans. Conclusions: Working with the ‘Diagnostic Guideline for Anxiety and CB’ leads to improved diagnoses and treatment plans compared with care as usual. (Publisher abstract)
Behavioral symptoms in mild cognitive impairment as compared with Alzheimer's disease and healthy older adults
- Authors:
- VAN DER MUSSELE Stefan, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(3), 2013, pp.265-275.
- Publisher:
- Wiley
Mild cognitive impairment (MCI) is a clinical concept that describes patients who are in an intermediate state between normal aging and dementia. It does not generally affect their activities of daily living but complex instrumental functions may be minimally impaired. Although behavioural symptoms are common in MCI they are not included in the concept. The aim of this study was to characterise behaviour in MCI compared with Alzheimer's disease (AD) and healthy older patients. The data were drawn from the baseline of a longitudinal study of behavioural symptoms of dementia and MCI. The study population, consisting of 270 MCI, 402 AD patients, and 108 healthy controls from Antwerp, underwent a battery of tests and assessments. Moderate-to-severe behavioural symptoms were present in 13% of MCI patients, compared with 39% in AD patients and 3% in controls. The general severity of behavioural symptoms was intermediate between controls and AD patients. The three most common symptoms in MCI patients were aggressiveness (49%), affective disturbance (45%), and anxiety (38%); in AD patients, they were aggressiveness (60%), activity disturbances (54%), and psychosis (40%). Overall the prevalence and severity of frontal lobe symptoms, aggressiveness, activity disturbances, and delusions was intermediate between normal aging and AD and the severity of physically non-aggressive, verbally agitated behaviour and the severity of depressive symptoms were also intermediate.
Efficacy of an adjunctive computer-based cognitive training program in amnestic mild cognitive impairment and Alzheimer's disease: a single-blind, randomized clinical trial
- Authors:
- GAITÁN Adrian, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(1), 2013, pp.91-99.
- Publisher:
- Wiley
This study tested the hypothesis that the addition of a 3-month computer-based cognitive training (CBCT) program for patients with multi-domain amnestic mild cognitive impairment or mild Alzheimer’ disease who were already receiving traditional cognitive training (TCT) would improve more outcomes at 12-month follow-up. Sixty Spanish patients were randomly assigned two groups; CBCT for 3 months and TCT (CBCT + TCT), (n = 23, 65% male mean age 74.8 years); TCT only (n=16, 25% male, mean age 76 years), Patients were assessed at baseline and after 3 and 12 months of treatment using a neuropsychological battery (primary outcomes) and measures of decision making, memory complaints, and emotional disturbances. The CBCT + TCT group showed fewer anxiety symptoms and fewer disadvantageous decisions than the TCT group at 12 months. No significant improvement or worsening was observed in the other measures examined. However, positive effect sizes favouring the CBCT + TCT group were observed for all variables. The authors conclude that the addition of a CBCT program was effective in anxiety and decision making but had no significant effects on outcomes in basic cognitive functions in patients who were already receiving cognitive training, possibly due to a ceiling effect. They suggest future studies should compare the efficacy of CBCT with TCT in naïve patients.
Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairment
- Authors:
- GARAND Lina, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(6), June 2005, pp.512-522.
- Publisher:
- Wiley
In this American study interview assessments were completed on a cohort of 27 spouses of persons with a recent diagnosis of mild cognitive impairment (MCI). Patient medical records were reviewed to collect information regarding the MCI patient's medical history. The results found respondents endorsed elevated levels of both task-related responsibilities and subjective caregiver burden. Depression and anxiety symptom levels also showed some elevations. Measures of caregiver burden were significantly associated with depression and anxiety levels. In particular, even after controlling for demographic risk factors for distress, nursing task burden was correlated with elevated depressive symptoms, and greater lifestyle constraints were correlated with higher anxiety levels. The findings suggest that MCI caregivers have already begun to experience distress in association with elevated caregiving burden. These individuals may be ideal targets for selective preventive interventions to maximize their psychological well-being as caregiving burdens related to their spouses' cognitive impairment increase.
Activities of daily living, cognitive impairment and other psychological symptoms among elderly recipients of home help
- Author:
- RANHOFF Anette Hylen
- Journal article citation:
- Health and Social Care in the Community, 5(3), May 1997, pp.147-152.
- Publisher:
- Wiley
This article examines the connection between having a home help and cognitive impairment and psychological symptoms. Analysis showed that cognitive impairment was significantly more frequent among home help clients, whereas indicators of anxiety and depression were not. After multivariate adjustment, living alone, poor perceived health, problems in performing primary activities of daily living (ADL), and, in particular, experiencing difficulties in cleaning the house remained the only variables independently related to having a home help. Results found that the home help seems to be used mainly to compensate for impaired mobility. An association between cognitive functioning and the provision of home help is related to a limitation in the ability to perform ADL associated with cognitive impairment.