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The presence of behavioural and psychological symptoms and progression to dementia in the cognitively impaired older population
- Authors:
- van der LINDE Rianne M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(7), 2013, pp.700-709.
- Publisher:
- Wiley
This study explores the predictive effect of the presence of behavioural and psychological symptoms (BPS) on the 2-year progression to dementia in a cognitively impaired population without dementia at baseline. Twelve symptoms were measured in 2024 participants from five areas of England and Wales. These included depression, apathy, anxiety, feelings of persecution, hallucination, agitated behaviour, irritability and wandering.The risk of progression to dementia was predicted in those with cognitive impairment for each individual BPS and using a BPS composite score. Wandering and persecution were independently associated with progression to dementia after adjustment for socio-demographic factors, cognitive domains and other BPS. When stratifying by cognitive function, those with low cognition (MMSE 0–18) and 4 or more BPS were more likely to progress to dementia than those without BPS. The predictive effect of BPS in dementia progression has implications for risk stratification of those at high risk of progression to dementia, along with memory impairment, other cognitive impairment and health variables. (Edited 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.
The effects of dependence and function on costs of care for Alzheimer's disease and mild cognitive impairment in Ireland
- Authors:
- GILLESPIE P., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(3), 2013, pp.256-264.
- Publisher:
- Wiley
Data from the Enhancing Care in Alzheimer’s Disease study was used to estimate the cost of formal and informal care in a cross sectional sample of 100 community-based patients with Alzheimer's disease (AD) and amnestic mild cognitive impairment (MCI) in Ireland over a period of six months. Further analysis explored the effects of patient dependence and function on cost. Formal care included general practice visits, hospitalisations, outpatient clinic consultations, accident and emergency visits, respite care, meals on wheels services and other health and social care professional consultations. Informal care included time input provided by caregivers. Resource unit costs valued formal care and the opportunity cost method informal care. Patient dependence was measured using the Dependence Scale and functional capacity using the Disability Assessment for Dementia scale. The result indicate that both dependence and function were independently and significantly associated with total formal and informal care cost: a one point increase in dependence was associated with a €796 increase in total cost and a one point improvement in function with a €417 reduction in total cost over 6 months. Patient function was associated with formal care costs, whereas patient function and dependence were both associated with informal care costs. The authors suggest that interventions that reduce patient dependence and functional decline may be associated with important economic benefits.
Losing track of time: dementia and the ageing prison population: treatment challenges and examples of good practice
- Author:
- MOLL Adam
- Publisher:
- Mental Health Foundation
- Publication year:
- 2013
- Pagination:
- 41
- Place of publication:
- London
Based on a research review and findings from a survey, this report examines treatment and management of male offenders with cognitive impairment, including ageing male prisoners with dementia. It also identifies and describes examples of good practice, focusing in particular on the United States and the United Kingdom. The study included a survey of 14 prisons in 7 jurisdictions across 4 countries (England, the US, Japan and Belgium), covering policy and service provision for older prisoners with cognitive impairment. The report looks at the rise of the older prisoner population, lack of provision for older prisoners, and dementia in prison. It describes the survey methodology and participating prisons, and reports on the results, covering assessing older prisoners, coordinating service provision, staff training, prisoner carer schemes, alternative employment and recreational activities, and additional resources. It draws on the research findings to make recommendations concerning routine screening for older prisoners, staff training, using the experience of specialist external agencies, promoting information sharing and adopting clear procedures, and low-cost modifications to prison living environments. A diagram illustrating the HMP Isle of Wight memory service referral process is included in an annex.
Predictors of comprehensive stimulation program efficacy in patients with cognitive impairment. Clinical practice recommendations
- Authors:
- BINETTI Giuliano, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(1), 2013, pp.26-33.
- Publisher:
- Wiley
This longitudinal study examined which factors best predict response to a comprehensive stimulation programme offered to patients with dementia and mild cognitive impairment (MCI) and their caregivers. A total of 145 Italian patients (55 with MCI and 90 with dementia), participating to a cognitive motor rehabilitation program, and their 131 caregivers, attending informational/psychoeducational interventions were followed for six months. Three alternative cognitive stimulation interventions were used: Reality Orientation Therapy, Global Reactivation Therapy, and Memory Training. Mini mental state examination, Alzheimer’s Disease Assessment Scale-Cognition, and Clinician’s Interview-Based Impression of Change-plus were the primary outcome measures. Sixty-eight (46.9%) of the 145 subjects were classified as clinical responders. At baseline, responders had a significantly less insight into impairment, greater functional capacity as well as fewer delusions, euphoria, and aberrant motor behaviours than the non-responder. After 6 months, along with an improvement in cognition, responders also showed decreased behavioural disturbances and severity of disturbances. During the analysis the caregiver's burden of distress remained stable; however after 6 months the burden of the caregivers of MCI responders was reduced. The authors conclude that a high level of insight, preserved functional abilities as well as the lack of severe delusions, euphoria, and aberrant motor behaviours are significant predictors of responsiveness to stimulation programmes.