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Alcohol, dementia and cognitive decline in the elderly: a systematic review
- Authors:
- PETERS Ruth, et al
- Journal article citation:
- Age and Ageing, 37(5), September 2008, pp.505-512.
- Publisher:
- Oxford University Press
Evidence from the review and meta-analysis of results from 23 longitudinal studies of people aged 65 and older suggests that small amounts of alcohol may be protective against unspecified incident dementia (risk ratio 0.63) and Alzheimer’s disease (RR 0.57) but not vascular dementia (RR 0.82) or cognitive decline (RR 0.89). However, studies varied, with differing lengths of follow-up, measurement of alcohol intake, inclusion of true abstainers and assessment of potential confounders. The results should therefore be interpreted with caution and, given the ethical objections to randomised placebo-controlled trials in this area, it may never be possible to know for certainty the relationship between alcohol intake and dementia.
Prevalence of clinically significant depressive symptoms in an epidemiologic sample of community-dwelling elders with milder forms of cognitive impairment in Hong Kong SAR
- Authors:
- CHAN Sandra S. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(6), June 2008, pp.611-617.
- Publisher:
- Wiley
Depression and cognitive impairment in later-life have great bearings on public health. The two conditions often co-occur and have mutual implications on short-term risk and long-term prognosis. A two-phase epidemiologic survey on the prevalence of dementia in elders aged 60 and over was conducted in Hong Kong in 2005-06. In the first phase, 6,100 randomly selected community dwelling elders were assessed with a Cantonese version of Mini-Mental State Examination (C-MMSE) and Abbreviated Memory Inventory for Chinese (AMIC), of whom 2,073 were screened positive and invited for second phase cognitive and psychiatric assessment. 35.5% of screen-positive subjects participated in Phase 2 assessment conducted by psychiatrists for diagnosis of dementia. Severity of dementia was determined using Clinical Dementia Rating Scale (CDR). Cornell Scale for Depression in Dementia (CSDD) and a structured bedside cognitive battery were also administered to each subject. The results showed that 1.7% of subjects with CDR 0.5 and 5.9% of subjects with CDR 1 had clinically significant depressive symptoms. Score on CSDD correlated positively with duration of cognitive symptoms, scores on CIRS and CMMSE in linear regression model. In a logistic regression model, male gender, duration of cognitive symptoms, CIRS and CMMSE was associated with increased risk for clinically significant depressive symptoms. It was concluded that in the sample, milder forms of cognitive impairment were associated with increased risk for depression in the presence of other risk factors such as male gender, higher physical illness burden and longer duration of cognitive symptoms.
Evaluation of effect of cognitive intervention programs for the community-dwelling elderly with subjective memory complaints
- Authors:
- TSAI Athena Yi-jung, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(11), November 2008, pp.1172-1174.
- Publisher:
- Wiley
This study compared the efficacy of cognitive training (CT) and cognitive stimulation (CS) programs for the community elderly with subjective memory complaints (SMC). The single-blind non-randomized controlled study was applied. The numbers of CT and CS participants were 14 and 11. The mean ages of CT and CS participants were 68.71 and 70.36. Memory training and problem solving strategies were applied in the CT group. There were ten 2-hourly sessions of CT, held twice weekly. CS group met once weekly in a 1.5-h class for eight classes. Cognitive performance tests of general cognitive performance, verbal memory and executive function were measured before/after the training and at 6 months follow-up. In both training conditions, the general cognitive performance were enhanced. The CT group showed improvement in the verbal memory test. The CS group did not trigger any training effect in the verbal memory test but the executive function. All cognitive progresses remained at follow-up. Both cognitive training and cognitive stimulation programs showed training effects and remained until 6 months.
Anxiety symptoms and cognitive performance in later life: results from the longitudinal aging study Amsterdam
- Authors:
- BIERMAN Ellis J.M., et al
- Journal article citation:
- Aging and Mental Health, 12(4), July 2008, pp.517-523.
- Publisher:
- Taylor and Francis
This study investigates whether, and if so how, anxiety symptoms are related to cognitive decline in elderly persons and whether anxiety symptoms precede cognitive decline. Data were obtained from the Longitudinal Aging Study Amsterdam. Anxiety symptoms were measured with the Hospital Anxiety and Depression Scale. General cognitive functioning was measured with the Mini-Mental State Examination, episodic memory with the Auditory Verbal Learning Test, fluid intelligence with the Raven's Coloured Progressive Matrices and information processing speed with the coding task. Multilevel analyses were performed to investigate the relationship between anxiety symptoms and cognitive decline over 9 years, taking into account confounding variables. Although not consistent across all dimensions of cognitive functioning, a curvilinear effect of anxiety on cognitive performance was found. Furthermore, we found that previous measurement of anxiety symptoms were not predictive of cognitive decline at a later time-point. This study suggests that the effect of anxiety on cognition depends on the severity of the present anxiety symptoms with mild anxiety associated with better cognition, whereas more severe anxiety is associated with worse cognition. The effect of anxiety symptoms on cognitive functioning seems to be a temporary effect, anxiety is not predictive of cognitive decline.
Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: a meta-analysis
- Authors:
- HEYN P. C., JOHNSON K. E., KRAMER A. F.
- Journal article citation:
- Journal of Nutrition Health and Aging, 12(6), 2008, pp.401-409.
- Publisher:
- Springer
Nursing home residents are often viewed as too frail or cognitively impaired to be able to participate in or benefit from exercise rehabilitation, and those with a Mini Mental State Examination (MMSE) score of under 25 are frequently excluded from such programmes. This systematic review and meta-analysis identifies 41 randomised trials of exercise programmes: 21 conducted with cognitively impaired individuals (defined as MMSE scores of less than 25); and 20 with cognitively intact individuals (MMSE scores over 25). Moderate to large effect sizes were found for both groups, with no statistically significant differences between the two in respect of strength or endurance outcomes. The paper concludes that cognitively impaired people should not be excluded from exercise rehabilitation programmes.
Mild cognitive impairment in the older population: who is missed and does it matter?
- Authors:
- STEPHAN Blossom C. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(8), August 2008, pp.863-871.
- Publisher:
- Wiley
Classifications of mild cognitive impairment (MCI) vary in the precision of the defining criteria. Their value in clinical settings is different from population settings. This difference depending on setting is to be expected, but must be well understood if population screening for dementia and pre-dementia states is to be considered. Of importance is the impact of missed diagnosis. The magnitude of missed at-risk cases in the application of different MCI criteria in the population is unknown. Data were from the Medical Research Council Cognitive Function and Ageing Study, a large population based study of older aged individuals in the UK. Prevalence and two-year progression to dementia in individuals whose impairment failed to fulfil published criteria for MCI was evaluated. Prevalence estimates of individuals not classified from current MCI definitions were extremely variable (range 2.5-41.0%). Rates of progression to dementia in these non-classified groups were also very variable (3.7-30.0%), reflecting heterogeneity in MCI classification requirements. Narrow definitions of MCI developed for clinical settings when applied in the population result in a large proportion of individuals who progress to dementia being excluded from MCI classifications. More broadly defined criteria would be better for selection of individuals at risk of dementia in population settings, but at the possibility of high false positive rates. While exclusion may be a good thing in the population since most people are presumably normal, over-inclusion is more likely to be harmful. Further work needs to investigate the best classification system for application in the population.
Neurocognitive profiles in older adults with and without major depression
- Authors:
- FISCHER Corinne, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(8), August 2008, pp.851-856.
- Publisher:
- Wiley
To delineate the differences between older persons with and without a diagnosis of major depression participants were recruited from three outpatient clinics serving older patients at St Michael's Hospital. To be included in the study, participants had to speak English and have no evidence of significant sensory deficits that would interfere with neuropsychological testing. Participants were excluded if they had active delirium, active CNS disease (including dementia), active substance abuse, unstable medical disease, recent ECT treatment and a current/past diagnosis of a psychotic disorder. The diagnosis of major depression was made by qualified professionals in accordance with established guidelines. Participants were administered structured measures assessing global cognition, medical co-morbidity, subjective memory complaints, mood and detailed neurocognitive testing evaluating working memory, attention and speed of processing. Differences between depressed and non-depressed subjects with respect to these measures were analyzed using analysis of variance (ANOVA). Thirty-six participants were included in this study. The depressed (n = 17) and non-depressed (n = 19) groups were well matched in terms of age, education, medical co-morbidity and mini-mental state exam (MMSE) score. While the depressed subgroup had significantly higher subjective memory, language and cognitive complaints, there were no significant differences observed between the two subgroups on measures of memory and learning, attention and speed of information processing, fine motor dexterity and verbal fluency. This study suggests that while significant depressive symptoms are strongly associated with increased cognitive complaints, they are not associated necessarily with objective cognitive impairment.
Mild cognitive impairment: coping with an uncertain label
- Authors:
- BANNINGH Liesbeth Joosten-Weyn, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(2), February 2008, pp.148-154.
- Publisher:
- Wiley
The recently introduced diagnostic label of Mild Cognitive Impairment (MCI) identifies patients with a cognitive decline that is more pronounced than is usual for a person's age and educational level but does not notably interfere with activities of daily living (ADL). The natural course of the syndrome is uncertain although MCI sufferers have a higher risk of developing dementia. The objective was to investigate how patients fulfilling MCI criteria experience and cope with their cognitive decline with the secondary aim to derive key themes for a prospective MCI support-group programme. Analysis of guided interviews with eight MCI patients revealed four common themes. Changes related to cognitive abilities, mobility, affect, vitality and somatic complaints. Attributions were numerous and concerned aetiologies such as personality traits and overload of information. Consequences were all negative and concerned the patients themselves such as anxiety and loss of self-confidence, others such as feelings of irritation and anger towards others or activities like abandoning leisure activities. Patients applied emotion-oriented, problem-focused and avoidant coping strategies. MCI patients encounter stress-inducing practical, social and psychological difficulties. Based on the current preliminary findings, the key themes for an MCI support-group programme should include the provision of information about the syndrome's causes, course, concomitant symptoms, attributions, social consequences, and available treatments. The impact of receiving an MCI label warrants further investigation.
Clinical issues in responding to alleged elder sexual abuse
- Authors:
- CHIHOWSKI Kathryn, HUGHES Susanne
- Journal article citation:
- Journal of Elder Abuse and Neglect, 20(4), 2008, pp.377-400.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Allegations of sexual abuse of older people are complex and difficult to investigate and resolve for Adult Protective Services. The response model developed and used by the Massachusetts Elder Protective Services Program is described, and examples of both effective and ineffective investigation and case management are described in relation to a range of issues: diagnostic evaluation; distinguishing between consenting marital relations and sexual abuse; dealing with a victim’s desire to protect the perpetrator; the reluctance of health care professionals to conduct physical examinations of cognitively impaired individuals; recognising harmful genital or rectal procedures as sexual abuse; sexual abuse in assisted living facilities; and substantiating sexual abuse on the basis of a cluster of indicators.
Subjective cognitive functioning as a predictor of all cause mortality in an Israeli national sample of community dwelling older adults
- Author:
- AYALON Liat
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(8), August 2008, pp.830-836.
- Publisher:
- Wiley
Cognitive functioning has been identified as a predictor of all cause mortality in several epidemiological studies. As a result, researchers have suggested the use of short cognitive screens as prognostic indicators in older adults. Little is known, however, about subjective complaints of cognitive functioning as predictors of all cause mortality. A 7-year follow-up of a national sample of 4,921 Israelis over the age of 60. Main predictors were subjective complaints of memory problems, confusion, and recognition problems. Outcome was time to death. As expected, in the fully adjusted model, age, gender, subjective health, baseline health, and ADL and IADL impairments were significant predictors of all cause mortality. In addition, complaints about difficulties recognizing familiar people also were associated with a greater risk for mortality. Subjective complaints about recognition problems serve as a risk for all cause mortality above and beyond well-known risk factors. Health care professionals can use this information about subjective cognitive functioning in conjunction with other measures in order to identify older adults at risk for an earlier death.