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Making physical activity accessible to older adults with memory loss: a feasibility study
- Authors:
- LOGSDON Rebecca G., et al
- Journal article citation:
- Gerontologist, 49(S1), June 2009, pp.S94-S99.
- Publisher:
- Oxford University Press
The Resources and Activities for Life Long Independence (RALLI) program in the US uses behavioural principles to make exercise more accessible for older people with memory loss. Exercises are broken into small steps, sequenced, and linked with cues to help participants remember them. Memory aids, easy-to-follow instructions, and tracking forms to facilitate adherence and proper technique are provided to enhance exercise training and compensate for memory loss. Thirty-seven individuals participated in RALLI pilot groups held in retirement residences. Attendance was excellent, with participants attending 90% of classes. At post-test (12 weeks), 84% of participants had exercised at least once during the prior week, compared with 62% who had exercised at least once during the week prior to baseline, mean exercise time increased by 156 min per week, and SF-36 physical components scale significantly improved. After 6 months, 76% of participants continued exercising and mean exercise time remained significantly improved. Persons with MCI can significantly benefit from an exercise program specifically designed to address their cognitive needs. Participants’ ratings indicate improvement in perceived physical health and emotional well-being as a result of the intervention. Thus, RALLI is a promising intervention to promote exercise in individuals with MCI.
Cognitive, functional and behavioral factors associated with the burden of caring for geriatric patients with cognitive impairment or depression: evidence from a South American sample
- Authors:
- MACHNICKI Gerard, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(4), April 2009, pp.382-389.
- Publisher:
- Wiley
Primary caregivers assessed were included if the geriatric patient cared for had a cognitive impairment or dementia (degenerative, vascular or mixed) (Group 1) or depression and cerebrovascular disease (CVD) (Group 2). Caregivers completed the Zarit questionnaire, the Neuropsychiatric Inventory (NPI) and Instrumental Activities of Daily Living (IADL). Patients were evaluated for dementia severity using the Clinical Dementia Rating (CDR), Mini Mental State Examination (MMSE) and Beck Depression Inventory (BDI). Structural equation modelling (SEM) was used to assess measurement models and the factors associated with burden. Two hundred and fifty-eight caregiver-patient pairs were included. The best model fit was obtained with a model with two constructs: function-cognition (CDR, MMSE, and IADL) and behaviour (neuropsychiatric symptoms from the NPI). In Group 1, both function and behaviour were significantly correlated with caregiver burden, although the strength of association was more than two times higher for behaviour. In Group 2, behaviour was related to caregiver burden but not function-cognition. These findings suggest that behavioural symptoms are an important factor associated with caregiver burden in patients with cognitive impairment, dementia, or depression, while functional and cognitive factors seem to also have an influence in patients with cognitive impairment.
The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) is associated with informant stress
- Authors:
- NYGAARD Harald A., NAIK Mala, GEITUNG John T.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(11), November 2009, pp.1085-1191.
- Publisher:
- Wiley
This study aimed to assess the association between informant stress and appraisal of patients’ cognitive functioning as reported by the IQCODE, which is designed to measure cognitive changes over time as perceived by an informant. Routinely collected data from a geriatric outpatient department during the period 1995 to 1998 were analysed, and the relationship between IQCODE and categorised Relative Stress Scale (RSS), an instrument to detect stress in caregivers, and informant groups and patient age was studied. The study concluded that IQCODE is associated with informant stress and that categorisation of RSS score into groups of low, intermediate and high risk or psychiatric morbidity can be a valuable contribution to a more meaningful application of RSS in general practice.
Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity
- Authors:
- ZUIDEMA Sytse, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(10), October 2009, pp.1079-1086.
- Publisher:
- Wiley
This study aimed to assess the influence of dementia severity and gender on neuropsychiatric symptoms in demented nursing home patients. It assessed a sample of Dutch nursing home patients using the Cohan-Mansfield Agitation Inventory and the Neuropsychiatric Inventory-Nursing Home version. The influence of gender and severity of cognitive decline, assessed with the Global Deterioration Scale (GDS), was investigated with correction for factors such as age, duration of institutionalisation, and psychoactive medication use. The results showed that while physically aggressive behaviour was more common in patients with very severe cognitive deterioration, disinhibition, irritability, physically non-aggressive and verbally agitated behaviour were more common in patients with moderately severe and severe cognitive decline. Physically aggressive behaviour was more common in men, whereas female patients demonstrated more verbally agitated behaviour. The study concluded that neuropsychiatric symptoms were associated with the severity of dementia, with most symptoms occurring in patients showing moderately severe cognitive decline, that only physical aggression, anxiety and apathy were more common in patients with very severe cognitive decline and that dementia severity and gender were important predictors of neuropsychiatric symptoms in this patient cohort.
Predictors of rapid cognitive decline among demented subjects aged 75 or more: (Sujet Agé Fragile - Evaluation et Suivi Cohort - SAFES)
- Authors:
- VIATONOU Saturnin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(7), July 2009, pp.709-715.
- Publisher:
- Wiley
This study aimed to identify factors predictive of rapid cognitive decline (RCD) among elderly subjects aged 75 or over suffering from dementia. The analysis concerned 250 patients drawn from the Sujet Agé Fragile - Evaluation et Suivi (SAFES) cohort, presenting a dementia syndrome at inclusion and followed-up for at least 1 year. RCD was defined as the loss of at least 3 points on the Mini-Mental State Examination (MMSE) in the follow-up period of 12 months. All patients underwent a standardised geriatric evaluation. Logistic regression was used to identify factors predictive of RCD. In the study sample, 84 patients (33.6%) presented RCD. The factors identified in multivariate analysis as predictive of RCD were: high level of education, risk of depression, and the initial MMSE score. Among subjects with a main caregiver (n = 177), the predictive factors were malnutrition or risk thereof, risk of a fall, caregiver burden and initial MMSE score. The authors conclude that as soon as dementia is diagnosed in elderly subjects, information should be collected about the subject's socioeconomic status, nutritional status, risk of falling, mood state, and caregiver burden. This would enable the provision of appropriate therapeutic care, and make it possible to adapt follow-up in case of a risk of accelerated cognitive deterioration.
Is the geriatric depression scale a reliable screening tool for depressive symptoms in elderly patients with cognitive impairment?
- Authors:
- DEBRUYNE Hans, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(6), June 2009, pp.556-562.
- Publisher:
- Wiley
This study aimed to determine the reliability of the 30-item Geriatric Depression Scale (GDS-30) for the screening of depressive symptoms in dementia and mild cognitive impairment (MCI) using the Cornell Scale for Depression in Dementia (CSDD) as the gold standard. Participants, diagnosed according to strictly applied clinical diagnostic criteria, with MCI (n = 156) and probable Alzheimer's disease (AD) (n = 247) were included. GDS-30, CSDD, Mini Mental State Examination (MMSE) and Global Deterioration Scale were assessed in all patients at inclusion. The AD group was divided in three subgroups: mild AD, moderate AD and severe AD. In MCI patients, moderate but highly significant correlations were found between GDS-30 and CSDD scores. In mildly, moderately and severely affected AD patients, only weak correlations between GDS-30 and CSDD scores were calculated. ROC curve analysis showed that sensitivity and specificity values of respectively 95% and 67% were achieved when a GDS-30 cut-off score of 8 was applied in MCI patients. In AD patients, too low sensitivity and specificity values did not allow selecting an optimal cut-off score by means of ROC curve analysis. Using the CSDD as gold standard, the authors demonstrated that the GDS-30 is a reliable screening tool for depressive symptoms in MCI but not in AD patients.
Factors associated with depression in Norwegian nursing homes
- Authors:
- LAGE BARCA Maria, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(4), April 2009, pp.417-425.
- Publisher:
- Wiley
This study aimed to confirm or reject the hypothesis that depression in nursing homes is associated with worse medical health, cognitive and functional impairment. A sample of 902 randomly selected nursing-home patients was assessed using the Cornell Scale, the Clinical Dementia Rating Scale (CDR) the Self-Maintenance Scale and a general measurement of medical health. Additionally, information was collected from the patients' records. A multiple linear regression was performed with the Cornell Scale total score, and mood and non-mood subscale scores as the dependent variables. In the adjusted analysis, depression according to the Cornell total score was associated with worse medical health (strongest) and worse cognitive impairment, but not with worse functional impairment. The mood subscale score was associated with worse medical health, being unmarried and female gender, but not with worse cognitive impairment. The non-mood subscale score was correlated with cognitive impairment, worse medical health, younger age, digestive diseases and not having suffered from stroke. The hypothesis was partially confirmed. Worse general medical health was the strongest factor associated with depression, followed by degree of cognitive impairment. Cognitive impairment was not associated with the mood subscale score, but was the strongest correlate for the non-mood symptoms of the Cornell Scale.
Does dementia predict adverse hospitalization outcomes? A prospective study in aged inpatients
- Author:
- ZEKRY Dina
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(3), March 2009, pp.283-291.
- Publisher:
- Wiley
This study assesses the relative value of dementia for predicting hospitalization outcomes, taking into account comorbidity, functional and nutritional status in 435 inpatients (age 85.3 ± 6.7; 207 cognitively normal, 48 with mild cognitive impairment and 180 demented) from the acute and rehabilitation geriatric hospital of Geneva. Hospitalization outcomes (death in hospital, length of stay, institutionalisation and formal home care needs) were predicted using logistic regression models with sociodemographic characteristics, cognitive status, comorbid Charlson index-CCI, functional and nutritional status as independent variables. Moderate and severe dementia and poor physical function strongly predicted longer hospital stay, institutionalization and greater home care needs in univariate analyses. CCI was the best single predictor, with a four-fold difference in mortality rates between the highest and lowest scores. In multivariate analysis, the best predictor of institutionalisation was dementia, whereas the best predictor of death in hospital or longer hospital stay was higher comorbidity score, regardless of cognitive status. Functional status was the best predictor of greater home care needs. Dementia in very old medically ill inpatients was predictive only of discharge to a nursing home. Higher levels of comorbidity and poor functional status were more predictive than dementia for the other three hospitalization outcomes. Thus, comorbid medical conditions, functional and nutritional status should be considered, together with cognitive assessment, when predicting hospitalization outcome.
Anxiety symptoms in mild cognitive impairment
- Authors:
- ROZZINI Luca, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(3), March 2009, pp.300-305.
- Publisher:
- Wiley
This study aimed to validate the Italian version of Geriatric Anxiety Inventory (GAI), an instrument that measures dimensional anxiety in elderly people, and assess whether MCI subjects with anxiety symptoms show different neuropsychological profiles in comparison with MCI without anxiety symptoms. Fifty-seven outpatients with MCI were consecutively recruited. All patients were assessed using a complete neuropsychological battery to detect the cognitive impairment, and the GAI for the presence of anxiety symptoms. Anxiety + patients (GAI 10) show more behavioral and psychological disturbances than patients with Anxiety- (GAI < 10); in particular they had more agitation, anxiety, depression and more sleep disorders. Moreover, Anxiety + patients are more compromised on instrumental daily functions and on executive functions evaluated with Trail Making B test (TMB). Linear Regression analysis was completed to estimate the coefficients of the linear equation, involving neuropsychological, psychobehavioural and functional characteristics: the executive functions (TMB) are the only variable independently related to the presence of anxiety disturbances. It is concluded that executive functions are independently related to anxiety disorders in MCI patients. It is hypothesized that the strict interaction between anxiety symptoms and executive functions could depend on specific pathological features at the level of caudate nucleus characterizing early phases of dementia.
Memory loss, depression, 'confusion' and dementia
- Author:
- COUNSEL AND CARE
- Publisher:
- Counsel and Care
- Publication year:
- 2009
- Pagination:
- 36p.
- Place of publication:
- London
Factsheet for older people and their carers. Information includes why they may experience memory loss, depression and confusion, different types of dementia, what can be done to help older people and carers cope with illness.