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The link between depressive symptoms, negative cognitive bias and memory complaints in older adults
- Authors:
- CRANE M. K., et al
- Journal article citation:
- Aging and Mental Health, 11(6), November 2007, pp.708-715.
- Publisher:
- Taylor and Francis
This American study sought to examine the relationship between depressive symptoms and subjective memory problems. The authors hypothesized that the relationship between depressive symptoms and poor subjective memory functioning is mediated by negative cognitive bias that is associated with hopelessness, a wish to die and low self-esteem. Complete data were available for 299 older adults with and without significant depressive symptoms who were screened in primary care offices and invited to participate, completed a baseline in-home assessment. Subjective memory functioning and psychological status was assessed with commonly used, validated standard questionnaires. In regression models that included terms for age, gender and cognitive measures, depressive symptoms were significantly inversely associated with the global self-assessment of memory. When components of negative cognitive bias were included in the model (hopelessness, low self-esteem, a wish to die), the relationship of depressive symptoms with subjective memory problems was attenuated, consistent with mediation. The results suggest that assessment and successful interventions for memory complaints in non-demented older adults need to account for negative cognitive bias as well as depressive symptoms. Longitudinal research is needed to confirm these findings before a mediator relationship can be presumed.
Cognitive functioning in elderly patients with early onset bipolar disorder
- Authors:
- SCHOUWS S. N. T. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(9), September 2007, pp.856-861.
- Publisher:
- Wiley
Very little is known about the long term cognitive sequelae of bipolar disorder. The aim was to investigate neuropsychological functioning in older euthymic persons with early onset bipolar disorder. Fifteen older patients (age >60) with an early onset (<50 years) bipolar-I disorder in a euthymic mood were tested using a comprehensive neuropsychological test battery. Neuropsychological functioning was compared with that of a sex, age and education-matched group of 15 comparison subjects without mood disorders or memory complaints. Bipolar subjects scored lower than comparison subjects on selective attention, verbal memory, verbal fluency and mental effort tests. The findings suggest that euthymic bipolar patients are impaired across a range of cognitive domains. This could represent a trait-like cognitive disability related to the disease, as the impairments are comparable with those found in younger bipolar patients.
The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment
- Authors:
- DAVISON T. E., et al
- Journal article citation:
- Aging and Mental Health, 11(1), January 2007, pp.82-88.
- Publisher:
- Taylor and Francis
Previous research has demonstrated a high level of depression in nursing homes. The current study was designed to determine the prevalence of depression, using a structured diagnostic interview, among older people with and without mild-moderate cognitive impairment residing in low-level care facilities. The results demonstrated that, consistent with previous research in nursing homes, 16.9% of older people were diagnosed with major depressive disorder. Less than half of these cases had been detected or treated. Individuals with moderate cognitive impairment were more likely to be depressed, but cognitive impairment did not appear to act as a strong impediment to the detection of depression by general practitioners. A low awareness of their use of antidepressant medications was demonstrated among older people prescribed this treatment, including those with normal cognitive function. Reasons for the poor recognition of depression among older people are discussed.
Cognitive plasticity in people at risk for dementia: Optimising the testing-the-limits-approach
- Authors:
- SCHREIBER M., SNEIDER R.
- Journal article citation:
- Aging and Mental Health, 11(1), January 2007, pp.75-81.
- Publisher:
- Taylor and Francis
A topic of great interest in gerontology research is the prediction of cognitive deterioration which marks the transition from mild cognitive impairment (MCI) to dementia. In this area, the term cognitive plasticity can be of great interest. We examined the utility of the Adaptive Figure Series Learning Test (ADAFI) to evoke cognitive plasticity and to show whether reduced plasticity can be found in people with MCI. In a pre-test–intervention–post-test design, intervention with the ADAFI was compared to an unspecific brain jogging task in MCI participants and healthy controls. A total of 42 subjects were included. Independent of mental health status only using the ADAFI led to pronounced improvements in post-test performances, but MCI participants profited less from the intervention with the ADAFI than healthy controls, that is, showed lower cognitive plasticity. Thus, the overlap in performance distributions between healthy participants and MCI individuals at pre-test was reduced at the time of post-test once the ADAFI had been given as intervention. The findings of the present article indicate that plasticity oriented information can be gained when the ADAFI is given as an intervention in a pre-test–training–post-test-design. The cognitive plasticity approach seems potentially useful for purposes of early identification of dementia.
Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents
- Authors:
- PAGUAY Louis, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(4), April 2007, pp.286-293.
- Publisher:
- Wiley
This study aimed to compare the diagnostic accuracy of an outcome measurement scale of the Minimum Data Set of the Resident Assessment Instrument for nursing homes (MDS/RAI-NH), the Cognitive Performance Scale (CPS) and the Mini-Mental State Exam (MMSE) for the detection of cognitive impairment. The Cambridge Examination for Mental Disorders of the Elderly - Revised (CAMDEX-R) was used as the reference standard. This study was part of a larger prospective study (QUALIDEM) involving a diagnostic procedure and two-year follow-up on the quality of primary care for demented patients. CAMDEX-R and MDS/RAI-NH were administered to 198 residents, aged 65 or more, living in 42 low and high care institutions for older people in Belgium. Main outcome measures used were indicators of diagnostic accuracy: sensitivity, specificity, predictive values, likelihood ratios, odds ratio and area under receiver operating characteristics curve (AUC). The CAMDEX-based prevalence of cognitive impairment was 75%. The results found that CPS and MMSE demonstrated similar performance to detect cognitive impairment in nursing home residents.
Group reminiscence therapy for cognitive and affective function of demented elderly in Taiwan
- Author:
- WANG Jing Jy
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(12), December 2007, pp.1235-1240.
- Publisher:
- Wiley
Elderly people with cognitive impairments are often associated with depressed mood and are heavy consumers in both medical services and need in caregivers. Reminiscence is believed to be effective in improving the cognition and mood of demented people. This study tested the hypothesis that structured group reminiscence therapy can prevent the progression of cognitive impairment and enhance affective function in the cognitively impaired elderly. A randomized controlled trial (RCT) based on a two group pre- and post-test design was used. The experimental subjects underwent eight group sessions, one session per week. The measurements were performed using Mini-Mental State Examination (MMSE), Geriatric Depression Scale short form (GDS-SF), and Cornell Scale for Depression in Dementia (CSDD). The sample consisted of 102 subjects, with 51 in the experimental group and 51 in the control group. Results demonstrated that the intervention significantly affected cognitive function and affective function as measured by MMSE and CSDD (p = 0.015 and 0.026), indicating that the cognitive function of the experimental subjects increased and their depressive symptoms diminished following intervention. Participation in reminiscence activities can be a positive and valuable experience for demented older persons. Consequently, the development of a structured care program for elderly persons with cognitive impairment and the need for long-term care is essential. Thus, health providers in long-term care facilities should be trained in reminiscence group therapy, and to be able to deliver such a program to the targeted group.
Alone and confused: community-residing older African Americans with dementia
- Authors:
- EDWARDS Dorothy F., MORRIS John C.
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 6(4), November 2007, pp.489-488.
- Publisher:
- Sage
Despite significant increases in the number of adults who live alone, little is known about adults with cognitive impairment who live without co-resident caregivers. This study examined demographic, cognitive, and functional characteristics and service use patterns of a sample (N = 343) of older community-residing African Americans with dementia who were referred for assessment. Of this group, 52 percent (179) lived alone. Adults who lived alone were compared with those who had co-resident caregivers to determine differences in cognitive and functional status and formal service use. Comprehensive multidisciplinary assessment included diagnosis and staging of dementia, status evaluation of activities of daily living and instrumental activities of daily living, and informal and formal support. Adults living alone had significantly more caregivers than those with co-resident caregivers. Neighbours and friends were more common primary care providers for live-alone adults. A significant proportion of adults had inadequate care, given their cognitive and functional deficits. Although formal service use was low in both groups, live-alone adults were more likely to receive social services than were adults with a co-resident caregiver. Predictors of formal service use included the presence of a caseworker, Medicaid certification, mild dementia, and living alone. The results indicate the need for better identification of, and supportive services for, older African Americans with dementia who live alone.
Memory impairment among primary care veterans
- Authors:
- CHODOSH Joshua, et al
- Journal article citation:
- Aging and Mental Health, 11(4), July 2007, pp.444-450.
- Publisher:
- Taylor and Francis
Memory impairment is the most frequent cognitive dysfunction for older patients. Though studies have shown that dementia is often overlooked in primary care settings, there has been minimal focus specifically on memory impairment, on patients' concerns about memory, or their desire to address these concerns. The objectives of this study were to (1) investigate the prevalence of memory impairment among patients without dementia diagnoses, (2) determine the degree of patients' concern about memory impairment and (3) identify other patient characteristics associated with memory impairment among older primary care patients. Using telephone versions of a four-item memory test and proxy-reported cognitive decline for patients unable to complete interviews, a memory assessment of randomly selected patients, 75 years and older, without dementia diagnoses who see primary care physicians at least twice every six months was performed. Among 260 patients and 20 proxies, 19.8% had memory impairment at a level indicative of probable dementia. Adjusting for age, ethnicity, and education, subjects who were more concerned about memory impairment were more likely to be impaired. (Adjusted odds ratio [AOR]: 1.4 (for each additional level of concern); 95% confidence interval [CI]: (1.0-2.0)). Similarly, subjects wanting their physician to discuss with them their memory concerns were more likely to be impaired (AOR: 1.4; 95% CI: 1.0-1.9). Memory impairment is common among older primary care patients without diagnosed dementia. Knowing patients' concerns about memory impairment and their desire to discuss these concerns may facilitate cognitive screening in this setting.
The Weigl Colour-Form Sorting Test: a quick and easily administered bedside screen for dementia and executive dysfunction
- Authors:
- HOBSON Peter, MEARA Jolyon, TAYLOR Carolyn
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(9), September 2007, pp.909-915.
- Publisher:
- Wiley
Screening for cognitive impairment in hospital and the community requires a valid, reliable, concise, well tolerated, easily administered instrument. In this investigation, we have studied a non-verbal cognitive screening instrument; Weigl's Colour-Form Sorting Test (WCFT), to determine its utility as a brief cognitive screen in a community based sample of stroke survivors, Parkinson's disease (PD) patients and age/sex matched controls. A total of 236 subjects consented to participate in this investigation, consisting of 105 stroke survivors, 40 PD and 91 control subjects. The sensitivity and specificity of the WCFT to detect significant cognitive impairment was based upon psychiatric interview, cognitive assessment and application of DSMIV criteria. The optimal cut-point of the WCFT to detect cases of cognitive impairment was 2/4 in all of the groups in this investigation. The sensitivity and specificity of the WCFT at the cut point of 2 in the stroke survivors was 77.8% and 78.3, in the PD patients, it was 78.6% and 85.5% and, in the control group 83.3% and 94.1% respectively. The diagnostic accuracy of the WCFT as calculated by the area under the receiver operating curve was greater than 0.70 in all subject groups, which suggests that it has acceptable psychometric properties to discriminate between case and non-cases of cognitive impairment. The WCFT was able to demonstrate good sensitivity and specificity, at detecting cognitive impairments in all of the subjects. This instrument will prove to be a useful adjunct to existing cognitive screens in clinical practice, due to its excellent psychometric properties, and lack of dependency on language skills.
Behavioural disturbance triggers recognition of dementia by family informants
- Authors:
- EUSTACE A., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(6), June 2007, pp.574-579.
- Publisher:
- Wiley
This study aimed to determine the frequency for recognition of dementia by carers in a sample of community dwelling elderly people and the factors associated with recognition. People over 65 years with an AGECAT case or subcase organic diagnosis or an MMSE 23 were identified from a database of community dwelling elderly. A psychiatrist to confirm the diagnosis of dementia according to ICD-10 criteria interviewed these individuals. Sixty-two community dwelling elderly meeting ICD-10 criteria for dementia whom had reliable informants. Prior to the start of the interview the informant was questioned about whether they felt the patient had memory difficulties and if so whether they had a medical evaluation for their memory problems. A psychiatrist then interviewed the patient and informant to establish whether that patient met ICD-10 criteria for dementia. Basic sociodemographic details were collected and the following assessments were carried out: the Blessed Dementia Rating Scale, the Clinical Dementia Rating Scale, the Behave-AD and the Baumgarten Behavioural Disturbance Scale. Univariate and step-wise forward logistic regression analysis were used to examine the factors associated with recognition of memory difficulties. Twenty-nine percent of family informants of people with dementia failed to recognise a problem with their relatives' memory. Where memory difficulties were recognised only 39% of this group received a medical evaluation. Using univariate analysis recognition of memory difficulties by family informants was associated higher levels of behaviour disturbance, greater functional impairment, with increasing cognitive impairment. Using a logistic regression model, to test the independence of these variables, increasing behavioural disturbance was associated with recognition of dementia by family informants. Recognition of memory problems by family members is associated with increasing behavioural disturbance. Even with recognition of dementia, families often fail to seek medical attention. Education of the lay public on the early signs and symptoms of dementia must be a key first step in improving recognition of dementia in the community dwelling elderly.