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Taking a positive spin: preserved initiative and performance of everyday activities across mild Alzheimer's, vascular and mixed dementia
- Authors:
- GIEBEL Clarissa M., BURNS Alistair, CHALLIS David
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(9), 2017, pp.959-967.
- Publisher:
- Wiley
Objectives: The literature commonly evaluates those daily activities which are impaired in dementia. However, in the mild stages, people with dementia (PwD) are still able to initiate and perform many of those tasks. With a lack of research exploring variations between different dementia diagnoses, this study sought to investigate those daily activities with modest impairments in the mild stages and how these compare between Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia. Methods: Staff from memory assessment services from nine National Health Service trusts across England identified and approached informal carers of people with mild dementia. Carers completed the newly revised Interview for Deteriorations in Daily Living Activities in Dementia 2 assessing the PwD's initiative and performance of instrumental activities of daily living (IADLs). Data were analysed using analysis of variance and Chi-square tests to compare the maintenance of IADL functioning across AD, VaD, and mixed dementia. Results: A total of 160 carers returned the Interview for Deteriorations in Daily Living Activities in Dementia 2, of which 109, 21, and 30 cared for someone with AD, VaD, and mixed dementia, respectively. There were significant variations across subtypes, with AD showing better preserved initiative and performance than VaD for several IADLs. Overall, PwD showed greater preservation of performance than initiative, with tasks such as preparing a hot drink and dressing being best maintained. Conclusion: Findings can help classify dementia better into subtypes in order to receive bespoke support. It suggests that interventions should primarily address initiative to improve overall functioning. (Publisher abstract)
Measuring disability in patients with neurodegenerative disease using the Yesterday Interview
- Authors:
- LOMAX Claire L., BROWN Richard G., HOWARD Robet J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1058-1064.
- Publisher:
- Wiley
The aim was to illustrate the use of time-budget methodology as a means of measuring disability within the framework of the World Health Organisation (WHO) International Classification of Functioning, Disability and Health (ICF) in a mixed group of patients with neurodegenerative disease. A semi-structured interview method (the Yesterday Interview) was used to reconstruct the preceding 24-hour period in terms of activity, social and environmental context, and subjective enjoyment. Data were collected on 40 elderly control subjects and a sample of 99 community based patients diagnosed with either Parkinson's disease without or with dementia, Alzheimer's disease, Dementia with Lewy bodies, Progressive Supranuclear Palsy or Multiple System Atrophy. All participants were seen in their own home. The results were translated hierarchically into the ICF framework of disability domains, and further into a higher level formulation based on the constructs of discretionary/obligatory activity. Disability profiles were obtained for the patient group as a whole and for the individual disorders. Restricted patterns of time-use were noted across a range of domains encompassing both obligatory and discretionary activity, and accompanied by a significant increase in passive activity such as day-time sleeping or sitting in front of the television. The data also illustrated the restrictions in both the social and environmental contexts of the patient's lives, and the diminished levels of subjective enjoyment associated with their pattern of daily time-use. With the exception of time spent on discretionary activities, these various indices were significantly associated with standard clinical measures disability. With further studies to assess reliability and validity, time-use and contextual data obtained from structured interviews may provide a useful means of measuring disability within the ICF framework in patients with degenerative neurological disease.
Predictors of circadian sleep-wake rhythm maintenance in elders with dementia
- Authors:
- SULLIVAN S. C., RICHARDS K. C.
- Journal article citation:
- Aging and Mental Health, 8(2), March 2004, pp.143-152.
- Publisher:
- Taylor and Francis
Minimal data exists to predict which elders with dementia in nursing homes will maintain circadian sleep-wake rhythms during senescence and which elders with dementia in nursing homes will experience sleep-wake rhythm deterioration. This circadian deterioration is one of the background factors identified in the Needs-driven Dementia-compromised Behavior Model. The objective of this study was to determine predictors of circadian sleep-wake rhythm maintenance in elders with dementia residing in nursing homes. This secondary analysis identifies predictors of maintaining circadian sleep-wake rhythm in a convenience sample of 171 elders with dementia residing in seven nursing homes in the Southern United States. An autocorrelogram of the circadian sleep-wake rhythm for each participant determined whether or not the rhythm had deteriorated. Using measures of depression, cognitive function, physical and psychosocial activity, medications, and sleep apnea, as well as demographic characteristics of the sample, logistic regression determined the best predictors of rhythm maintenance. The best predictors of circadian sleep-wake rhythm maintenance in elders with dementia residing in nursing homes were physical activity (p = 0.00) and psychosocial activity (p = 0.00). The interaction term between these variables was not significant (p = 0.24). These findings suggest that providing meaningful daytime physical and psychosocial activity may assist in maintaining circadian sleep-wake rhythmicity. Additional research is needed to determine if these interventions would improve circadian sleep-wake rhythm in elders with dementia residing in nursing homes.
Using the life course perspective to study the entry into the illness trajectory: the perspective of caregivers of people with Alzheimer's disease
- Authors:
- CARPENTIER Normand, et al
- Journal article citation:
- Social Science and Medicine, 70(10), May 2010, pp.1501-1508.
- Publisher:
- Elsevier
Although the research community shows increased interest in the analysis of the care trajectory of people with chronic health problems, especially dementias such as Alzheimer's disease, there is little research on the initial phases of the care trajectory. The first symptoms of dementia are normally noticed by those surrounding the elderly person, which suggests that the recognition of the disease is linked to interactions amongst family members, friends, neighbours and health professionals. This study, focusing on the period beginning with the first manifestations of cognitive difficulties and ending with the diagnosis of Alzheimer-type dementia, interviews 60 caregivers in Montreal, Canada, which were used to reconstruct how older people with Alzheimer-type dementia enter into the care trajectory. Methods consisted of the analysis of social networks, social dynamics and action sequences. Findings are presented in the form of a typology comprised of 5 pathways of entries into the care trajectory that are structured around the following four principles of the Life Course Perspective: family history, linked lives, human agency and organisational effects. The authors suggest that analyses of the initial phases of the care trajectory, such as this one, are essential for the application of effective early detection and intervention policies. They are also central to informing future studies that seek to understand the care experience in its entirety.
The diagnostic value of IADL evaluation in the detection of dementia in general practice
- Authors:
- DE LEPELEIRE J., et al
- Journal article citation:
- Aging and Mental Health, 8(1), January 2004, pp.52-57.
- Publisher:
- Taylor and Francis
It is assumed that general practitioners can make an important contribution to the diagnosis of dementia. One of the used strategies comprises an evaluation of the Instrumental Activities of Daily Living (IADL). There are contradictory data on the value of this strategy. During one month, 21 Flemish general practitioners evaluated the IADL capacities of all subjects older than 65 years with whom they had contact. Subjects with dementia and/or living in a residential home for the elderly were excluded. Housing and living conditions, medication use and IADL were registered. The general practitioner formulated a clinical evaluation. All subjects with an IADL score 1 and a random sample from the group IADL = 0 underwent a Mini Mental State Examination. Subjects with an IADL score = 4 were referred for neuropsychological and specialist examination. The average age of the 1003 registered subjects was 75.1 years (SD = 6.8). A large majority of them (85%) were totally independent. There was a large discrepancy between the family's and the patient's judgment on the presence of memory problems. There was an inverse correlation between the IADL and MMSE: when the IADL score increased, the MMSE score fell. The diagnostic value of the IADL for the diagnosis of dementia with Camdex-N as a reference standard could not be evaluated because the number of tested subjects was too small. Against the MMSE, sensitivity was 0.81 (SE = 0.03), and specificity was 0.48 (SE = 0.05). The evaluation of the IADL activities had some drawbacks as a detection method for dementia but the use of IADL data may still be clinically valuable in general practice. The correlation between the general practitioner's judgment and that of the specialist was very good. This study showed that the use of the IADL score might change the general practitioner's diagnostic judgment. Furthermore this study confirms the existence of a major threshold for the referral to a specialist of patients with suspected dementia by general practitioners.
Anxiety disorder and accompanying subjective memory loss in the elderly as a predictor of future cognitive decline
- Authors:
- SINOFF Gary, WERNER Perla
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(10), October 2003, pp.951-959.
- Publisher:
- Wiley
The aim of the study was to empirically investigate the hypothesis that anxiety in the elderly, secondary to loss of memory, predicts future cognitive decline. The participants were 137 elderly subjects with no depression or cognitive impairment from a community geriatric assessment unit, 45% with anxiety. In addition to demographic characteristics, cognitive status was assessed using the Mini Mental State Examination; depression was assessed by Tucker's short Interviewer-Assisted Depression Rating Scale; anxiety by Sinoff's Short Anxiety Screening Test and Activities of Daily Living function by Shah's modified Barthel's Index. At follow-up 37 persons had dropped out, leaving 100 participants for final analysis. Mean re-examination time was 3.2 years with no group differences. The mean MMSE and modified Barthel scores decreased significantly more in those with anxiety. A relative risk of 3.96 for developing future cognitive impairment was found. Regression analysis showed that only anxiety was a significant predictor of cognitive decline. By path analysis, a more parsimonious model showed anxiety to have both a direct and an indirect effect on predicting future cognitive decline, and that the effect of loss of memory on cognitive decline was via anxiety. Anxiety is inter-related and inseparable with loss of memory and its presence is a strong predictor for future cognitive decline, directly or indirectly via depression. It appears that loss of memory is the initial problem with consequent development of anxiety. Therefore, anxiety, like depression, is probably an early predictor of future cognitive decline and even possible future cognitive impairment.
Alternative statistical approaches to identifying dementia in a community-dwelling sample
- Authors:
- KUCHIBHATLA M., FILLENBAUM G. G.
- Journal article citation:
- Aging and Mental Health, 7(5), September 2003, pp.383-389.
- Publisher:
- Taylor and Francis
Little attention has been paid to examining the extent to which alternative statistical models may facilitate identification of persons with dementia. Using a sub-sample of the Duke Established Populations for Epidemiologic Studies of the Elderly, two analytical approaches were compared: logistic regression (which focuses on identifying specific characteristics predictive here of dementia), and recursive partitioning methods using tree-based models (which permit identification of the characteristics of those groups with high dementing disorder). In the stepwise multiple logistic regression model which included as potential predictors, gender, age, history of chronic health conditions, scales of basic and instrumental activities of daily living (IADL), and cognitive status, only IADL and cognitive status were significant predictors, with cognitive status the single most important factor. The classification tree approach, which permits identification of the characteristics of those groups with particularly high dementia rates, identified cognitive status as the most important criterion for dementia (as did logistic regression analysis). Among those without cognitive impairment, older age was a risk factor, confirming findings consistently reported in the literature. Among the cognitively impaired, IADL was an important risk factor. Those with five or more IADL problems were further classified into two risk groups, based on number of ADL problems. While classification tree analysis encourages identification of groups at risk, logistic regression encourages targeting of specific characteristics.