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Cognitive and functional neuroimaging correlate for anosognosia in Mild Cognitive Impairment and Alzheimer's disease
- Authors:
- VOGEL Asmu, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(3), March 2005, pp.238-246.
- Publisher:
- Wiley
To investigate the correlation between anosognosia and behavioural symptoms, performance on executive tests, and frontal cortex regional cerebral blood flow (rCBF) in patients with amnestic mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). From a prospective Memory Clinic cohort including consecutively referred patients, age 60 years or above, and with MMSE score 20 or above, 36 patients with AD and 30 with MCI were included in this study. Anosognosia was assessed using a categorical scale and discrepancy scores between patients' and relatives' reports on a 20-item Memory Questionnaire (MQ). Behavioural symptoms were assessed with Frontal Behavioural Inventory (FBI). Executive functions were examined with a range of neuropsychological tests. Tc99m-HMPAO SPECT was obtained in an unselected sample of 55 of the 66 patients, and rCBF was analysed in six cortical frontal regions. Insight was equally impaired in the two patient groups. A significant correlation was found between impaired awareness and dementia severity (MMSE). Discrepancy-scores on the MQ were significantly correlated to scores on FBI and to rCBF in the right inferior frontal gyrus, but not to executive tests. The groups classified by the categorical ratings full, shallow and no awareness were not characterized by differences in behavioural symptoms, executive performance or frontal rCBF. Impaired awareness is associated with behavioural symptoms and may reflect functional impairment in the right inferior frontal cortex.
Conceptualisation of mild cognitive impairment: a review
- Authors:
- DAVIS Heather S., ROCKWOOD Kenneth
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(4), April 2004, pp.313-319.
- Publisher:
- Wiley
Several factors have prompted renewed interest in the concept of declines in cognitive function that occur in association with aging, in particular the area between normal cognition and dementia. We review the changing conceptualization of what has come to be known as mild cognitive impairment (MCI) in an effort to identify recent developments and highlight areas of controversy. Standard MEDLINE search for relevant English-language publications on mild cognitive impairment and its associated terms, supplemented by hand searches of pertinent reference lists. Many conditions cause cognitive impairment which does not meet current criteria for dementia. Within this heterogenous group, termed Cognitive Impairment, No Dementia (CIND), there are disorders associated with an increased risk of progression to dementia. Still, the conceptualization of these latter disorders remains in flux, with variability around assumptions about aging, the relationship between impairment and disease, and how concomitant functional impairment is classified. Amongst patients with MCI, especially its amnestic form, many will progress to Alzheimer's disease (AD). In contrast with clinic-based studies, where progression is more uniform, population-based studies suggest that the MCI classification is unstable in that context. In addition to Amnestic Mild Cognitive Impairment (AMCI), other syndromes exist and can progress to dementia. For example, an identifiable group with vascular cognitive impairment without dementia shows a higher risk of progression to vascular dementia, Alzheimer's disease and mixed dementia. Recent attempts to profile patients at an increased risk of dementia suggest that this can be done in skilled hands, especially in people whose symptoms prompt them to seek medical attention. Whether these people actually have early AD remains to be determined. The more narrowly defined MCI profiles need to be understood in a population context of CIND.
Assessing the cognitive abilities that differentiate patients with Alzheimer's disease from normals: single and multiple factor models
- Authors:
- OWNBY Raymond L., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(3), March 2004, pp.232-242.
- Publisher:
- Wiley
Understanding the structure of cognitive abilities in Alzheimer's disease (AD) has considerable practical and theoretical importance. Some investigators have argued that a single cognitive process underlies the deficits seen in AD, while others have argued for multiple cognitive processes. As deficits in cognitive abilities may reflect the pathological process or processes occurring in AD, determination of the structure of abilities in AD is important. The purpose of this study was to assess the utility of single and multiple ability factor models in differentiating patients with AD from normals. Findings show that although a single factor model accounts for a large part of the variability of a battery of measures used to differentiate patients and normals, a multiple factor model performed substantially better based on multiple fit criteria. At least in this sample, a multiple ability factor model of cognitive abilities fit data better than a single factor model in differentiating patients with AD from normals.
Poor mental and physical health differentially contributes to disability in hospitalized geriatric patients of different ages
- Authors:
- MARENGONI Alessandra, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(1), January 2004, pp.27-34.
- Publisher:
- Wiley
This article seeks to evaluate the relationship between depressive symptoms, cognition and somatic diseases on functional status of geriatric patients at hospital discharge. Patients 65+ years consecutively admitted to the acute care geriatric ward of the Internal Medicine Department I, Civil Hospital of Brescia, Italy, from February 1998 to December 2000 (n = 830) were examined. Functional disability was defined as need of physical assistance in at least one of the basic Activities of Daily Living (ADL). The Greenfield Index of Disease Severity (IDS) and the Geriatric Index of Comorbidity (GIC) were used to measure number and severity of diseases. The Mini-Mental State Examination (MMSE) assessed cognitive status and the Geriatric Depression Scale (GDS) measured depressive symptoms. Prevalence of functional disability at discharge was 29.3% in the younger age group (65-74 years) and 55.2% in the older age group (75+ years). Using logistic regression models, older age, poorer cognitive status, and depressive symptoms were independently associated with functional disability in the younger and older age group, respectively. Additionally cognitive impairment and depressive symptoms showed an additive association with disability, especially in younger patients, while comorbidity was correlated with functional status only in the oldest old, in particular among those who were cognitively impaired. Functional disability after acute hospitalization is highly prevalent in geriatric patients. Depressive symptoms, comorbidity, and cognitive impairment often coexist, interact and are differentially associated with function depending on age. Considering that depressive symptoms are a modifiable problem, their detection in hospital settings may help clinicians in targeting subjects at high risk of functional disability.
Visuospatial impairment in dementia with Lewy bodies and Alzheimer's disease: a process analysis approach
- Authors:
- SIMARD Martine, VAN REEKUM Robert, MYRAN David
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(5), May 2003, pp.387-391.
- Publisher:
- Wiley
Reports of differential impairments on visual-construction tasks in dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) are sometimes controversial, whereas visual-perceptual data are lacking. The existence of different clinical sub-groups of DLB has been hypothesized to explain the discrepancies among the cognitive results. The goal of this study was to compare the visual-perceptual performance of subjects with DLB with predominant psychosis, DLB with predominant parkinsonian features and AD. This is a cross-sectional neuropsychological study with between diagnostic group comparisons. The Benton Judgement Line Orientation (BJLO) test was administered to four DLB patients with predominant psychosis (DLB-psy), four DLB subjects with predominant parkinsonian features (DLB-PD), and 13 patients with AD. An analysis of error types was applied to the results of the BJLO with QO1, QO2, QO3, QO4 (visual attention) errors, as well as VH, IQO, IQOV, and IQOH (visual-spatial perception) errors. A MANOVA showed significant differences between the DLB, and AD groups on the number of VH (F = 6.049, df = 1,19, p = 0.024), IQOH (F = 4.645, df = 1,19, p = 0.044) and QO1 (F = 4.491, df = 1,19, p = 0.047) errors, but no difference on the total score of the BJLO. Another MANOVA and post hoc Student-Newman-Keuls analyses demonstrated that the DLB-psy sub-group made significantly more VH and IQOH errors than AD and the DLB-PD subjects. Subjects with DLB and psychosis have more severe visual-perception (VH errors) impairments than subjects with DLB and predominant parkinsonian features, and AD subjects.
Defining 'early dementia' and monitoring intervention: what measures are useful in family caregiving?
- Authors:
- RICHARDS K., et al
- Journal article citation:
- Aging and Mental Health, 7(1), January 2003, pp.7-14.
- Publisher:
- Taylor and Francis
Measures of cognition are often used to define and measure the progress of dementia and outcomes of intervention. This paper examines whether measures of psychosocial disability used with those of cognition are more useful than measures of cognition alone, particularly in early dementia. A measure of cognition and two instruments of caregiver burden, used as routine clinical outcome measures of three types of Old Age Psychiatry dementia services, were examined. The use of psychosocial measures of disability in conjunction with those of cognition, are important in the definition and longitudinal measurement of intervention and support in early dementia.
Fluctuating awareness and the breakdown of the illness narrative in dementia
- Author:
- PHINNEY Alison
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 1(3), October 2002, pp.329-344.
- Publisher:
- Sage
Examines how awareness of dementia symptoms fluctuates over time and circumstance, thus forcing the breakdown of the illness narrative. Five women and four men with mild to moderate Alzheimer's disease participated in this study along with their family caregivers. In-depth interviews and participant observations were conducted with each individual and their caregiver to gather data about the person's understanding of their symptoms. Findings illustrate how symptoms may be salient, or vague and inconspicuous; symptoms may be forgotten, or they may be entirely absent for the person. Experiencing symptoms in all of these ways means that it is difficult for people to articulate a narrative understanding of what is happening in their lives.
Intentions of first-degree relatives of patients with Alzheimer's disease to seek a cognitive status examination
- Authors:
- WERNER Peerla, HEINIK Jermia
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(5), May 2004, pp.479-486.
- Publisher:
- Wiley
The aim of the present study was to examine the factors influencing intentions to seek a cognitive status evaluation among first-degree relatives of persons with Alzheimer's disease. Phone interviews were conducted with 93 first-degree relatives of persons with Alzheimer's disease, recruited from a large memory clinic. Intentions to seek a cognitive status examination were examined by asking participants to rate their willingness to seek a cognitive status examination during the next year and during the next five years. Independent variables included participants' and patients' characteristics, caregiving characteristics, knowledge about AD, worries about memory problems, and perceptions of the benefits and barriers of seeking a cognitive status examination. Overall, first-degree relatives reported only moderate intentions to seek a cognitive status examination. Their willingness to seek an examination was related to the characteristics of the first-degree relative (income and subjective memory), the characteristics of the patients (behavioral problems), the caregiving characteristics (primary caregiver), and to the perceptions of barriers associated with the examination. These findings stress the complexity of the decision-making process confronting first-degree relatives regarding their intentions to seek a cognitive status examination, and suggest the need to provide information to reach an informed decision.
The Apathy Inventory: assessment of apathy and awareness in Alzheimer's disease, Parkinson's disease and mild cognitive impairment
- Authors:
- ROBERT P. H., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 17(12), December 2002, pp.1099-1105.
- Publisher:
- Wiley
This study was designed to establish the validity and reliability of the apathy inventory (IA), a rating scale for global assessment of apathy and separate assessment of emotional blunting, lack of initiative, and lack of interest. Information for the IA can be obtained from the patient or from a caregiver. The authors evaluated 115 subjects using the IA, consisting of 19 healthy elderly subjects, 24 patients with Mild Cognitive Impairment (MCI), 12 subjects with Parkinson's disease (PD) and 60 subjects with Alzheimer's disease (AD). Internal consistency, item reliability, and between-rater reliability were high. A test-retest reliability study demonstrated that caregiver responses to IA questions were stable over short intervals. A concurrent validity study showed that the IA assesses apathy as effectively as the Neuro Psychiatric Inventory apathy domain. In the caregiver-based evaluation, AD subjects had significantly higher scores than controls, both for global apathy score and for the lack of interest dimension. When the AD patients were subdivided according to diagnostic criteria for apathy, apathetic patients had significantly higher scores than non apathetic patients. With the patient-based evaluations, no differences were found among the AD, MCI and control groups. The scores in the patient-based evaluations were only higher for the PD group versus the control subjects. The results also indicated that AD patients had poor awareness of their emotional blunting and lack of initiative.