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Journal article

The relationship between age and neurocognitive and daily functioning in adults with hoarding disorder

Authors:
DOZIER Mary E., et al
Journal article citation:
International Journal of Geriatric Psychiatry, 31(12), 2016, pp.1329-1336.
Publisher:
Wiley-Blackwell

Objective: Given the increase in hoarding symptoms with age, there is a pressing need for understanding the clinical features as they relate to potential interventions for older adults with hoarding disorder (HD). The aim of the current investigation was to explore age-related differences in the level of functional and cognitive impairment in individuals with HD. Methods: The current study utilized the baseline assessments of 122 adults with HD. Age-related differences in the raw scores of psychiatric, cognitive, and daily functioning were analyzed using a series of multiple regression models controlling for the possible age-related differences in premorbid IQ. Results: The results suggested that older adults with HD may experience increased levels of impairment in skills related to executive functioning and everyday functioning when compared with younger adults with HD. Conclusions: Given these difficulties with neurocognitive functioning, older HD patients may require interventions that focus more on behavioural and functional skills, rather than focusing on changing thought processes. (Edited publisher abstract)

Journal article

Self-management group for people with dementia

Authors:
QUINN Catherine, et al
Journal article citation:
Journal of Dementia Care, 24(5), 2016, pp.29-32.
Publisher:
Hawker

A self management approach for people with early stage dementia could be applied to help them understand the condition better, manage their memory difficulties and other challenges, and find ways of dealing with changes in their lifestyle. In this article the authors discuss findings from an evaluation of a new self-management programme, consisting of 8 weekly 90 minute group sessions. Research findings and recommendations for practice are given. (Edited publisher abstract)

Journal article

The clinical utility of naturalistic action test in differentiating mild cognitive impairment from early dementia in memory clinic

Authors:
BRUCE Irene, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 31(3), 2016, p.309–315.
Publisher:
Wiley-Blackwell

Objective: This study aimed to examine the validity of the Naturalistic Action Test in differentiating Mild Cognitive Impairment from early dementia compared to clinical diagnosis and ascertain Naturalistic Action Test cut-off points. Methods: This was a cross-sectional study of 70 consecutive patients diagnosed with Mild Cognitive Impairment attending the memory clinic in St James's Hospital, Dublin, Ireland. Patients with a diagnosis of Mild Cognitive Impairment who attended for routine annual assessment were asked to participate in the study. The Naturalistic Action Test was carried out after the patient had completed their routine assessment in the clinic. Results: The Area under the Curve, AUC ± SE was 0.808 ± 0.058, p < 0.001 with 95% CI (0.695–0.922). There was concordance in 40 and discrepancy in 30 patients between the NAT and the gold standard consensus diagnosis (PPV 38%, NPV 96%, sensitivity 94%, specificity 46% and accuracy 59%) using cut-off point of ≥14 for normal function on Naturalistic Action Test. The difference was not related to age, sex, level of education or informant. Using the Youden index, we determined a Naturalistic Action Test cut-off score of ≥11 for Mild Cognitive Impairment in our study (PPV 50%, NPV 91%, sensitivity 78%, specificity 73% and accuracy of 74%). There was discrepancy in 18 patients using the new cut-off point (≥11 for Mild Cognitive Impairment vs ≤10 for dementia). Conclusion: The Naturalistic Action Test is a useful tool that can increase diagnostic accuracy in differentiating Mild Cognitive Impairment from early dementia. (Publisher abstract)

Journal article

Mild cognitive impairment in Parkinson's disease and its progression onto dementia: a 16-year outcome evaluation of the Denbighshire cohort

Authors:
HOBSON Peter, MEARA Jolyon
Journal article citation:
International Journal of Geriatric Psychiatry, 30(10), 2015, pp.1048-1055.
Publisher:
Wiley-Blackwell

Objective: Mild cognitive impairment in Parkinson's disease (PD-MCI) has been suggested to be a predictor for the development of PD dementia (PDD). This study explored the incidence and possible neuropsychological domain differences between PD patients with PD-MCI and without cognitive impairment (normal cognitive function with PD), on the basis of the Movement Disorders Task Force Guidelines for PD-MCI. Methods: At baseline (T1), 4 years (T2) and 6 years (T3), 166 patients with PD were administered global neuropsychological assessments. At 16 years, case note and neuropsychological assessment review was employed to calculate the number of patients who had progressed to PDD. Results: At baseline, 68 patients were classified as normal cognitive function with PD, 18 with PD-MCI and 80 with PDD. At T2, 12 of the PD-MCI cohort at T1 had progressed to PDD, and there were 15 incident cases of PD-MCI. At T3, nine PD-MCI cases at T2 had progressed to PDD. There were 10 incident cases of PD-MCI at T3. The incidence of progression from PD-MCI to PDD was 98.0 per 1000 person-years, with an annual conversion rate to PDD of 11%. Neuropsychological predictors for conversion from PD-MCI to PDD were semantic language, praxis (figure drawing/copying) and visuospatial deficits. At 16 years, 91% of the PD-MCI cohort had progressed to PDD. Conclusions: Mild cognitive impairment in Parkinson's disease is an important predictor for the progression to PDD. This investigation also confirmed that if PD patients live long enough, they will develop cognitive impairment or dementia. Early detection of cognitive impairment in these individuals is possible with existing standardised global cognitive assessments, which include semantic language assessment. (Edited publisher abstract)

Journal article

Caregiver burden in mild cognitive impairment

Authors:
PARADISE Matt, et al
Journal article citation:
Aging and Mental Health, 19(1), 2014, pp.72-78.
Publisher:
Taylor and Francis

Objectives: This study reports the prevalence of significant levels of burden amongst caregivers of people with mild cognitive impairment (MCI), compared to informants of control-participants. Secondly it identifies which factors are associated with significant levels of burden: patient characteristics (including depressive symptoms, cognition and informant ratings of cognitive and behavioural change); caregiver characteristics; or the caregiving context. Method: Sixty-four participants with MCI, 36 control-participants and their respective caregivers/informants were recruited to a university research clinic. The proportion of those who showed clinically significant levels of burden was determined by a Zarit Burden Interview score of >21. Multivariate analyses were performed to examine the relative contribution of individual variables to burden amongst MCI-caregivers. Results: Thirty six per cent of MCI-caregivers reported clinically significant levels of burden, twice that of the control informant group. Participant behavioural problems contribute most to burden, with participant depression and possibly cognition also having a significant association. Conclusion: Caregiver burden is a considerable problem in MCI and shares some of the same characteristics as caregiver burden in dementia, namely a strong association with challenging behaviours in the patient. This has implications for further research and intervention studies. (Edited publisher abstract)

Journal article

Collaborative stretching: a research agenda for enhancing the quality of lives of people with severe cognitive impairments

Authors:
LYONS Gordon Stuart, ARTHUR-KELLY Michael
Journal article citation:
Journal of Care Services Management, 7(3), 2013, pp.107-115.
Publisher:
Taylor and Francis

This paper explains and demonstrates the early application of collaborative stretching: a new and practical technique for enhancing the quality of lives of people in care – particularly those who have severe cognitive impairments. An introduction explains severe cognitive impairment and the notion of quality of life. This is followed by an explanation of the nature of, theory behind, and the key steps of collaborative stretching. An illustrative vignette is then presented to demonstrate its application, utility, and value in one care setting. The paper concludes with a discussion around advancing a research agenda for this technique, and its potential implications for care service managers. (Publisher abstract)

Journal article

Recognising the agency of people with dementia

Author:
BOYLE Geraldine
Journal article citation:
Disability and Society, 29(7), 2014, pp.1130-1144.
Publisher:
Taylor and Francis,

People with dementia have been assumed to possess weak or even no agency. This article examines their actual potential for agency. The author draws on findings from a qualitative study of everyday decision-making by people with dementia that aimed to identify the role of social factors (such as gender) in influencing their involvement in decisions. Whilst decision-making constitutes a form of deliberative agency, the research also identified when agency was alternatively habituated, embodied or emotional. Existing theoretical perspectives on agency are critiqued, particularly in relation to rationality, language and individualised agency. The study highlighted that people with dementia who lack deliberative capacity can nonetheless demonstrate creative capacity for agency. A more expansive concept of agency is needed in social science theory that is informed by the experiences of cognitively disabled people. (Edited publisher abstract)

Book

Coping with memory problems: a practical guide for people with memory impairments, their relatives, friends and carers

Authors:
CLARE Linda, WILSON Barbara A.
Publisher:
Pearson Assessment
Publication year:
1997
Pagination:
64p., bibliog.
Place of publication:
London

This practical guide shares techniques for alleviating, compensating for, or bypassing many of the daily problems confronted by memory impaired people and their relatives, friends and carers. It grew out of plans for an information leaflet for people referred to the Memory Clinic at Addenbrooke’s Hospital. The short guide contains information that is supported by examples taken from the daily lives of memory impaired people whether the impairment is through illness such as Alzheimer’s disease, or injury. Chapters cover: what memory is, what it means to have a memory problem, how to adapt and cope, and how to make the most of memory.

Journal article

Chronic endurance exercise training prevents aging-related cognitive decline in healthy older adults: a randomized controlled trial

Authors:
MUSCARI Antonio, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 25(10), October 2010, pp.1055-1064.
Publisher:
Wiley-Blackwell

This study investigated the effects of endurance exercise training (EET) on the cognitive status of healthy community-dwelling older people in Pianoro, northern Italy. One hundred and twenty healthy subjects, aged 65 to 74 years, were randomised into treatment and control groups. The treatment consisted of 12 months of supervised EET in a community gym. All participants were assessed both at baseline and after 12 months. Cognitive status was assessed by the Mini Mental State Examination (MMSE). Anthropometric indexes, routine laboratory measurements and C-reactive protein (CRP) were also assessed. The control group showed a significant decrease in MMSE score, which differed significantly from the treatment group scores. The odds ratio for the treated older adults to have a stable cognitive status after 1 year, as compared to the control group, was 2.74 after adjustment for age, gender, educational level and several other possible confounders. Blood pressure, body mass index, waist circumference and serum cholesterol did not differ significantly between the two groups, while CRP decreased only in the treatment group. The authors concluded that a 12-month EET intervention may reduce the onset of age-related cognitive decline.

Journal article

Coping with challenges to memory in people with mild to moderate Alzheimer's disease: observation of behaviour in response to analogues of everyday situations

Authors:
OYEBODE Jan Rachel, et al
Journal article citation:
Aging and Mental Health, 13(1), January 2009, pp.46-53.
Publisher:
Taylor and Francis

Twenty-four participants (12 with mild and 12 with moderate AD) recruited from two UK NHS Trusts were presented with a set of seven tasks that were analogues of everyday situations that tax memory. The participants' responses were videotaped and analysed.  Participants' coping responses were grouped into seven categories to best reflect the main strategies. Individuals used a significantly greater frequency of effortful problem solving (self-reliance and reliance on carers) than other ways of coping. Positive acknowledgement of memory difficulties was used significantly more than negative acknowledgement and defensive coping (concealment and avoidance).  This study used novel methodology of observation of behavioural responses in analogues of everyday situations. The predominance of effortful problem-solving emphasizes the role of the person with AD as an active agent in the management of memory loss. An emphasis in previous literature on defensive coping and denial is counter-balanced by the finding that participants commonly coped by acknowledging their memory impairment.

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