International Journal Of Geriatric Psychiatry[JOURNAL]
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200 papers
A Psychometric Evaluation of the Staff-Reported EOLD-CAD Measure Among Nursing Home Residents With Cognitive Impairment.
Cagle JG, Stump TE, Tu W … +6 more , Ersek M, Floyd A, Van den Block L, Zhang P, Becker TD, Unroe KT
Int J Geriatr Psychiatry · 2025 Jan · PMID 39743326 · Full text
OBJECTIVES: The End-of-Life Dementia-Comfort Assessment in Dying (EOLD-CAD) scale is one of the few outcome instruments designed to capture symptom burden and well-being among nursing home residents with dementia; howeve...
OBJECTIVES: The End-of-Life Dementia-Comfort Assessment in Dying (EOLD-CAD) scale is one of the few outcome instruments designed to capture symptom burden and well-being among nursing home residents with dementia; however, psychometric evaluations of the EOLD-CAD are limited. Although the instrument is often used to assess outcomes prospectively, it was originally developed and tested as a postmortem assessment. The purpose of this study is to evaluate the instrument properties of the EOLD-CAD using staff reports from a large sample of nursing home residents with cognitive impairment prior to death. METHODS: Using data from the multi-state UPLIFT clinical trial, this study evaluated the psychometric properties of the EOLD-CAD from 168 nursing home staff members reporting outcomes for 611 living residents with moderate to severe cognitive impairment. Staff also reported on resident quality-of-life using two different single item measures. We conducted confirmatory factor analysis (CFA) and assessed construct validity, inter-item reliability, and observer report bias. RESULTS: CFA produced a four-factor solution. All factor loadings were > 0.40, ranging from 0.61-0.95 for Physical Distress, 0.71-0.91 for Dying Symptoms, 0.61-0.78 for Emotional Distress, and 0.89-0.94 for Well-Being. Model indices suggest a good fit to the data with root mean square error of approximation (RMSEA) = 0.053 (95% CI = (0.044, 0.062)), comparative fit index (CFI) = 0.971, and standardized root mean square residual (SRMR) = 0.093, with the SRMR slightly above the conventional threshold of > 0.08. Based on intraclass correlation coefficients (ICC), patterns of observer reports were identified among staff who provided data for multiple residents. ICCs were notably high (> 0.60) for Well-Being items. The EOLD-CAD elicited a Cronbach's alpha of 0.73, and the instrument was negatively correlated with items measuring resident quality of life. CONCLUSIONS: We found that when the EOLD-CAD was completed by nursing home staff familiar with the respective residents, observer-based patterns were detectable. Such patterns were adjusted for in our CFA, from we found that the EOLD-CAD exhibited multidimensionality with a four-factor structure capturing: Physical Distress, Emotional Distress, Dying Symptoms, and Well-Being. In addition to the CFA, the EOLD-CAD demonstrated generally valid and reliable psychometric properties in our population of long-stay nursing home residents with moderate to severe cognitive impairment. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04520698.
Risks of Dementia Associated With Anticholinergic Medication Compared to Beta-3 Agonist Among Older Patients With Overactive Bladder in Japan: The LIFE Study.
Okita Y, Shimomura Y, Komukai S … +9 more , Zha L, Komatsu M, Kimura Y, Gon Y, Murata F, Maeda M, Kiyohara K, Kitamura T, Fukuda H
Int J Geriatr Psychiatry · 2025 Jan · PMID 39743323 · Publisher ↗
OBJECTIVES: Anticholinergic drugs can cause cognitive impairment. The risk of dementia associated with anticholinergics compared to beta-3 agonists (mirabegron and vibegron) has not been extensively investigated in the s...
OBJECTIVES: Anticholinergic drugs can cause cognitive impairment. The risk of dementia associated with anticholinergics compared to beta-3 agonists (mirabegron and vibegron) has not been extensively investigated in the super-aging society of Japan. This study evaluated the association between the dementia risk and anticholinergics compared to beta-3 agonists in older adults with overactive bladder in Japan. METHODS: This study had 1,493,202 participants from the Longevity Improvement & Fair Evidence Study, which includes claim data in Japan from 2014 to 2022. The participants included 13,448 anticholinergic drug users and 24,669 beta-3 agonist users diagnosed with overactive bladder and aged ≥ 65 years. The Cox proportional hazards regression model was used to calculate hazard ratios and 95% confidence intervals being adjusted for confounding variables to evaluate the impact of anticholinergic drugs compared to beta-3 agonists prescribed at index date to patients with overactive bladder. RESULTS: Among the beta-3 agonist and anticholinergic drug users, the mean (standard deviation) age was 78.9 (6.7) and 78.8 (7.0) years, and the percentage of men was 47.2% and 39.7%, respectively. In the beta-3 agonist group, 2130 participants were newly diagnosed with dementia during the 51,605 person-years of follow-up from the index date, whereas in the anticholinergic drug group, 1826 participants were diagnosed during the 34,929 person-years of follow-up. In the Cox proportional hazard regression model, there was an increased risk of dementia in the anticholinergic drug group compared to the beta-3 agonist group (adjusted hazard ratio [aHR] = 1.22; 95% confidence interval [CI], 1.15-1.30). The increased risk remained identical when Inverse Probability Weighting (IPW) model was used for the analysis (aHR = 1.19; 95% CI, 1.11-1.28). CONCLUSIONS: Compared to beta-3 agonists, anticholinergic drugs are associated with an increased risk of dementia in older adults with overactive bladder, in Japan. These findings suggest that beta-3 agonists may have a lower risk of dementia than anticholinergics and have potential to be a good alternative opinion for older people with OAB, which warrants further study.
Inequalities in the Quality and Safety of Post-Diagnostic Primary Care for People With Dementia: A Scoping Review.
Morris C, Techache R, Davies K … +4 more , Blakeman T, Kontopantelis E, Ashcroft DM, Robinson DL
Int J Geriatr Psychiatry · 2024 Dec · PMID 39716035 · Full text
INTRODUCTION: International guidelines make recommendations for the delivery of safe, high-quality primary care for people with dementia including prescribing, personalised care planning and regular holistic reviews. It...
INTRODUCTION: International guidelines make recommendations for the delivery of safe, high-quality primary care for people with dementia including prescribing, personalised care planning and regular holistic reviews. It is unclear how the quality and safety of this healthcare varies with socio-economic factors. OBJECTIVE: This scoping review aimed to understand the depth and breadth of existing evidence exploring socio-economic variation in the quality and safety of primary care for people with dementia. METHODS: Prescribing and care planning indicators of high-quality, safe primary care were defined from guidance. Composite and proxy markers of socio-economic status (SES) were defined. EMBASE, MEDLINE, PsychInfo, The Cochrane Database of Systematic Reviews, worldcat.org and clinicaltrial.gov databases were searched. Studies in English, on human participants from 2006 onwards were eligible. Narrative synthesis was conducted. Studies explored how one or more selected indicators (anti-dementia medication and anti-psychotic prescribing, potentially inappropriate prescribing (PIP), medication review, dementia review or care planning) varied with a recognised marker of SES in people with dementia. RESULTS: Searches identified 1980 studies after removing duplicates. 385 full texts were reviewed, with 53 eligible for inclusion (51 quantitative, 2 reviews). Most identified studies explored prescribing processes (50 quantitative, 2 reviews), with 2 exploring annual review. There was evidence of substantial disparity in quality and safety indicators in studies exploring prescribing; 20/29 (69%) of studies exploring anti-dementia medication prescribing found those with markers of lower SES were significantly less likely to receive these. 16/28 studies exploring PIP/Anti-psychotics found significant disparities in safe prescribing for those with markers of lower SES. Neither study exploring annual reviews found any significant differences across SES. CONCLUSION: We found evidence of disparity in the quality and safety of post-diagnostic primary care for people with dementia based on SES, particularly for a range of prescribing indicators. Further work exploring inequalities in care planning and reviews for people with dementia is needed to understand existing inequalities in the quality and safety of primary care for people with dementia.
The Mini-Cog: A Community Screening Tool for Dementia in Indonesia.
Turana Y, Farina N, Theresia I … +7 more , Sani TP, Suswanti I, Fitri FI, Albanese E, Comas-Herrera A, Knapp M, Banerjee S
Int J Geriatr Psychiatry · 2024 Dec · PMID 39681548 · Publisher ↗
BACKGROUND: Early detection of dementia enables more effective planning and can enable access to treatment and support. The Mini-Cog is a widely used screening instrument in Indonesia; however, this instrument has never...
BACKGROUND: Early detection of dementia enables more effective planning and can enable access to treatment and support. The Mini-Cog is a widely used screening instrument in Indonesia; however, this instrument has never undergone a translation and cultural adaptation process. Currently, there is no data on how accurate the tool is against diagnostic criteria, particularly in low-education. METHODS: Embedded within the community-based dementia prevalence study was the Strengthening Responses to Dementia in Developing Countries (STRiDE) project; older adults (aged ≥ 65 years) were randomly recruited from sites in Jakarta and North Sumatra, Indonesia. All participants were asked to complete the Mini-Cog and the 10/66 short dementia diagnostic schedule. The accuracy of three Mini-Cog algorithms (Mini-Cog1, Mini-Cog2, and Mini-Cog3) were compared against and the 10/66 short dementia diagnostic schedule. Additional analysis explored its performance accuracy at different educational levels. RESULTS: The Mini-Cog test performance assessment was conducted on 2098 older adults The area under the curve (AUC) of Mini-Cog1, Mini-Cog2, and Mini-Cog3 receiver operator characteristic (ROC) curves were 0.66, 0.62, and 0.64, respectively. All algorithms demonstrated high sensitivity (Sv) but low specificity (Sp). (Mini-Cog1: Sv 83.2%; Sp 49.2%, Mini-Cog2: Sv 87.1%; Sp 37.8% and Mini-Cog3: Sv 72.5%; Sp 56%). All algorithms showed no affected by education. Only 59.1% of people without dementia could do the CDT. CONCLUSIONS: The high sensitivity of the Mini-Cog1 algorithm lends itself to screening purposes. Given that the specificity is still low, and less than 60% of patients without dementia can complete the CDT. Further research is needed, as is the development of screening instruments with high accuracy values in low- and middle-income countries, particularly in Indonesia.
Assessment of Dementia in Minority Ethnic Groups in Europe: A 14-Year Follow-Up Survey.
Nielsen TR, de Mendonça A, Frölich L … +5 more , Engelborghs S, Gove D, Lamirel D, Calia C, Waldemar G
Int J Geriatr Psychiatry · 2024 Dec · PMID 39663199 · Full text
OBJECTIVES: There is no European consensus on good clinical practice for timely diagnosis and culturally appropriate care of people with dementia from minority ethnic groups. Despite significant advances in culture-sensi...
OBJECTIVES: There is no European consensus on good clinical practice for timely diagnosis and culturally appropriate care of people with dementia from minority ethnic groups. Despite significant advances in culture-sensitive dementia diagnostics, little is known about how this has been implemented in clinical practice. The aims of this follow-up survey were to explore current practices for assessing dementia in patients from minority ethnic groups in Europe and to determine whether barriers in access to specialized dementia services have changed during the last 14 years. METHODS: A cross-sectional online survey was conducted in the European Alzheimer's Disease Consortium (EADC) in June 2023. The survey utilized questionnaires from a previous EADC survey from 2009 and focused on different points in the clinical assessment of dementia in patients from minority ethnic groups. RESULTS: Thirty-three centers from 15 countries participated in the survey, of which 21 were the same as in the 2009 survey. Patients from minority ethnic groups were seen on a regular basis in 91% of these centers, which was a significant increase compared to 2009 (69%, p = 0.04). Despite perceived clinical expertise increasing, implemented strategies for bypassing cultural and linguistic barriers were sparse and communication problems and lack of adequate assessment tools continued to be the main perceived barriers in diagnostic assessment of dementia in minority ethnic groups. CONCLUSIONS: Patients from minority ethnic groups are increasingly being referred for diagnostic assessment of dementia in Europe. Despite some improvements, diagnostic challenges generally remained the same as in 2009 and there is a continuous need to implement effective cross-cultural communication and assessment practices.
A Dual Group-Based 11-Year Trajectory Analysis of Cognitive Impairment and Transport Restriction for Community-Dwelling Older Adults.
Yang Y, Jiang Y, Wen M … +1 more , Wang L
Int J Geriatr Psychiatry · 2024 Dec · PMID 39653385 · Publisher ↗
OBJECTIVES: To examine the trajectories of cognitive impairment and transport restriction over time and the interrelation between these trajectories among older adults. METHODS: Group-based trajectory modeling was used o...
OBJECTIVES: To examine the trajectories of cognitive impairment and transport restriction over time and the interrelation between these trajectories among older adults. METHODS: Group-based trajectory modeling was used on the longitudinal National Health and Aging Trends Study (NHATS) over 11 years from 2011 to 2021, among 5753 participants, stratified by age in 2011 to three groups of 65-74 years, 75-84 years, and 85 years and above. RESULTS: For transport restrictions, these trajectory groups were: (1) a majority with no restrictions, (2) low and increasing or stable, and (3) moderate or high and decreasing. The overall pattern was largely consistent across the three age groups, with the older group showing a higher predicted likelihood of transport restrictions compared to the younger group. For each of the three age groups, there were two cognitive impairment trajectories including (1) low and (2) increasing cognitive impairment. The proportions of increasing cognitive impairment were 12.3% among the 65-74 years old, 27.3% among the 75-84 years old, and 40.4% among the 85 years and above old. Compared with those with no transport restriction, the other two trajectories with either low or moderate transport restrictions were more likely to belong to increasing cognitive impairment. The odds ratio was 3.06 (95% CI 2.0-4.68) for low & increasing transport restrictions versus 1.57 (95% CI 0.96-2.56) for moderate & decreasing transport restrictions among 65-74 years old. The odds ratio was 2.38 (95% CI 1.68-3.38) for low & increasing transport restrictions versus 1.88 (95% CI 1.39-2.55) for moderate & decreasing transport restrictions among 75-84 years old. CONCLUSIONS: Cognitive impairment was more likely to co-occur with those with low and increasing transport restrictions than with those with moderate and decreasing transport restrictions. Addressing transport restriction among older adults holds the potential to ameliorate cognitive outcomes.
Establishing Gold Standard Assessment for Young Onset Dementia: A Modified E-Delphi Consensus Survey Based in Australia.
Lau J, Cations M, O'Malley M … +5 more , Stamou V, Oyebode JR, Parkes JH, Carter J, Loi SM
Int J Geriatr Psychiatry · 2024 Dec · PMID 39653381 · Publisher ↗
OBJECTIVES: A modified e-Delphi was used to explore subject-expert consensus to create a minimum & gold standard assessment for young-onset dementia (YOD) for clinicians based in Australia. METHODS: A list of 72 statemen...
OBJECTIVES: A modified e-Delphi was used to explore subject-expert consensus to create a minimum & gold standard assessment for young-onset dementia (YOD) for clinicians based in Australia. METHODS: A list of 72 statements adapted from an international study, O'Malley et al. 2020, was included in an online survey that was distributed to clinical experts in the field. Respondents were asked to rate statements on a Likert scale of 1-7 (ranging from '1' being 'not at all important' to '7' being 'absolutely essential'). The mean and standard deviation (SD) were calculated for each statement. Full consensus, designated as 'minimum standard' was defined as 100% of respondents rating statement(s) as 'absolutely essential' (7) or 'very important' (6), while high consensus, designated as 'gold standard' was defined as 80% (16 out of 20) of respondents rating statement(s) as either 'absolutely essential' or 'very important' in the assessment for YOD. The statements that had overall mean scores below 6 did not reach consensus. RESULTS: Full consensus was achieved on 13 statements ('minimum standard'), 80% consensus was reached on 37 statements ('gold standard'), and no consensus was reached on 35 statements. Most clinicians agreed that the diagnosis of YOD is largely based on history, with less emphasis placed on aspects of the examination and investigations conducted. History of first-degree family members with YOD and any past psychiatric symptoms were reported to be potential triggers for a YOD diagnosis. There was agreement that the routine dementia blood screen and baseline structural imaging should be a part of the diagnostic assessment criteria of YOD. Comparisons were made between the results of this Australian-based study to the original international study, which found that 55/72 statements (76%) were similarly rated. CONCLUSIONS: Based on the results of this modified e-Delphi study, full and high consensus was reached on 37 statements which were comparable to results in an international study. This suggests that in general, clinicians in Australia have agreement with international experts about what is important for the assessment and diagnosis of YOD. Because the statements used in the international study were used in this Australian study, consideration of what issues may be specific to the Australian context such as YOD in Aboriginal Australians and rurality may have not been ascertained. In spite of this, these results may be useful to aid clinicians in their assessment for YOD but consensus statements may change over time as development in knowledge and available tests increases.
Can the Short-Form UCLA Loneliness Scale Be Used to Measure Loneliness Among Chinese Older Adults? From Classical Test Theory to Rasch Analysis.
Zhong Q, Jiang Y, Conwell Y … +1 more , Chen S
Int J Geriatr Psychiatry · 2024 Dec · PMID 39648272 · Publisher ↗
BACKGROUND: Loneliness among older adults, is a subjective experience and a public health issue in aging societies. Psychometrically sound and culturally sensitive measures are needed for developing precisely targeted in...
BACKGROUND: Loneliness among older adults, is a subjective experience and a public health issue in aging societies. Psychometrically sound and culturally sensitive measures are needed for developing precisely targeted interventions in culturally distinct groups. This study tested the Short-Form UCLA Loneliness Scale (ULS-8) among Chinese older adults. METHOD: Confirmatory factor analysis, internal consistency, and the correlation with the single question of loneliness were conducted with a sample of Chinese older adults. Rasch analyses assessed the unidimensionality, response category functioning, item difficulty, and targeting of the ULS-8 for older Chinese adults. RESULTS: Data from 347 Chinese older adults (mean age 71.36 ± 9.51 years) were analyzed; 74.64% of the participants were female. The ULS-8 showed acceptable internal consistency and criterion validity in Classical Test Theory. Confirmatory factor analysis and Rasch analysis indicated that the ULS-8 did not demonstrate a unidimensional structure. Additionally, Rasch analysis revealed (1) a misfit in item 3, indicating a problem with construct validity; (2) the need to combine response categories; and (3) that Chinese older adults are less likely to endorse a high level of loneliness when using the ULS-8. CONCLUSIONS: To ascertain the adequacy of the loneliness measure, it is crucial to customize a new short version of the loneliness scale for Chinese older adults through Rasch analysis.
The Janus Face of Person-Centred Care.
Gallagher J, Evans C, Sampson E … +2 more , Barclay S, Ward J
Int J Geriatr Psychiatry · 2024 Dec · PMID 39648161 · Publisher ↗
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Using Routinely Collected Health Data to Estimate the Prevalence of Alzheimer's Disease and Potentially Modifiable Risk Factors in Colombia.
Salazar-Londoño S, Silva-Buriticá C, Herrera-Velez L … +1 more , Rosselli D
Int J Geriatr Psychiatry · 2024 Dec · PMID 39643588 · Publisher ↗
OBJECTIVE: With an increasing prevalence, Alzheimer's Disease (AD) is the most common cause of dementia. However, a percentage of potentially modifiable cases have been reported. This article describes the prevalence of...
OBJECTIVE: With an increasing prevalence, Alzheimer's Disease (AD) is the most common cause of dementia. However, a percentage of potentially modifiable cases have been reported. This article describes the prevalence of four of these potentially modifiable risk factors: hearing loss, diabetes mellitus (DM), obesity, and hypertension. METHODS: Descriptive cross-sectional study with data from 2018 to 2022, using the Colombian health system database SISPRO. The population of this study consisted of all people within the age range 50-100 with a main diagnosis of AD according to the ICD-10 codes. Subjects were divided by decades, and the prevalence ratio (PR) for the outcome of AD and each of its potentially modifiable risk factors was then calculated and adjusted by age using the Mantel-Haenszel formula. RESULTS: 167,556 cases of AD were identified, with 66.4% being females. Peak age was in octogenarians, and the five-years period prevalence for people older than 50 was 12.6 cases/1000 people. The PRs showed a positive association for all risk factors, except obesity. Following age correction, obesity's PR value shifted to positive in males and overall population but remained negative for females. The highest post-correction PR in the overall population was hypertension (1.44), followed by DM (1.34), hearing loss (1.31) and obesity (1.12). Notably, PRs had a greater magnitude in younger and male age groups. CONCLUSION: The results of this study are consistent with the fact that the prevalence of potentially modifiable risk factors is higher within the group of people with AD as their main diagnosis.
Addressing the Gaps in Assessing Dementia in Older Autistic Adults.
O'Donald F, Ferrie J, Calia C
Int J Geriatr Psychiatry · 2024 Dec · PMID 39643587 · Publisher ↗
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Profiling Social Detachment in Older People in Taiwan: A Cluster Analysis.
Tu CY, Wu CS, Yen CM … +12 more , Chang HY, Yu CY, Chang KC, Chen HS, Chang CK, Hwang JJ, Huang SH, Chen YM, Cheng BW, Weng MH, Hsu CC, Huang WL
Int J Geriatr Psychiatry · 2024 Dec · PMID 39632283 · Publisher ↗
OBJECTIVES: The Social Detachment Questionnaire for the Older Population (SDQO) is a validated tool that assesses various dimensions of social relationships. This study aimed to profile social detachment among older peop...
OBJECTIVES: The Social Detachment Questionnaire for the Older Population (SDQO) is a validated tool that assesses various dimensions of social relationships. This study aimed to profile social detachment among older people in Taiwan using the SDQO and explore its use in distinguishing groups with varying levels of social engagement. METHODS: A telephone-based survey was conducted, collecting demographic data and responses to the SDQO and Brief Symptom Rating Scale-5 (BSRS-5). Cluster analysis based on SDQO dimension scores was performed to identify groupings. Regression analyses examined the association between social engagement clusters, demographic variables, and BSRS-5 scores. A receiver operating characteristic curve was established and the area under the curve was calculated to identify the cutoff for distinguishing individuals with high and low social engagement. RESULTS: In a representative sample of 2549 individuals aged 55 and above in Taiwan, cluster analysis identified two groups based on social engagement levels as measured by the SDQO. The low social engagement cluster, indicating higher social detachment, was more likely to consist of older individuals (≥ 75 years), those without children, and those with lower education levels (≤ 9 years). After adjusting for demographics, the low social engagement cluster was associated with higher BSRS-5 scores. The optimal SDQO cutoff for identifying low social engagement was 27/28. CONCLUSIONS: The SDQO can identify socially detached older people, who are more likely to experience increased psychological distress. Screening older individuals with demographic risk factors using the SDQO could help identify those most vulnerable to adverse health outcomes related to social detachment.
Neuropsychiatric Symptoms Associated With Frontotemporal Atrophy in Older Adults Without Dementia.
Liampas I, Siokas V, Stamati P … +6 more , Kyriakoulopoulou P, Tsouris Z, Zoupa E, Folia V, Lyketsos CG, Dardiotis E
Int J Geriatr Psychiatry · 2024 Dec · PMID 39617744 · Full text
OBJECTIVES: We investigated the association between neuropsychiatric symptoms (NPS) and frontotemporal atrophy (FTA) in older adults without dementia. We hypothesized that the odds of having NPS would be increased in the...
OBJECTIVES: We investigated the association between neuropsychiatric symptoms (NPS) and frontotemporal atrophy (FTA) in older adults without dementia. We hypothesized that the odds of having NPS would be increased in the presence of FTA. METHODS: NACC participants ≥ 50 years old with available data on FTA were considered for eligibility. Those with a diagnosis of mild cognitive impairment (MCI) and those who were cognitively unimpaired (CU) were separately analyzed. NPS were quantified on the Neuropsychiatric Inventory Questionnaire. Binary logistic regression models estimated the association (odds ratios and 95% confidence intervals are provided) between FTA and having each of 11 NPS (psychotic symptoms were grouped together) in CU and MCI individuals. RESULTS: FTA data were available for 3165 participants with MCI and 4051 CU: 207 and 55 had FTA on structural MRI studies, respectively. In the MCI group, the presence of FTA was associated with higher odds of having elation [2.42(1.33-4.40), p = 0.004], aberrant motor behavior [2.43(1.61-3.69), p < 0.001], appetite disorders [2.15(1.52-3.04), p < 0.001], apathy [2.05(1.48-2.85), p < 0.001] and disinhibition [2.02(1.38-2.96), p < 0.001]. The odds of having specific NPS were not significantly elevated in CU individuals with FTA. Of note, the size and direction of the associations were indicative of a potential relationship between FTA and specific NPS (most notably elation, aberrant motor behavior, appetite disorders and anxiety); in light of the small number of CU individuals with FTA we believe this analysis was underpowered and obscured several true associations. CONCLUSIONS: FTA was associated with higher odds of some NPS in older adults with MCI but not with normal cognition.
Reliability and Validity of Four Step Tests in Older Adults With Dementia.
Chan WLS, Tsang SMH, Ho LYW
Int J Geriatr Psychiatry · 2024 Dec · PMID 39608824 · Publisher ↗
OBJECTIVES: To determine the test-retest and inter-rater reliability, concurrent and discriminative validity of the Four Square Step Test (FSST), the Choice Stepping Reaction Time Test (CSRTT), the Maximum Step Length Te...
OBJECTIVES: To determine the test-retest and inter-rater reliability, concurrent and discriminative validity of the Four Square Step Test (FSST), the Choice Stepping Reaction Time Test (CSRTT), the Maximum Step Length Test (MSLT), and the Alternate Step Test (AST) in older adults with dementia. METHODS: Thirty-seven older adults with dementia who could walk independently for at least 10 m were recruited at community centers and day care centers for older adults. The participants completed the step tests conducted by two independent raters on three separate testing occasions within 3 weeks. In addition, the physical and cognitive function of the participants were evaluated at baseline. RESULTS: The FSST, CSRTT, and MSLT showed good-to-excellent test-retest reliability (intraclass correlation coefficient [ICC] = 0.83-0.91), and the AST exhibited fair test-retest reliability (ICC = 0.70). All the step tests showed good-to-excellent inter-rater reliability (ICC = 0.75-0.94). The step tests had moderate-to-strong correlations with various physical and cognitive measures (Pearson correlation coefficients = 0.34-0.72). The MSLT side step and AST could differentiate between individuals who did and did not use a walking stick to ambulate (p ≤ 0.046). The FSST, CSRTT, and AST could differentiate between individuals with and without a major neurocognitive impairment (p ≤ 0.005). CONCLUSION: The FSST, CSRTT, and MSLT were reliable and valid for examining the stepping performance of older adults with dementia. Clinicians can use these tests to evaluate the physical and cognitive function of this population and identify those with significant cognitive impairment. TRIAL REGISTRATION: Clinical Trial Registration number: NCT04296123.
Evaluating Electroconvulsive Therapy for Dementia With Lewy Bodies, Including the Prodromal Stage: A Retrospective Study on Safety and Efficacy.
Morikawa F, Kobayashi R, Murayama T … +5 more , Fukuya S, Tabata K, Fujishiro H, Nakayama M, Naoe J
Int J Geriatr Psychiatry · 2024 Dec · PMID 39608804 · Publisher ↗
OBJECTIVES: Managing symptoms, notably psychiatric symptoms, in dementia with Lewy bodies (DLB) is complex, affecting both patients and caregivers. People with DLB often react poorly to antipsychotics, limiting treatment...
OBJECTIVES: Managing symptoms, notably psychiatric symptoms, in dementia with Lewy bodies (DLB) is complex, affecting both patients and caregivers. People with DLB often react poorly to antipsychotics, limiting treatment options. Although electroconvulsive therapy (ECT)'s potential for DLB is acknowledged, evidence is scarce owing to limited studies. This study investigated ECT's effectiveness and safety for DLB and prodromal DLB with antecedent psychiatric symptoms. METHODS: This retrospective study investigated people with DLB (N = 12) and mild cognitive impairment (MCI) with LB (N = 13), a prodromal form of DLB, who underwent ECT for psychiatric symptoms and had abnormal findings confirmed using dopamine transporter single-photon emission computed tomography and I-metaiodobenzylguanidine myocardial scintigraphy. We reviewed these patients' medical records and determined the severity of psychotic symptoms before and 1 week after the final ECT session with the Clinical Global Impressions Severity Scale (CGI-S). Improvement in psychotic symptoms was evaluated approximately 1 week after the final ECT session using the CGI Improvement Scale (CGI-I). Additionally, we assessed cognitive function and dementia severity before and after ECT, as well as any adverse events caused by ECT. RESULTS: ECT significantly improved psychiatric symptoms, as assessed using the CGI-S, with CGI-I reports in the order of 60% "very much improved," 20% "much improved," 16% "minimally improved," and 4% "no change." Parkinsonism improved (Hoehn and Yahr: 1.76 ± 1.2 before vs. 1.04 ± 0.7 after, p < 0.001) as did dementia severity (Clinical Dementia Rating, p = 0.037). Adverse events included delirium in 24% of patients and amnesia in 4% of patients. ECT did not worsen cognitive function. CONCLUSIONS: ECT for DLB and MCI with LB with antecedent psychiatric symptoms appears safe and effective in managing psychiatric symptoms and Parkinsonism. Further large-scale multicenter studies are warranted to conclusively establish its effectiveness and safety.
Validation of the Quick Mild Cognitive Impairment Screen in an American Sample of Patients With Mild Cognitive Impairment and Mild Dementia.
Fernandez DA, Schmitz S, Foil H … +3 more , Brouillette R, Keller JN, Hilsabeck RC
Int J Geriatr Psychiatry · 2024 Nov · PMID 39586819 · Full text
OBJECTIVE: Early detection of cognitive impairment is critical for patient outcomes, yet cognitive impairment is under identified in primary care settings largely due to time constraints. The Quick Mild Cognitive Impairm...
OBJECTIVE: Early detection of cognitive impairment is critical for patient outcomes, yet cognitive impairment is under identified in primary care settings largely due to time constraints. The Quick Mild Cognitive Impairment (Qmci) screen was developed to address the need for a short cognitive screening instrument (< 5 min) that is sensitive to early cognitive change but has not been validated in the United States (US). The objective of this study was to examine the classification accuracy of the Qmci in participants from two memory specialty (e.g., secondary outpatient) clinics in the US. METHODS: Participants were 152 older adults: 87 participants were cognitively normal (CN), 48 were diagnosed with mild cognitive impairment (MCI) and 17 were diagnosed with mild dementia (DEM). Classification accuracy of the Qmci and Mini Mental State Examination (MMSE) were compared in participants with and without cognitive impairment. RESULTS: The Qmci demonstrated higher classification accuracy in differentiating CN from cognitively impaired participants (i.e., MCI and DEM) (AUC = 0.82) than the MMSE (AUC = 0.77). The optimal cut-off score for the Qmci was < 67, which achieved a sensitivity of 79% and specificity of 80%. The optimal MMSE cut-off score was < 27, which achieved a sensitivity of 97% and specificity of 43%. CONCLUSIONS: The Qmci is a valid cognitive screening instrument for detecting early stages of cognitive impairment in memory clinic samples in the US. Its short administration time and increased specificity for detecting MCI make it an attractive option for use in primary care settings. Further validation of the Qmci is needed, specifically within primary care settings.
Plasminogen Activator Inhibitor-1 in the Pathophysiology of Late Life Depression.
Métivier L, Vivien D, Goy R … +3 more , Agin V, Bui E, Benbrika S
Int J Geriatr Psychiatry · 2024 Nov · PMID 39578639 · Publisher ↗
INTRODUCTION: Late life depression (LLD) is characterized by specific clinical features including a high frequency of vascular form and frequent antidepressant treatment resistance. The expression and functions of the se...
INTRODUCTION: Late life depression (LLD) is characterized by specific clinical features including a high frequency of vascular form and frequent antidepressant treatment resistance. The expression and functions of the serine protease inhibitor, Plasminogen Activator Inhibitor-1 (PAI-1) is known to be altered by aging, vascular damage, insulin levels associated with a sedentary lifestyle, chronic stress leading to hypercortisolemia, and inflammatory changes linked to stress responses. These phenomena would be implicated in LLD like vascular depression. This article thus aims to review the existing literature regarding the association between LLD and plasmatic levels of PAI-1, a marker of hypofibrinolysis. We hypothesize that increased age would be associated with changes in PAI-1 plasma level and function which influence LLD pathogenesis and its treatment. RESULTS: Although a large number of studies on PAI-1 changes in the elderly exist, studies about its implications in LLD are sparse. Despite heterogeneous findings regarding the direction of variation in plasmatic PAI-1 levels among elderly participants with LLD, all studies demonstrated an association between PAI-1 levels and current or remitted depressive symptoms. Moreover, disruptions in the concentrations of other biological markers influencing PAI-1 expression, such as cytokines or adipokines, were also observed, notably an increase in the levels of interleukins 6 and 8. DISCUSSION: LLD genesis appears to be influenced by PAI-1 regulatory loops which are implicated in senescence or cell death. The resistance to antidepressant treatment appears to be linked to distinct biological profiles involving inflammatory and fibrinolytic factors. Taken together these data suggest that PAI-1 pathway may be a promising target of treatment development efforts for LLD, and depression in general.
Exploring Determinants of Institutionalization Among Germany's Oldest Old.
Wei R
Int J Geriatr Psychiatry · 2024 Nov · PMID 39578416 · Publisher ↗
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Female Reproductive Period Length, Parity and Hormonal Replacement Therapy and Dementia: The Elsi-Brazil Study.
Barbosa MG, Keinert AÁM, Miguel ACC … +5 more , Macêdo MACF, Teixeira LM, Bertola L, Lima-Costa MF, Ferri CP
Int J Geriatr Psychiatry · 2024 Nov · PMID 39578412 · Publisher ↗
INTRODUCTION: Alzheimer's disease and other dementia have a higher incidence among women and that risk factors specific to the female sex could be involved. Few studies looked into female reproductive factors and their a...
INTRODUCTION: Alzheimer's disease and other dementia have a higher incidence among women and that risk factors specific to the female sex could be involved. Few studies looked into female reproductive factors and their association with dementia in low-and middle-income countries. MATERIALS AND METHODS: We analyzed the baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and included data from 2594 women aged 60 years and older. We used an algorithm approach to determine dementia status and performed logistic regressions using as predictors the self-reported total length of the reproductive period, total parity and use of hormonal replacement therapy. We also analyzed the effects of hormonal replacement therapy use for different age groups and the effects of number of living children. RESULTS: Reproductive period length, hormonal replacement therapy use and parity as a continuous measure were not significantly associated with dementia status. When compared with 0 births, the group with 5-8 had more dementia while the other groups displayed no differences. For the number of living children, but a higher occurrence of dementia was found among women with more children. CONCLUSIONS: We did not find any association between continuous parity, reproductive period length or hormonal replacement therapy use and dementia. Social factors of motherhood appear to play an important role, and group specific effects of parity and hormonal replacement therapy require further study.
ApoE Gene Polymorphism and Clinical, Biochemical, and Sociodemographic Characteristics of Alzheimer's Disease Patients From Northern and Southern Regions of Kazakhstan.
Zholdasbekova G, Kaiyrlykyzy A, Kassenova A … +3 more , Alzhanova D, Klyuev D, Askarova S
Int J Geriatr Psychiatry · 2024 Nov · PMID 39568323 · Full text
BACKGROUND: Alzheimer's disease (AD) is the most frequent cause of dementia in seniors and is also one of the critical social issues of modern healthcare. Since AD is considered a multifactorial disease, the significance...
BACKGROUND: Alzheimer's disease (AD) is the most frequent cause of dementia in seniors and is also one of the critical social issues of modern healthcare. Since AD is considered a multifactorial disease, the significance of particular risk factors in different ethnic populations is constantly reevaluated. METHOD: The study group consisted of 181 patients with AD, and the control group included 244 healthy seniors comparable in sex and age to the dementia group. Our study compared clinical data, blood biochemical parameters, various sociodemographic characteristics, and ApoE gene polymorphism in patients diagnosed with AD from Kazakhstan's north (Astana city) and south (Almaty city) regions. RESULTS: In our cohort, significant dementia-associated variables included smoking, clinically significant depression, dyslipidemia, impaired glucose metabolism, insulin resistance, and liver dysfunction. Notably, AD patients had higher HDL levels, lower ALT levels, and higher total bilirubin and AST/ALT ratios. The ApoE ɛ4 genotype, a well-known AD risk factor, was more prevalent in the northern AD group. Additionally, participants from Astana city had a higher incidence of strokes, potentially linked to elevated LDL levels, while Almaty city residents exhibited a higher prevalence of clinically severe depression. DISCUSSION: These findings underscore the importance of considering bio-geographic and environmental factors in AD research. The study's outcomes may aid in further research and the development of personalized approaches for managing and treating AD in distinct geographical regions.
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