Abstract
Cadieux et al (Needs of people with dementia in long-term care: a systematic review) assessed the care needs of person with dementia living in long-term care by reviewing 68 studies in 6 databases. They identified 19 needs of person with dementia. Their data support the notion that the need to engage in daily individualized activities and care should not be ignored in long-term care facilities.
In Correction for a potentially biased item on the Mattis Dementia Rating Scale, Dean et al review aspects of the Mattis Dementia Rating Scale. This is a multidimensional cognitive measure popular with clinicians for its brevity, diagnostic validity, and utility in monitoring impairment severity. In spite of the test’s significant value, 1 task can cause discomfort, because the patient is asked to name items the examiner is wearing. This task also creates possible cultural bias and standardization issues. The authors studied 102 Mattis Dementia Rating Scale profiles that included this item. Adjusted scores were calculated by giving all patients full credit for the apparel-naming item. The average adjustment was just 1 point, and the resulting dementia severity ratings remained unchanged in 97% of the patients. These results show that administration of the item can be defensibly skipped if there is concern about its appropriateness with an individual patient. The adjusted scores provide a viable and fair alternative that preserve the psychometric properties of this useful instrument.
In Reliability, validity, and interpretation of the dependence scale in mild to moderately severe Alzheimer’s disease, Lenderking et al studied a dependence scale in patients with mild moderately severe Alzheimer’s disease using 3-study databases. They found that the dependence scale has strong psychometric properties. Dependence scale scores differed significantly across known groups and demonstrated moderate-to-strong correlations with measures hypothesized to be related to dependence. Structural equation modeling supported the validity of the dependence scale concept. An anchor-based dependence scale responder definition to interpret a treatment benefit over time was identified. They concluded that the dependence scale is a reliable, valid, and interpretable measure of dependence associated with Alzheimer’s disease and is related to cognition, functioning, and behavior.
Koepsell et al (Stability of clinical etiologic diagnosis in dementia and mild cognitive impairment: results from a multi-center longitudinal database) sought to determine the stability of the clinical etiologic diagnosis over time and to identify factors associated with instability. The primary clinical etiologic diagnosis remained unchanged for most patients, but with a net shift toward dementia with Lewy bodies and Alzheimer’s disease. Lower diagnostic stability was significantly associated with older age, nonwhite race, milder disease at presentation, more underlying conditions contributing to cognitive decline, lack of a consistent spouse/partner informant, and being evaluated by different clinicians on different visits.
In The impact of mild cognitive impairment on sexual activity, authors studied the unique impact of mild cognitive impairment on sexual activity among older adults. Data were drawn from a national survey entitled the ‘‘Determinants of Wellness among Older Malaysians: A Health Promotion Perspective’’ conducted in 2010. According to the Mini-Mental State Examination education-adjusted cutoff points, 16% of the 1046 respondents were identified as having mild cognitive impairment. Older adults with MCI had a significantly lower level of sexual activity than the normal group. Three-step hierarchical logistic regression model revealed that mild cognitive impairment is significantly associated with decreased sexual activity in community-dwelling older adults, over and beyond demographic factors, and age-related medical conditions affecting sexual activity. Further research is needed to better understand the nature of this association.
Lopez et al (What is family-centered care for nursing home residents with advanced dementia) examined family members’ perspectives on person- and family-centered end-of-life care by conducting a qualitative follow-up interview with 16 respondents who had participated in an earlier prospective study, Choices, Attitudes, and Strategies for Care of Advance Dementia at End of Life. Family members of nursing home residents with advanced dementia participated in semistructured qualitative interviews that inquired about overall nursing home experience, communication, surrogate decision making, emotional reaction, and recommendations for improvement. Analysis identified 5 areas that are considered important by family members: (1) providing basic care; (2) ensuring safety and security; (3) creating a sense of belonging and attachment; (4) fostering self-esteem and self-efficacy; and (5) coming to terms with the experience.
Shea et al (Cerebrospinal fluid biomarkers of Alzheimer’s disease in Chinese patients. A pilot study) evaluated the validity of tau, phosphorylated tau 181 (p-tau), amyloid β 42 (Aβ 42), and Aβ 40 proteins in Chinese patients with Alzheimer’s disease by studying 24 patients with Alzheimer’s disease, 12 nondemented controls, and 12 non-Alzheimer’s disease dementia patients. We found the cerebrospinal fluid (CSF) levels of Aβ42, tau, p-tau, Aβ42/tau, and Aβ42/–p-tau ratios, except the Aβ40 protein level, were significantly different among the 3 groups of patients. Patients with Alzheimer’s disease had higher levels of CSF tau and p-tau, but lower levels of Aβ42 proteins, Aβ42/tau, and Aβ42/p-tau ratios, than nondemented controls. For the diagnosis of Alzheimer’s disease versus nondemented controls, the sensitivity and specificity of the ratios of Aβ42/ tau and Aβ42/p-tau were 96% and 83% and 92% and 83%, respectively. Only the Aβ42/p-tau ratio showed satisfactory sensitivity and specificity for the diagnosis of Alzheimer’s disease versus other dementia subtypes. These data are similar to biomarker data in other ethnic groups and support the notion that similar cerebrospinal fluid changes occur in all groups.
Another article determined whether subjective memory complaints are associated with performance on objective cognitive measures and psychological factors in healthy, community-dwelling older adults. They used the CogState computerized neurocognitive battery, Prospective Retrospective Memory Questionnaire, and personality and meaning-in life measures. Subjective memory complaints were associated with poorer performance on measures of executive function and delayed recall. Subjective memory complaints were inversely associated with conscientiousness and directly associated with neuroticism. Higher scores on subjective memory complaints were associated with higher perceived stress and ineffective coping styles. Factors contributing to meaning-in-life were associated with fewer subjective memory complaints. The authors concluded that subjective memory complaints may reflect early, subtle cognitive changes and are associated with personality traits in healthy older adults.
Finally, Nagaratnam et al examined the reliability of the Bayer-Activities of Daily Living Scale when used as a cognitive screening instrument for mild and moderate dementia of the Alzheimer’s type. They concluded that this scale was a valid indicator of the cognitive status of patients with Alzheimer’s disease.