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PubMed2005

Making sense of dementia and adjusting to loss: psychological reactions to a diagnosis of dementia in couples.

The current emphasis on early detection and disclosure of a diagnosis of dementia highlights the need to examine couples' shared constructions of, and responses to, the diagnosis, and to explore the appraisals that couples make about the illness at an early stage. While the experiences of carers and of people with dementia have mostly been considered separately, further investigation of the shared experience of couples where one partner is developing dementia is required. This study adopted a family systems perspective to investigate psychological reactions to a diagnosis of dementia in nine couples where one partner had received a diagnosis of either Alzheimer's disease or vascular dementia, with particular emphasis on the possible relevance of psychological responses to loss. Interpretative phenomenological analysis was used to explore participants' experiences of receiving a diagnosis of dementia, which were compared and contrasted across couples. Ten themes were subsumed under two higher-order themes, 'Not quite the same person, tell me what actually is wrong' and 'Everything's changed, we have to go from there', and linked through the overarching theme of 'Making sense and adjusting to loss'. A model is presented that encapsulates the oscillating processes couples appeared to go through in making sense of the experience of early-stage dementia and adjusting to the losses and difficulties evoked by the illness, which appeared to be similar to the process of adjustment outlined in dual-process models of grief. The findings suggest that couples who receive a diagnosis of dementia may be supported by helping them to create a joint construction that enables them to make sense of their situation, find ways of adjusting to the changes experienced in their roles and identity, and manage the losses they face in the early stages of dementia.

Adaptation, Psychological↗
PubMedDate not supplied

The validation of a caregiver assessment of dementia: the Dementia Severity Scale.

OBJECTIVE: The objective of this study was to refine and validate the Dementia Severity Scale (DSS), a newly developed assessment of dementia severity from a caregiver's perspective. The Dementia Severity Scale is designed to measure deficits in activities of daily living (ADL), behavioral disturbances, and the caregiver's perception of the patient's current cognitive abilities. METHODS: Community dwelling caregiver/patient dyads were recruited from 12 clinical sites. Patients had a primary dementia diagnosis for at least one year. In this cross-sectional study, caregivers were administered the Dementia Severity Scale, the Quality of Life-Alzheimer's Disease (QOL-AD), the Progressive Deterioration Scale (PDS), and the Neuropsychiatric Inventory (NPI). Patients were administered the Mini-Mental State Examination (MMSE) and the QOL-AD. To evaluate test-retest reliability, 25% of caregivers were randomized to a second visit. RESULTS: One hundred eighty-three caregiver/patient dyads were recruited. Mean caregiver age was 67.5; mean patient age was 78.8; 93% of patients had probable Alzheimer disease. Eighty-eight (48.1%) patients were male. Exploratory factor analysis established 6 subscales (Activities of Daily Living [ADL], Instrumental ADL [IADL], Communication, Agitation, Memory, and Disorganized Thinking). Cronbach's alphas ranged from 0.82 to 0.90 for the 6 subscales. Test-retest reliability was good with intraclass correlation coefficients ranging from 0.79 to 0.89. DSS subscales were moderately-to-highly correlated with the QOL-AD, NPI, MMSE, and PDS. Subscales significantly discriminated among severity levels of dementia, identified by both physician ratings and MMSE scores. CONCLUSION: The Dementia Severity Scale demonstrated excellent psychometric properties and appears to be useful both in clinical practice and research endeavors. Further research is needed to establish the longitudinal sensitivity of the Dementia Severity Scale to the progression of dementia.

Activities of Daily Living↗
PubMed2007

Is the dementia rate increasing in Beijing? Prevalence and incidence of dementia 10 years later in an urban elderly population.

OBJECTIVE: To examine the time trend of dementia morbidity over the past decade in Beijing, China. METHOD: In 1997, 1593 community-dwelling elderly aged 60+ years were examined and followed-up over 2-years to identify incident dementia. A similar cohort study of dementia conducted in the same district 10 years prior was used as historical comparison to examine the time trend of dementia incidence. RESULTS: Forty prevalent dementia cases were identified at the initial examination for a prevalence of 2.51% (95% CI: 1.74-3.28) and 25 incident cases were identified at the follow-up visit for an incidence of 0.90% (0.55-1.25) among residents aged 60+ years. Alzheimer's dementia (AD) was the most common type of dementia in both prevalent and incident cases. CONCLUSION: The prevalence and incidence rates of dementia in Beijing were slightly higher than those 10 years ago, which was partly because of population aging. AD became the most common subtype of dementia.

Aged↗
PubMed2004

CT brain findings in clinical dementia investigation--underestimation of mixed dementia.

Dementia has been found to display a more heterogeneous clinical picture than previously recognized. We investigated brain changes on computed tomography (CT) in a clinical dementia population consisting of 67 cases with Alzheimer's disease (AD), 13 with mixed dementia (AD and vascular dementia, VaD), 71 with VaD, and 12 cases that were not demented. Temporal cortical atrophy and atrophy around the temporal horns were more common in patients with mixed dementia compared to patients with VaD and the non-demented, respectively. Frontal white matter changes were present in 64% of AD, in 85% of mixed dementia and in 79% of VaD cases, but there were no differences between the dementia groups. Lacunes were present in almost 40% of AD cases and in 80 and 85% of VaD and mixed dementia cases, respectively. Only 14% of the VaD cases had large infarcts on the CT. We conclude that large infarcts were rare, even in VaD cases. The increased incidence of white matter changes and lacunes in AD patients strongly indicates an underestimation of the mixed dementia diagnosis. More distinct criteria for this diagnostic category are warranted.

Aged↗
PubMed2004

Dementia in first-degree relatives of patients with frontotemporal dementia. A family history study.

Several studies have found a clustering of dementia in relatives of patients with frontotemporal dementia (FTD). This study analysed the familial aggregation of FTD specifically as well as the occurrence of dementia in general in first-degree relatives of patients with FTD. A family history study was carried out on 478 first-degree relatives of 74 index patients suffering from FTD. Cases of organic dementia and of FTD were diagnosed according to internationally accepted diagnostic criteria. Age- and sex-specific incidences of organic dementia and of FTD were calculated as was the proportion of FTD in relation to organic dementia in general; comparisons with clinical and population studies were made. There was a tenfold increase in the incidence of FTD in the first-degree relatives of FTD patients compared with the incidence of FTD in a population study. The proportion of FTD in relation to all types of organic dementia was much higher in relatives of FTD patients compared to the corresponding proportions in clinical and population-based studies. There was a small, non-significant difference between the present family history study and the population studies as regards the incidence of organic dementia. The findings suggest that hereditary and/or shared environmental factors are strongly involved in the aetiology of FTD. There were no indications of familial clustering of organic dementia in general in relatives of FTD patients.

Adult↗
PubMed2005

Frontotemporal dementia, semantic dementia, and Alzheimer's disease: the contribution of standard neuropsychological tests to differential diagnosis.

CERAD-NAB (Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery) data were compared between 51 patients with frontotemporal dementia, 13 with semantic dementia, and 69 with Alzheimer's disease. There were statistically significant differences between the 3 groups. Compared with patients with Alzheimer's disease, patients with frontotemporal dementia were more impaired on Animal Fluency but not on any other CERAD-NAB subtest. Patients with semantic dementia performed worse in Animal Fluency and Boston Naming Test compared with frontotemporal dementia and Alzheimer's disease. Multiple logistic regression analysis revealed that in the differentiation between frontotemporal dementia and Alzheimer's disease, the combination of Animal Fluency and Boston Naming Test correctly classified 90.5% of patients. In segregating semantic dementia and Alzheimer's disease, the combination of Boston Naming Test and Mini Mental State Examination resulted in a correct classification of 96.3%. These findings demonstrate that the Mini Mental State Examination and the language subtests of the CERAD-NAB are valuable clinical instruments for the differential diagnosis between early frontotemporal dementia, semantic dementia, and Alzheimer's disease.

Aged↗
PubMed1994

Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons.

Identification of elderly individuals with low and high risk for future dementia has emerged as an important clinical and public health issue. To address this issue, we assessed neuropsychological performance in 317 initially nondemented elderly persons between 75 and 85 years of age and followed them for at least 4 years as part of the Bronx Aging Study. Four measures of cognitive function from the baseline assessment (delayed recall from the Buschke Selective Reminding Test, recall from the Fuld Object Memory Evaluation, the Digit Symbol subtest from the Wechsler Adult Intelligence Scale, and a verbal fluency score) can identify one subgroup with an 85% probability of developing dementia over 4 years and another with a 95% probability of remaining free of dementia. The model achieved an overall positive predictive value of 68%, or three times the base rate, for prediction of the development of dementia in our sample. The overall negative predictive value for prediction of absence of dementia was 88%. Baseline measures of cognitive function, often performed many years before the actual diagnosis of dementia, can provide important information about dementia risk. The group likely to develop dementia becomes a target for preventive or early therapeutic interventions, and the group unlikely to develop dementia can be reassured.

Aged↗
PubMed2005

[Awareness of dementia in older adults attending dementia-prevention programs in community healthcare centers].

Recently, the dementia-prevention program hosted by the Ministry of Health, Welfare and Labor has been widely implemented. We administered a questionnaire to 347 elderly adults (mean age: 71, mean MMSE score: 27.2) who attended programs in community healthcare centers. The questionnaire consisted of questions concerning: (1) belongings (2) knowledge about dementia (3) opinions about revealing the diagnosis of dementia to patients (4) anxiety for own onset of dementia. Regarding the knowledge about dementia, 17% of the participants knew about drug therapy, and 13% of them knew about legal guardianship. The results indicated a limited knowledge about facilities where demented people can be placed (home: 39%, hospital: 43%, nursing home: 62%, group-home: 25%). As for revealing the diagnosis, 68% of the participants hoped they would be informed of the diagnosis if they become demented, while 66% of them felt anxiety about having dementia in the future. In terms of difference by age (> or = 70 v.s. < or = 69), while the older group had low knowledge about the facilities and felt more anxiety about their own onset of dementia (chi2 test p < 0.05, Mann-Whitney U test p < 0.05), there were no intergroup difference regarding their expectations of being told about the diagnosis of dementia. Overall, the results of the questionnaire suggest that appropriate education of dementia to older adults may contribute to early diagnosis of the community level, thereby may maximize the effect of therapeutic interventions.

Aged↗
PubMedDate not supplied

[The other dementias: the neuropathology of the non-Alzheimer's disease dementias].

Alzheimer's disease (AD) is one of the most common causes of dementia, but requires neuropathological verification for a definitive diagnosis because there are a number of other neurodegenerative diseases that may present with dementia. Some of these disorders have considerable overlap both clinically and pathologically with AD, while others have distinct clinical and pathological profiles. Vascular dementia and dementia with Lewy bodies (DLB) have the greatest overlap with AD and considerable controversy still surrounds the exact contribution of the non AD pathology to the dementia syndrome. The frontotemporal dementias are loosely united by clinical presentation, but are pathologically heterogeneous and include Pick's disease, dementia lacking distinctive histopathology, motor neuron disease inclusion dementia and corticobasal degeneration (CBD). CBD can be difficult to distinguish from progressive supranuclear palsy, especially when the latter lacks the distinctive gaze palsy. Finally, Creutzfeldt Jakob disease (CJD) may be difficult to distinguish from AD when the symptoms progress at an atypically slow pace. Recently, a new variant of CJD (vCJD) that has been linked to bovine spongiform encephalopathy ('mad cow' disease) has heightened awareness of these prion protein disorders. The neuropathological criteria for the diagnosis of these non AD dementia disorders will be reviewed.

Aged↗
PubMed2005

[Assessment of dementia and use of anti-dementia drugs in nursing homes].

BACKGROUND: About 75% of nursing homes patients in Norway suffer from dementia, though only half of them have a dementia diagnosis. No consensus exists on how or when to do an assessment for dementia in the nursing home. MATERIAL AND METHODS: The paper is based on a search on Medline and personal experience in the field. RESULTS AND INTERPRETATION: Dementia assessment in nursing homes should be done in a co-operation between a physician, a nurse and an occupational therapist. The physician should carry out a Mini-Mental State Examination and a clock test, a physical and mental examination, an assessment of depressive symptomatology, and see to it that the thyroid function is measured. A CT scan of the brain should be done in cases with short duration of dementia symptomatology. A nurse and an occupational therapist should interview a family member and assess the patient's functioning by means of the Informant questionnaire on cognitive decline in the elderly and the Clinical dementia rating scale, or a similar assessment tool. Memantine could be a treatment for some patients with moderate to severe degrees of dementia, while acetylcholinesterase inhibitors could be useful for some patients with mild to moderate degrees of dementia of the Alzheimer type. Anti-dementia drug therapy must be individualised.

Alzheimer Disease↗
PubMedDate not supplied

Dementia in human populations exposed to neurotoxic agents: a portable microcomputerized dementia screening battery.

Dementia has been described as a clinical syndrome associated with chronic diffuse cerebral hemispheric dysfunction resulting in multiple involvement of cognition, memory, language, visual-spatial skills, and personality. While the specific diseases causing dementia are diverse, the severity of the dementia is directly correlated with the loss of functional brain tissue, independent of the primary neuropathology. Many neurotoxicants are pharmacologically nonselective. Thus, chronic exposure to these agents would be expected to result in progressive, diffuse impairment of CNS functioning that would present clinically as a substance-induced dementia. This suggests that diagnostic techniques developed for the early detection of incipient dementia in the aged might prove useful in screening for dementia in younger populations. A microcomputer based Psychometric Assessment System (PAS) and Dementia Screening Battery (DSB) with high predictive value for differentiating the normal age-related changes in cognition from those associated with incipient dementia in the aged have been developed. The DSB is DSM-III compatible as it evaluates intellectual deterioration, malignant memory loss, amnestic aphasia, and spatial disorientation. A diagnosis of dementia is obtained by findings of intellectual deterioration and malignant memory loss and either amnestic aphasia or spatial deterioration.

Aphasia↗
PubMed1997

Accurate prediction of histologically confirmed Alzheimer's disease and the differential diagnosis of dementia: the use of NINCDS-ADRDA and DSM-III-R criteria, SPECT, X-ray CT, and APO E4 medial temporal lobe dementias. The Oxford Project to Investigate Memory and Aging.

In a prospective study of more than 200 cases of dementia and 119 controls, annual technetium-99m-hexamethyl-propylene amineoxime (99mTc-HMPAO) single-photon emission computed tomography (SPECT) and annual medial temporal lobe (MTL) oriented X-ray computed tomography (CT) have been used to evaluate the diagnostic potential of functional and structural neuroimaging in the differential diagnosis of dementia. Some subjects have had up to 7 annual evaluations. So far, of 151 who have died, 143 (95%) have come to necropsy. Histology is known for 118, of whom 80 had Alzheimer's disease (AD), 24 had other "non-AD" dementias, and 14 controls with no cognitive deficit in life also had no significant central nervous system pathology. To compare the findings in the dementias with the profile of structural and functional imaging in the cognitively normal elderly, scan data from 105 living, elderly controls without cognitive deficit have also been included in the analysis. All clinical diagnoses were according to National Institute of Neurological and Communicable Disease and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) criteria, and all histopathological diagnoses according to the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) criteria. Early data from this cohort have suggested that the combination of both MTL atrophy seen on CT with parietotemporal hypoperfusion on SPECT may predict the pathology of AD. The diagnostic sensitivity, specificity, accuracy, and positive and negative predictive values of the NINCDS-ADRDA and DSM-III-R criteria could be assessed in this cohort against the gold standard of histopathology. The diagnostic potential of CT evidence of MTL atrophy alone, SPECT evidence of parietotemporal hypoperfusion alone, and the combination of both of these scan changes in the same individual could then be compared against the diagnostic accuracy of clinical operational criteria in the pathologically confirmed cases. Furthermore, all of these modalities could be compared with the diagnostic accuracy of apolipoprotein E4 (Apo E4) genotyping to predict AD in the histopathologically confirmed cohort. In this population, NINCDS "probable-AD" was 100% specific, 49% sensitive, and 66% accurate; "possible-AD" was only 61% specific, but 93% sensitive and 77% accurate; and the combination of both "probable-AD" and "possible-AD" was 61% specific, 96% sensitive, and 85% accurate. DSM-III-R criteria were 51% sensitive, 97% specific, and 66% accurate. In the same cases and including the 105 living, elderly controls, the diagnostic accuracy of the Oxford Project to Investigate Memory and Aging (OPTIMA) scanning criteria showed CT alone to be 85% sensitive, 78% specific, and 80% accurate; SPECT alone had 89% sensitivity, 80% specificity, and 83% accuracy; and the combination of the two was 80% sensitive, 93% specific, and 88% accurate. The Apo E4 genotype was 74% sensitive but yielded 40% false positives in the histologically confirmed series. The diagnostic accuracy afforded by this method of CT and SPECT used alone is better than that of any established clinical criteria and reveals that the combination of MTL atrophy and parietotemporal hypoperfusion is common in AD, much less common in other dementias, and rare in normal controls. In the NINCDS-ADRDA criteria "possible-AD" cases, the combination of CT and SPECT findings alone were better in all diagnostic indices than the presence of Apo E4 alone in predicting AD. The frequent occurrence of MTL atrophy in AD and also in other "non-AD" dementias later in the course of the disease suggests the concept of medial temporal lobe dementia. This could explain some of the overlap of clinical profiles in the dementias, particularly as the dementia progresses, making clinical differential diagnosis difficult. In this context, the use of SPECT can significantly e

Aged↗
PubMed2005

The clinical dementia rating sum of box score in mild dementia.

BACKGROUND: Making an early diagnosis of dementia is becoming increasingly important, but is difficult in practice. The Clinical Dementia Rating (CDR) scale is a widely used dementia staging instrument, yielding a global score and a summated score (sum of box score). This study examines the utility of the CDR sum of box score, rather than the CDR global score, in making a diagnosis of early dementia. OBJECTIVE: To determine whether the CDR sum of box score is predictive of an ICD-10 diagnosis of dementia in cases with mild cognitive deficits. METHODS: Clinical data recorded on our Memory Clinic database were examined for all patients seen over a 6-year period. Data were extracted from 276 first visits in which patients had scored 0.5 using the CDR global score. We examined the relationship between CDR sum of box score and consensus diagnosis of dementia using logistic regression. RESULTS: We found that increased CDR sum of box score was significantly associated with a higher probability of being assigned an ICD-10 diagnosis of dementia (p < 0.001). The odds ratio for the coefficient of CDR sum of box was 2.3 (95% CI 1.7-3.1), indicating that the likelihood of being diagnosed as having dementia increased by a factor of 2.3 for every point increase on the CDR sum of box score. CONCLUSION: These findings indicate that the CDR sum of box score provides additional information to the CDR global score in mild cases. The CDR sum of box score is a helpful indicator in making/excluding a diagnosis of dementia in people with mild cognitive deficits.

Alzheimer Disease↗
PubMed2006

Plasma cortisol and progression of dementia in subjects with Alzheimer-type dementia.

OBJECTIVE: Studies of subjects with dementia of the Alzheimer type have reported correlations between increases in activity of the hypothalamic-pituitary-adrenal (HPA) axis and hippocampal degeneration. In this study, the authors sought to determine whether increases in plasma cortisol, a marker of HPA activity, were associated with clinical and cognitive measures of the rate of disease progression in subjects with Alzheimer-type dementia. METHOD: Thirty-three subjects with very mild and mild Alzheimer-type dementia and 21 subjects without dementia were assessed annually for up to 4 years with the Clinical Dementia Rating scale and a battery of neuropsychological tests. Plasma was obtained at 8 a.m. on a single day and assayed for cortisol. Rates of change over time in the clinical and cognitive measures were derived from growth curve models. RESULTS: In the subjects with dementia, but not in those without dementia, higher plasma cortisol levels were associated with more rapidly increasing symptoms of dementia and more rapidly decreasing performance on neuropsychological tests associated with temporal lobe function. No associations were observed between plasma cortisol levels and clinical and cognitive assessments obtained at the single assessment closest in time to the plasma collection. CONCLUSIONS: Higher HPA activity, as reflected by increased plasma cortisol levels, is associated with more rapid disease progression in subjects with Alzheimer-type dementia.

Age Factors↗
PubMed2000

Reminiscence therapy for dementia.

BACKGROUND: Reminiscence Therapy (RT) has been defined as vocal or silent recall of events in a person's life, either alone, or with another person or group of people. It typically involves group meetings, at least once a week. in which participants are encouraged to talk about past events, often assisted by aids such as photos, music, objects and videos of the past. There is, often, little consistent application of psychological therapies in dementia services. A number of these 'therapies' were greeted with enthusiasm by health care practitioners in understimulating care environments. They were expected to work miracles and their 'failure' to do this has led to their widespread disuse. A systematic review of the available evidence is important in order to identify the effectiveness of the different therapies. Subsequently, guidelines for their use can be made on a sound evidence base. OBJECTIVES: RT involves groups of elderly people talking of past events, assisted by aids such as videos, pictures and archives, as a means of communicating and reflecting upon their life experiences. The objective of the review is to assess the effects of RT for dementia. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, PSYCHLIT, EMBASE, OMNI, BIDS, Dissertation Abstracts International, SIGLE and reference lists of relevant articles up to 1998, and we contacted specialists in the field. We also searched relevant internet sites and we handsearched Aging and Mental Health, the Gerontologist, Journal of Gerontology, Current Opinion in Psychiatry, Current Research in Britain: Social Sciences, British Psychological Society conference proceedings and Reminiscence database. SELECTION CRITERIA: Randomised controlled trials and quasi-randomised trials of RT for dementia in elderly people. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. MAIN RESULTS: Two trials are included in the review, but only one trial with 15 participants had extractable data. The results were statistically non-significant for both cognition and behaviour. REVIEWER'S CONCLUSIONS: No firm conclusions could be reached regarding the effectiveness of RT for dementia. The review highlighted the urgent need for more systematic research in the area.

Dementia↗