Relationship Between Patient and Informant Assessment of Personality and Cognitive Status

Abstract Personality has been linked to risk of dementia. Most studies ask individuals to rate their own personality traits or for a knowledgeable informant to perform the rating; few collect data from both. When informants are asked to give an estimate of the patient’s lifelong personality traits, they often describe personality before disease onset. When asked to self-rate, patients may instead assess their personality as they see themselves, providing a personality-state measure. The goal of this study was to assess agreement between two independent measures of personality and evaluate whether stage of cognitive impairment and characteristics of patients or caregivers impact concordance. In 79 consecutive patient-caregiver dyads presenting to our center (mean age:76.8±8.4; 44.1% female; 6% cognitively normal, 41% MCI; and 53% dementia) with in-depth psychosocial and neuropsychological evaluations, we found informants rated patients lower on openness (O) (ICC=0.434; 95%CI: 0.235-0.598) and agreeableness (A) (ICC=0.491; 95%CI: 0.302-0.643) and higher on extraversion (O) (ICC=0.396; 95%CI: 0.191-0.568) and neuroticism (N) (ICC=0.444; 95%CI: 0.247-0.607). Greater discordance was observed in established dementia (ICCE=0.497; 95%CI: 0.222-0.700; ICCA=0.337; 95%CI:0.031-0.586; ICCN=0.422; 95%CI: 0.191-0.683), compared with MCI (ICCO=0.568; 95%CI: 0.282-0.762). We explored the effect of patient and caregiver mood and caregiver burden on personality ratings. Although personality is typically described as a trait, we present evidence that in the eyes of patients, personality ratings may represent a state that changes across the spectrum of cognitive impairment. Understanding how patients and caregivers differentially perceive personality may assist in developing novel psychotherapeutic interventions and approaches dealing with behavioral manifestations of dementia.

Download Full-text

Telemedicine assessment of long-term cognitive and functional status in anti-leucine-rich, glioma-inactivated 1 encephalitis

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000652 ◽

2019 ◽

Vol 7 (2) ◽

pp. e652 ◽

Cited By ~ 4

Author(s):

Nuria Sola-Valls ◽

Helena Ariño ◽

Domingo Escudero ◽

Elisabeth Solana ◽

Albert Lladó ◽

...

Keyword(s):

Cognitive Impairment ◽

Functional Status ◽

Verbal Memory ◽

Cognitive Reserve ◽

Disease Onset ◽

Cognitive Status ◽

Functional Activities ◽

Telephone Interviews ◽

Status Assessment

ObjectiveTo assess the feasibility of a structured telephone interview examining the long-term cognitive and functional status in anti–leucine-rich, glioma-inactivated 1 (LGI1) encephalitis.MethodsTelephone interviews were conducted with 37 patients after a median follow-up of 87 months from disease onset and 23 healthy controls matched for age and sex. Cognitive status was assessed with the telephone Mini-Mental State Examination (t-MMSE) and 3 tests exploring verbal memory, fluency, and executive function. Functional status was evaluated with the Functional Activities Questionnaire and the modified Rankin Scale (mRS). Patients were classified as normal, with mild cognitive impairment (MCI), or with dementia based on cognitive and functional status. Assessment of the cognitive reserve was performed with a structured questionnaire. Logistic regression analysis was applied to identify predictors of cognitive impairment.ResultsTelephone interviews were successful in 36/37 (97%) patients. Cognitive impairment was detected in 27 (75%) including 17 with MCI and 10 with dementia. Eight (29%) patients would have been misclassified using only the t-MMSE. Twenty-six (72%) patients were functionally independent according to the mRS, but only 9 (35%) were cognitively normal. Independent predictors for long-term cognitive impairment were a low cognitive reserve (OR = 1.36, 95% CI: 1.05–1.76; p = 0.02) and bilateral hippocampal hyperintensity at initial MRI (OR = 27.03, 95% CI: 1.87–390; p = 0.02).ConclusionsTelemedicine is a feasible tool to assess the cognitive and functional outcome in patients with anti-LGI1 encephalitis. Cognitive impairment is often missed if only functional scales are used. Premorbid cognitive reserve and MRI with bilateral hippocampal hyperintensity were predictors for long-term cognitive impairment.

Download Full-text

Frequencies and Neuropsychological Characteristics of Errors in the Clock Drawing Test

Journal of Alzheimer s Disease ◽

10.3233/jad-210456 ◽

2021 ◽

pp. 1-10

Author(s):

Hiroyuki Umegaki ◽

Yusuke Suzuki ◽

Hitoshi Komiya ◽

Kazuhisa Watanabe ◽

Yosuke Yamada ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Status ◽

Cognitively Normal ◽

Clock Drawing Test ◽

Assessment Scores ◽

Clock Drawing ◽

Neurocognitive Assessment ◽

Drawing Test ◽

Neuropsychological Characteristics ◽

Neuropsychological Assessments

Background: Few studies have investigated associations between types of clock drawing test (CDT) errors and cognitive impairment. Objective: To explore associations of qualitative errors in the CDT with comprehensive neurocognitive assessment scores and clinical diagnosis. Methods: Outpatients at a memory clinic were enrolled. Frequencies of errors determined by Cahn’s method were explored according to cognitive status (cognitively normal [CN] (n = 279), mild cognitive impairment [MCI] (n = 321), and Alzheimer’s disease [AD]) (n = 575). Neuropsychological assessment scores were compared between participants with and without errors. Results: Stimulus-bound response (SB) was relatively rare (6.8%) in the CN group but was markedly more common in the MCI (23.4%) and AD (33.2%) groups. Conceptual deficit (CD) was found in more than 20%of CN individuals, as well as about 50%of AD patients. Planning deficit (PD) frequencies were relatively similar among the groups. SB in both of CN and MCI individuals, and CD in both of CN and MCI individuals were associated with lower scores in several neuropsychological assessments. Meanwhile, PD was not associated with lower assessment scores in any of CN, MCI, or AD individuals. Conclusion: The frequencies of SB and CD increased from CN, MCI, to AD but showed somewhat different patterns. Both SB and CD were associated with lower cognition in all three cognitive stages.

Download Full-text

Caregiving burden and out-of-home mobility of cognitively impaired care-recipients based on GPS tracking

International Psychogeriatrics ◽

10.1017/s1041610212001135 ◽

2012 ◽

Vol 24 (11) ◽

pp. 1836-1845 ◽

Cited By ~ 16

Author(s):

Shirli Werner ◽

Gail K. Auslander ◽

Noam Shoval ◽

Tamar Gitlitz ◽

Ruth Landau ◽

...

Keyword(s):

Cognitive Impairment ◽

Caregiver Burden ◽

Well Being ◽

Cognitive Status ◽

Gps Tracking ◽

Emotional States ◽

Caregiving Burden ◽

Positioning Systems ◽

Care Recipients ◽

The Relationship

ABSTRACTBackground: Out-of-home mobility refers to the realization of trips outside the home, by foot or by other means of transportation. Although out-of-home mobility is important for the well-being of older people with cognitive impairment, its importance for their caregivers is not clear. This study aims to clarify the relationship between caregiving burden and out-of-home mobility of care-recipients using Global Positioning Systems (GPS) technology.Methods: Seventy-six dyads (care-recipients and caregivers) were recruited from a psychogeriatric center, where they underwent cognitive assessment, followed by psychosocial interviews at home. Care-recipients received GPS tracking kits to carry for a period of four weeks, whenever they left home. Mobility data and diagnostic and psychosocial data were examined in relation to caregiver burden.Results: The strongest predictors of burden were care-recipients’ lower cognitive status and more time spent walking out-of-home. An interaction was found between cognitive status and time spent walking in relation to caregiver burden. The relationship between walking and burden was stronger among caregivers of care-recipients with dementia than caregivers of care-recipients with no cognitive impairment or mild cognitive impairment. Care-recipients’ behavioral and emotional states were also positively related to caregiver burden.Conclusions: The findings stress the importance of maintaining older persons’ out-of-home mobility during cognitive decline.

Download Full-text

Increased Serum Neuropeptide Galanin Level Is a Predictor of Cognitive Dysfunction in Patients with Hip Fracture

Disease Markers ◽

10.1155/2021/9141978 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Zichao Xue ◽

Ke Zhang ◽

Biao Luo ◽

Long Fan ◽

Ruizhe Zhao ◽

...

Keyword(s):

Regression Analysis ◽

Cognitive Impairment ◽

Hip Fracture ◽

Cognitive Decline ◽

Cognitive Dysfunction ◽

Large Scale ◽

Linear Regression Analysis ◽

Cognitive Status ◽

Significant Independent Predictor ◽

Cognitively Normal

Background. Hip fracture is a common occurrence in elderly populations and is frequently followed by various levels of cognitive dysfunction, leading to adverse functional outcomes. Risk stratification of hip fracture patients to identify high-risk subsets can enable improved strategies to mitigate cognitive complications. The neuropeptide galanin has multiple neurological functions, and altered levels are documented in dementia-type and depression disorders. The present study investigated the association of serum neuropeptide galanin levels in hip fracture patients with the occurrence of cognitive dysfunction during the first week of admission. Methods. 276 hip fracture patients without preexisting delirium, cognitive impairment, or severe mental disorders were included in a cross-sectional study. Serum galanin levels were assessed by ELISA on the second day of admission. Routine clinical and laboratory variables were documented. MoCA was performed within 1 week, and those with a score < 26 were categorized with “cognitive decline.” Inferential statistics including multiple linear regression analysis were applied to determine the association of serum galanin level and cognitive status. Results. 141 patients were categorized with “cognitive decline,” and 135 patients were categorized as “cognitively normal.” Serum galanin was highly significantly increased in the “cognitive decline” group ( 34.2 ± 4.8 , pg/ml) compared to the “cognitively normal” group ( 28.9 ± 3.7 , pg/ml) and showed significant negative correlation with MoCA scores ( r = − 0.229 , p = 0.016 ). Regression analysis showed serum galanin as the sole significant independent predictor of lower MoCA scores ( β = 0.231 , p = 0.035 ) while age, gender, blood pressure, cholesterol, and blood glucose levels had no significant association. Conclusion. Higher serum galanin predicted the development of cognitive dysfunction and worse MoCA scores in a cohort of hip fracture patients without preexisting cognitive impairment or delirium at admission, thus warranting large-scale studies investigating galanin as a candidate biomarker to identify hip fracture patients at risk of cognitive decline.

Download Full-text

Intraindividual Cognitive Variability in Middle Age Predicts Cognitive Impairment 8–10 Years Later: Results from the Wisconsin Registry for Alzheimer’s Prevention

Journal of the International Neuropsychological Society ◽

10.1017/s135561771600093x ◽

2016 ◽

Vol 22 (10) ◽

pp. 1016-1025 ◽

Cited By ~ 19

Author(s):

Rebecca L. Koscik ◽

Sara E. Berman ◽

Lindsay R. Clark ◽

Kimberly D. Mueller ◽

Ozioma C. Okonkwo ◽

...

Keyword(s):

Cognitive Impairment ◽

Executive Function ◽

Middle Age ◽

Cognitive Status ◽

Risk Indicator ◽

Parental History ◽

Cognitively Normal ◽

Risk Variable ◽

Cognitive Variability ◽

Intraindividual Cognitive Variability

AbstractObjectives: Intraindividual cognitive variability (IICV) has been shown to differentiate between groups with normal cognition, mild cognitive impairment (MCI), and dementia. This study examined whether baseline IICV predicted subsequent mild to moderate cognitive impairment in a cognitively normal baseline sample. Methods: Participants with 4 waves of cognitive assessment were drawn from the Wisconsin Registry for Alzheimer’s Prevention (WRAP; n=684; 53.6(6.6) baseline age; 9.1(1.0) years follow-up; 70% female; 74.6% parental history of Alzheimer’s disease). The primary outcome was Wave 4 cognitive status (“cognitively normal” vs. “impaired”) determined by consensus conference; “impaired” included early MCI (n=109), clinical MCI (n=11), or dementia (n=1). Primary predictors included two IICV variables, each based on the standard deviation of a set of scores: “6 Factor IICV” and “4 Test IICV”. Each IICV variable was tested in a series of logistic regression models to determine whether IICV predicted cognitive status. In exploratory analyses, distribution-based cutoffs incorporating memory, executive function, and IICV patterns were used to create and test an MCI risk variable. Results: Results were similar for the IICV variables: higher IICV was associated with greater risk of subsequent impairment after covariate adjustment. After adjusting for memory and executive functioning scores contributing to IICV, IICV was not significant. The MCI risk variable also predicted risk of impairment. Conclusions: While IICV in middle-age predicts subsequent impairment, it is a weaker risk indicator than the memory and executive function scores contributing to its calculation. Exploratory analyses suggest potential to incorporate IICV patterns into risk assessment in clinical settings. (JINS, 2016, 22, 1016–1025)

Download Full-text

Obtaining Information from Family Caregivers Is Important to Detect Behavioral and Psychological Symptoms and Caregiver Burden in Subjects with Mild Cognitive Impairment

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000441893 ◽

2016 ◽

Vol 6 (1) ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Tetsuya Yamagami ◽

Kazuhiro Harada ◽

Hiroyuki Hashidate ◽

Yasuyoshi Asakawa ◽

Kenji Nihei ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Family Caregivers ◽

Caregiver Burden ◽

Day Care ◽

Psychological Symptoms ◽

Adult Day Care ◽

Cognitively Normal ◽

Behavioral And Psychological Symptoms ◽

At Home

Background: The objectives of this study are to clarify the differences between the difficulties in daily life experienced by patients with both mild cognitive impairment (MCI) and chronic disease and those experienced by healthy elderly individuals. Methods: We assessed (a) cognitive function; (b) gait ability; (c) behavioral and psychological symptoms (observed at home); (d) activities of daily living (observed at home); (e) family caregiver burden, and (f) intention to continue family caregiving of 255 cognitively normal and 103 MCI subjects attending adult day care services covered by long-term care insurance, and compared the two groups. Results: Subjects with MCI display more behavioral and psychological symptoms than cognitively normal subjects, posing a heavy caregiver burden (p < 0.01). Behavioral and psychological symptoms most commonly observed in subjects with MCI are apathy, hallucinations, delusions, agitation, and aberrant motor behavior. Conclusion: Information regarding the behavioral and psychological symptoms displayed at home by patients with MCI can only be obtained from family caregivers living with the patients. To provide early-stage support for elderly patients with MCI, adult day care workers should collect information from family caregivers regarding behavioral and psychological symptoms observed at home.

Download Full-text

Cognitive trajectories in multiple sclerosis: a long-term follow-up study

Neurological Sciences ◽

10.1007/s10072-021-05356-2 ◽

2021 ◽

Author(s):

Antonio Carotenuto ◽

Teresa Costabile ◽

Giuseppe Pontillo ◽

Moccia Moccia ◽

Fabrizia Falco ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Cognitive Rehabilitation ◽

Trajectory Analysis ◽

Disease Onset ◽

Disease Diagnosis ◽

Cognitive Status ◽

Grey Matter Volume ◽

Disease Course

Abstract Background Cognitive impairment occurs in multiple sclerosis (MS) and undergoes a progressive worsening over disease course. However, clinicians still struggle to predict the course of cognitive function. To evaluate baseline clinical and imaging predictors of cognitive abilities worsening over time, we performed a latent trajectory analysis for cognitive performances in MS patients, up to 15 years from disease onset. Methods We collected age, sex, education, dominant and non-dominant 9-hole peg test (9HP) and timed 25-foot walk (T25-FW) as well as MRI measures (grey matter volume and lesion load) within 6 months from disease diagnosis for relapsing–remitting MS (RR-MS) patients. At diagnosis and over the follow-up, we also assessed cognitive status through the symbol digit modalities test (SDMT). Cognitive impairment was defined by applying age-, gender- and education-adjusted normative values. Group-based trajectory analysis was performed to determine trajectories, and the predictive value of clinical and imaging variables at baseline was assessed through multinomial logistic regression. Results We included 148 RR-MS (98 females and 50 males). Over 11 ± 4 year follow-up, 51.4% remained cognitively stable whereas 48.6% cognitively worsened. Cognitively worsening patients had a higher T25FW time (p = 0.004) and a reduced hippocampal volume at baseline (p = 0.04). Conclusion Physical disability as well as hippocampal atrophy might depict patients at risk of cognitive worsening over the disease course. Therefore, using such predictors, clinicians may select patients to carefully evaluate for cognitive impairment as to eventually introduce cognitive rehabilitation treatments.

Download Full-text

Cognitive impairment and the regional distribution of cerebellar lesions in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458517730132 ◽

2017 ◽

Vol 24 (13) ◽

pp. 1687-1695 ◽

Cited By ~ 5

Author(s):

Sean M Tobyne ◽

Wilson B Ochoa ◽

J Daniel Bireley ◽

Victoria MJ Smith ◽

Jeroen JG Geurts ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

White Matter ◽

Regional Distribution ◽

Disease Onset ◽

Cognitive Status ◽

Cerebellar Lesion ◽

Lesion Load ◽

Cerebellar White Matter ◽

Cerebellar Lesions

Background: Cerebellar lesions are often reported in relapsing-remitting multiple sclerosis (RRMS) and have been associated with impaired motor function and cognitive status. However, prior research has primarily focused on summary measures of cerebellar involvement (e.g. total lesion load, gray/white matter volume) and not on the effect of lesion load within specific regions of cerebellar white matter. Objective: Spatially map the probability of cerebellar white matter lesion (CWML) occurrence in RRMS and explore the relationship between cognitive impairment and lesion (CWML) location within the cerebellum. Methods: High-resolution structural magnetic resonance imaging (MRI) was acquired on 16 cognitively impaired (CI) and 15 cognitively preserved (CP) RRMS subjects at 3T and used for lesion identification and voxel-based lesion-symptom mapping (VLSM). Results: CI RRMS demonstrated a predilection for the middle cerebellar peduncle (MCP). VLSM results indicate that lesions of the MCP are significantly associated with CI in RRMS. Measures of cerebellar lesion load were correlated with age at disease onset but not disease duration. Conclusion: A specific pattern of cerebellar lesions involving the MCP, rather than the total CWML load, contributes to cognitive dysfunction in RRMS. Cerebellar lesion profiles may provide a biomarker of current or evolving risk for cognitive status change in RRMS.

Download Full-text

Impact of Cognitive Impairment on Functional Outcome in Stroke

Stroke Research and Treatment ◽

10.4061/2010/652612 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 11

Author(s):

Nurdan Paker ◽

Derya Buğdaycı ◽

Demet Tekdöş ◽

Betül Kaya ◽

Çağlayan Dere

Keyword(s):

Cognitive Impairment ◽

Mini Mental State Examination ◽

Inpatient Rehabilitation ◽

Cognitive Status ◽

Cognitively Impaired ◽

Cognitively Normal ◽

Subacute Stroke ◽

Significant Difference ◽

State Examination

The aim of this study was to investigate the effect of the cognitive impairment on functional status in patients with subacute stroke. Fifty-two patients with subacute stroke were included in the study. Mini mental state examination (MMSE) test was used for the evaluation of cognitive status. Patients were separated into two groups according to their cognitive functions. Functional follow-up parameters were activities of daily living (ADL), global recovery and ambulation status. All patients were evaluated on admission to rehabilitation unit, at discharge and 6 months after discharge. Forty-four patients were completed the study. Mean age was 66 and 57 years; disease duration on admission was 4,8 and 3,5 months in the cognitively impaired and normal groups, respectively. Significant improvement was found in terms of functional follow-up parameters in both groups at discharge . Functional follow-up parameters did not show statistically significant difference between the groups. But community ambulation rate was higher in cognitively normal group at the sixth month visit. As a result of this study, inpatient rehabilitation was effective both cognitively normal and impaired subacute stroke patients.

Download Full-text

Preexisting Mild Cognitive Impairment, Dementia, and Receipt of Treatments for Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.120.032258 ◽

2021 ◽

Author(s):

Deborah A. Levine ◽

Andrzej T. Galecki ◽

Lewis B. Morgenstern ◽

Darin B. Zahuranec ◽

Kenneth M. Langa ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Cognitive Status ◽

Quality Measure ◽

Patient Factors ◽

Cognitively Normal ◽

Normal Cognition

Background and Purpose: Differences in acute ischemic stroke (AIS) treatment by cognitive status are unclear, but some studies have found patients with preexisting dementia get less treatment. We compared AIS care by preexisting cognitive status. Methods: Cross-sectional analysis of prospectively obtained data on 836 adults ≥45 with AIS from the population-based Brain Attack Surveillance in Corpus Christi project from 2008 to 2013. We compared receipt of a composite quality measure representing the percentage of 7 treatments/procedures received (ordinal scale; values, <0.75, 0.75–0.99, and 1.0), a binary defect-free quality score, and individual treatments after AIS between patients with preexisting dementia (Informant Questionnaire on Cognitive Decline in the Elderly score ≥3.44), mild cognitive impairment (MCI, score 3.1–3.43), and normal cognition (score ≤3). Results: Among patients with AIS, 42% had normal cognition (47% women; median age [interquartile range], 65 [56–76]), 32% had MCI (54% women; median age, 70 [60–78]), 26% had dementia (56% women; median age, 78 [64–85]). After AIS, 44% of patients with preexisting dementia and 55% of patients with preexisting MCI or normal cognition received defect-free care. Compared with cognitively normal patients, patients with preexisting MCI had similar cumulative odds (unadjusted cumulative odds ratio =0.99, P =0.92), and patients with preexisting dementia had 36% lower cumulative odds of receiving the composite quality measure (unadjusted cumulative odds ratio [OR]=0.64, P =0.005). However, the dementia-quality association became nonsignificant after adjusting for patient factors, namely sex, comorbidity, and body mass index (adjusted cumulative OR [acOR]=0.79, P =0.19). Independent of patient factors, preexisting MCI was negatively associated with receipt of IV tPA (intravenous tissue-type plasminogen activator; acOR=0.36, P =0.04), rehabilitation assessment (acOR=0.28, P =0.016), and echocardiogram (acOR=0.48, P <0.001). Preexisting dementia was negatively associated with receipt of antithrombotic by day 2 (acOR=0.39, P =0.04) and echocardiogram (acOR=0.42, P <0.001). Conclusions: Patients with preexisting MCI and dementia, compared with cognitively normal patients, may receive less frequently some treatments and procedures, but not the composite quality measure, after AIS.

Download Full-text