scholarly journals Assessing Dependency in a Multiethnic Community Cohort of Individuals With Alzheimer’s Disease

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Maria Meinerding ◽  
Brittany DeFeis ◽  
Preeti Sunderaraman ◽  
Martina Azar ◽  
Siobhan Lawless ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Disease Severity ◽  
Living Arrangement ◽  
Institutional Care ◽  
Clinical Dementia Rating ◽  
Cross Sectional ◽  
Scale Scores ◽  
Dependence Scale ◽  
Design And Methods

Abstract Background and Objectives Clinic-based studies of patients with Alzheimer’s disease (AD) have demonstrated the value of assessing dependence when characterizing patients’ functional status. The Dependence Scale, a validated tool to assess level of caregiving needs, is associated with markers of disease severity, cost, and progression, while offering independent functional information about patients. This study examines whether such associations between the Dependence Scale and markers of disease severity demonstrated in clinical cohorts are similarly exhibited in a multiethnic community population of individuals with AD. Research Design and Methods One hundred fifty four elders with AD enrolled in the Predictors 3 cohort were assessed with the Dependence Scale, modified Mini-Mental State Examination (mMMS), instrumental (IADL) and basic (BADL) activities of daily living, and Clinical Dementia Rating (CDR) Scale, and were assigned an Equivalent Institutional Care (EIC) rating. Cross-sectional associations were examined using bivariate correlations and one-way analysis of variance analyses. Fisher-z tests examined differences in strengths of associations across previous clinic and current community cohorts. Results Dependence Scale scores were associated with CDR (r = .20, p = .013), mMMS (r = −.23, p = .005), IADL (r = .39, p < .001), BADL (r = .65, p < .001), and EIC (r = .51, p < .001). Dependence was unassociated with ethnicity (F[3,144] = 1.027, p = .3822), age (r = .120, p = .145), and education (r = −.053, p = .519). The strength of the correlations was comparable across cohorts except that BADLs were more strongly associated with dependence (z = −4.60, p < .001) in the community cohort, and living arrangement was not associated with dependence (r = .13, p = .130). Discussion and Implications Associations between the Dependence Scale and markers of disease severity in a clinic-based cohort of AD patients are similar to associations in a multiethnic community cohort of individuals diagnosed with AD. The Dependence Scale relates to markers of disease severity rather than demographic factors, and may offer an unbiased assessment of care required in multiethnic and community populations.

scholarly journals Neuropsychiatric symptoms and severity of dementia

2013 ◽  
Vol 7 (2) ◽  
pp. 171-175
Author(s):  
Gustavo Henrique de Oliveira Caldas ◽  
Sueli Luciano Pires ◽  
Milton Luiz Gorzoni
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Motor Behavior ◽  
Neuropsychiatric Symptoms ◽  
Prevalence Ratio ◽  
Cross Sectional Study ◽  
Clinical Dementia Rating ◽  
Cross Sectional ◽  
Specific Stage ◽  
Severity Of Dementia

ABSTRACT Neuropsychiatric symptoms (NPS) cause distress, disabilitiy and reduced quality of life for both the patient and their families Objective: To evaluate the prevalence of NPS as a specific stage of dementia status. Methods: A cross-sectional study in patients attending an outpatient clinic for dementia was performed. We applied the Neuropsychiatric Inventory and Clinical Dementia Rating (CDR) scale. Statistical analysis was carried out with SPSS 17 software. Results: The 124 subjects (mean age of 80.4±7.0 years), 88 women (70.9%) had average duration of dementia of 7.1±3.2 years, most common dementias of Alzheimer's disease (35.5%) and mixed (31.5%) and most prevalent NPS of apathy (75%) and irritability (66.9%). Correlation between apathy and a CDR 1 had a PR (prevalence ratio) = 0.289 and p<0.001 while between apathy and CDR 4-5 (PR=8.333, p<0.005). A similar result was found between aberrant motor behavior (AMB) and CDR 1 (PR=0.352, p<0.003) and between AMB and CDR4-5 (PR=2.929, p<0.006). Conclusion: Alzheimer's disease and mixed dementia were predominant, while apathy and AMB were detected in association with the progressive stages of dementia.

scholarly journals Classification of Alzheimer’s Disease with and without Imagery Using Gradient Boosted Machines and ResNet-50

2019 ◽  
Vol 9 (9) ◽  
pp. 212 ◽  
Author(s):  
Lawrence Fulton ◽  
Diane Dolezel ◽  
Jordan Harrop ◽  
Yan Yan ◽  
Christopher Fulton
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Family Planning ◽  
Prediction Accuracy ◽  
Network Models ◽  
Training Set ◽  
Clinical Dementia Rating ◽  
Cross Sectional ◽  
Term Care ◽  
Class Prediction

Background. Alzheimer’s is a disease for which there is no cure. Diagnosing Alzheimer’s disease (AD) early facilitates family planning and cost control. The purpose of this study is to predict the presence of AD using socio-demographic, clinical, and magnetic resonance imaging (MRI) data. Early detection of AD enables family planning and may reduce costs by delaying long-term care. Accurate, non-imagery methods also reduce patient costs. The Open Access Series of Imaging Studies (OASIS-1) cross-sectional MRI data were analyzed. A gradient boosted machine (GBM) predicted the presence of AD as a function of gender, age, education, socioeconomic status (SES), and a mini-mental state exam (MMSE). A residual network with 50 layers (ResNet-50) predicted the clinical dementia rating (CDR) presence and severity from MRI’s (multi-class classification). The GBM achieved a mean 91.3% prediction accuracy (10-fold stratified cross validation) for dichotomous CDR using socio-demographic and MMSE variables. MMSE was the most important feature. ResNet-50 using image generation techniques based on an 80% training set resulted in 98.99% three class prediction accuracy on 4139 images (20% validation set) at Epoch 133 and nearly perfect multi-class predication accuracy on the training set (99.34%). Machine learning methods classify AD with high accuracy. GBM models may help provide initial detection based on non-imagery analysis, while ResNet-50 network models might help identify AD patients automatically prior to provider review.

scholarly journals Longitudinal Sensitivity of Alzheimer’s Disease Severity Staging

2020 ◽  
Vol 35 ◽  
pp. 153331752091871 ◽  
Author(s):  
Julia S. Benoit ◽  
Wenyaw Chan ◽  
Linda Piller ◽  
Rachelle Doody
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Decision Making ◽  
Disease Severity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Disease Assessment ◽  
Progression Rate ◽  
Clinical Dementia Rating ◽  
Cognitive Subscale

Understanding Alzheimer’s disease (AD) dynamics is essential in diagnosis and measuring progression for clinical decision-making; however, clinical instruments are imperfect at classifying true disease stages. This research evaluates sensitivity and determinants of AD stage changes longitudinally using current classifications of “mild,” “moderate,” and “severe” AD, using Mini-Mental State Examination (MMSE), Alzheimer’s Disease Assessment Scale–Cognitive subscale (ADAS-Cog), and the Clinical Dementia Rating–Sum of Boxes (CDR-SB) thresholds. Age and pre-progression rate were significant determinants of AD progression using MMSE alone to stage AD, and pre-progression was found to impact disease progression with CDR-SB. Sensitivity of these instruments for identifying clinical stages of AD to correctly staging a “moderate” level of disease severity for outcomes MMSE, CDR-SB, and ADAS-Cog was 92%, 78%, and 92%, respectively. This research derives longitudinal sensitivity of clinical instruments used to stage AD useful for clinical decision-making. The MMSE and ADAS-Cog provided adequate sensitivity to classify AD stages.

Relationship of frontal lobe dysfunction and aberrant motor behaviors in patients with Alzheimer's disease

2009 ◽  
Vol 22 (3) ◽  
pp. 463-469 ◽  
Author(s):  
Tomoyuki Nagata ◽  
Shunichiro Shinagawa ◽  
Yusuke Ochiai ◽  
Hirohide Kada ◽  
Hiroo Kasahara ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Frontal Lobe ◽  
Motor Behavior ◽  
Cross Sectional Study ◽  
Stepwise Multiple Regression ◽  
Clinical Dementia Rating ◽  
Cross Sectional ◽  
Motor Behaviors ◽  
Relationship Of

ABSTRACTBackground: In order to address the neuropsychological pathogenesis of aberrant motor behaviors in Alzheimer's disease (AD), we used a cross-sectional study design to investigate the association between frontal lobe function, including executive function, and activity disturbances (wandering, purposeless activities and inappropriate activities).Methods: Among 75 consecutive outpatients with AD, 50 subjects with a Clinical Dementia Rating (CDR) score of 1 or 2 were selected and divided into two groups based on data obtained from interviews with their caregivers: an aberrant motor behaviors (AMB) group (n = 22), and a non-aberrant motor behaviors (NAMB) group (n = 28). Aberrant motor behavior was defined according to whether the “activity disturbance” score (ranging from 0 to 9) of the Behavioral Pathology in Alzheimer Disease (Behave-AD) scale was 0 or ≥1. The total and subtest scores of the Frontal Assessment Battery (FAB) were then compared between the two groups.Results: Significant differences were found between the FAB total (P < 0.05) and the subtest scores (lexical fluency, conflicting instructions; P < 0.05) in the two groups. The FAB score was significantly associated with the activity disturbance score (r = −0.49; P<0.001). A stepwise multiple regression analysis showed that only the FAB score significantly influenced the activity disturbance score (P < 0.001).Conclusions: This finding suggested that in addition to episodic memory disturbance, frontal lobe dysfunctions might lead patients with AD to develop aberrant motor behavior.

scholarly journals Diagnostic Value of Subjective Memory Complaints Assessed with a Single Item in Dominantly Inherited Alzheimer’s Disease: Results of the DIAN Study

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Christoph Laske ◽  
Hamid R. Sohrabi ◽  
Mateusz S. Jasielec ◽  
Stephan Müller ◽  
Niklas K. Koehler ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Depression Scale ◽  
Diagnostic Value ◽  
Subjective Memory Complaints ◽  
Subjective Memory ◽  
Clinical Dementia Rating ◽  
Cross Sectional ◽  
Single Item ◽  
Memory Complaints

Objective. We examined the diagnostic value of subjective memory complaints (SMCs) assessed with a single item in a large cross-sectional cohort consisting of families with autosomal dominant Alzheimer’s disease (ADAD) participating in the Dominantly Inherited Alzheimer Network (DIAN).Methods. The baseline sample of 183 mutation carriers (MCs) and 117 noncarriers (NCs) was divided according to Clinical Dementia Rating (CDR) scale into preclinical (CDR 0; MCs:n=107; NCs:n=109), early symptomatic (CDR 0.5; MCs:n=48; NCs:n=8), and dementia stage (CDR ≥ 1; MCs:n=28; NCs:n=0). These groups were subdivided by the presence or absence of SMCs.Results. At CDR 0, SMCs were present in 12.1% of MCs and 9.2% of NCs(P=0.6). At CDR 0.5, SMCs were present in 66.7% of MCs and 62.5% of NCs(P=1.0). At CDR ≥ 1, SMCs were present in 96.4% of MCs. SMCs in MCs were significantly associated with CDR, logical memory scores, Geriatric Depression Scale, education, and estimated years to onset.Conclusions. The present study shows that SMCs assessed by a single-item scale have no diagnostic value to identify preclinical ADAD in asymptomatic individuals. These results demonstrate the need of further improvement of SMC measures that should be examined in large clinical trials.

scholarly journals Factors associated with caregiver burden: comparative study between Brazilian and Spanish caregivers of patients with Alzheimer's disease (AD)

2016 ◽  
Vol 28 (8) ◽  
pp. 1363-1374 ◽  
Author(s):  
Maria Fernanda B. Sousa ◽  
Raquel L. Santos ◽  
Oriol Turró-Garriga ◽  
Rachel Dias ◽  
Marcia C. N. Dourado ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Day Care ◽  
Neuropsychiatric Symptoms ◽  
Care Center ◽  
Clinical Dementia Rating ◽  
Cross Sectional ◽  
Day Care Center ◽  
High Burden ◽  
Factors Associated

ABSTRACTBackground:Transcultural studies regarding the comparison of levels of burden in caregivers of patients with Alzheimer's disease (AD) from Europe and Latin America are rare. We designed this study to investigate the differentiating factors associated with burden in Brazilian and Spanish caregivers of patients with AD.Methods:This is a cross-sectional study composed by samples of outpatients with AD and their caregivers from Brazil (n = 128) and Spain (n = 146). Caregivers answered the Zarit Burden Interview (ZBI) and a Sociodemographic Questionnaire. Patients were assessed with the Mini-Mental State Examination (MMSE), Functional Activities Questionnaire (FAQ), Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI), and Clinical Dementia Rating (CDR) Scale.Results:In the multivariate regression analysis, high burden levels were reported in Brazil, when caregivers were female (p = 0.025) and when patients did not attend Day Care Center (p = 0.025). In Spain, high burden levels were associated with living with the patient (p = 0.014), younger caregivers (p = 0.003), and participation of patients at Day Care Center (p = 0.046). Also, different neuropsychiatric symptoms explained high burden levels: in Brazil, depression (p < 0.001) and anxiety (p = 0.024) and, in Spain, apathy/indifference (p < 0.001), agitation/aggression (p = 0.019) and irritability/lability (p = 0.027).Conclusions:Caregivers’ gender, patients who attended Day Care Center and neuropsychiatric symptoms were differentiating factors in the burden of Brazilian and Spanish caregivers.

Clinical progression of moderate-to-severe Alzheimer's disease and caregiver burden: a 12-month multicenter prospective observational study

2010 ◽  
Vol 22 (8) ◽  
pp. 1265-1279 ◽  
Author(s):  
Luis Agüera-Ortiz ◽  
Ana Frank-García ◽  
Pedro Gil ◽  
Alfonso Moreno
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Observational Study ◽  
Caregiver Burden ◽  
Major Influence ◽  
Functional Impairments ◽  
Clinical Progression ◽  
Clinical Dementia Rating ◽  
Cross Sectional ◽  
Use Of Resources

ABSTRACTBackground: Prospective studies on the clinical progression of Alzheimer's disease (AD) and its relationship to caregiver burden are needed to improve illness management and use of resources.Methods: This national, multicenter, observational study evaluated 1235 moderate to severe AD patients under routine care in Spain. Baseline cross-sectional sociodemographic and clinical data, and changes from baseline to month 12 of various neuropsychological tests and clinical ratings, including Blessed Dementia Scale, Mini-mental State Examination (MMSE), Hughes Clinical Dementia Rating sum-of-boxes (CDR-SB), Clinical Global Impression of Change (CGIC) and Zarit Caregiver Burden scales, were recorded and comprehensively analyzed.Results: Baseline data were in accordance with characteristics consistently reported to influence AD risk regarding anthropometrics, sociocultural features and comorbidities. Significant progressive functional impairments (i.e. in routine activities and essential daily tasks) and cognitive (i.e. MMSE and CDR-SB) impairments were found at month 12. However, patients' behavior and caregivers' burden improved slightly, but significantly, corroborating the major influence of behavioral symptoms on caregivers' distress. Caregivers showed significantly lower burden with patients with higher levels of education and, to a lesser extent, when patients received AD-specific medication. Physicians accurately detected AD clinical evolution as their CGIC ratings significantly correlated with all tests.Conclusions: These findings reinforce previous AD knowledge and add data on the clinical course of advanced stages of AD. Caregiver burden depended more on patients' behavioral alterations than on their functional or cognitive declines; and it was diminished by their patients having higher levels of education and being treated with AD-specific medications. Research into unexplored factors that might reduce caregiver burden, ultimately benefiting both patients and caregivers, is encouraged.

scholarly journals Depression, quality of life and cortisol: a cross-sectional study of caregivers of patients with Alzheimer’s disease

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 672
Author(s):  
Emanuela Bernardi ◽  
Katiuscia de Oliveira Francisco Gabriel ◽  
Luana Bernardi ◽  
Gláucia Renée Hilgemberg ◽  
Elizama de Gregório ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Elderly Patients ◽  
Salivary Cortisol ◽  
Short Form ◽  
Cross Sectional Study ◽  
Clinical Dementia Rating ◽  
Extrinsic Factors ◽  
Cross Sectional

Background: Stress can impact human health in multiple ways. Among the related mechanisms are the hormonal systems of the hypothalamic–pituitary–adrenal axis, which produces cortisol. Current research aims to evaluate the relationship between the daily variation of salivary cortisol dosages and the level of stress in caregivers of patients with Alzheimer's disease (AD). Methods: A sociodemographic questionnaire was applied to 25 caregivers, as well as the 36 Item Short-Form Health Survey and Beck’s Depression Inventory. In the 25 patients of the caregivers, the Instrumental Activities of Daily Living of the patient and Clinical Dementia Rating were assessed. Saliva samples were collected to assess the cortisol level of the caregivers three times over one day for each caregiver, (morning, afternoon and evening) to investigate the correlation of the aforementioned questionnaires with the age and degree of kinship among caregivers of elderly patients to investigate the correlation with the results of the previously described tests, and the age and degree of relatedness of caregivers and elderly patients. Results: There was a significant positive correlation between daily cortisol levels and increasing caregiver age. However, the daily dosage of salivary cortisol was not significantly associated with the stress level of the caregivers of patients with AD, suggesting that this is not a good neuroendocrine marker of response to mood disorders. This fact can be related to intrinsic and extrinsic factors to the caregiver. Conclusions: Compared with previous studies that correlate cortisol and stress in humans, our findings suggest that the stress mechanism may be more complex and depend on more factors than the levels of this hormone. Thus, further work is required to delineate possible cortisol modulators, as well as the type of stress that target this population and their ability to adapt and face adversity in their work.

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