PROTECTIVE EFFECT OF LIFETIME EXPERIENCES ON FUNCTIONAL STATUS IN YOUNG-ONSET DEMENTIA

Abstract Patients with Frontotemporal degeneration (FTD), a common form of young-onset dementia, experience decline in cognitive, social and daily functioning as the disease progresses. Research shows that lifestyle factors may be an important modifiable risk factor for dementia, but this has not been well studied in FTD. In this study, we test the hypothesis that lifetime experiences, including education, occupation, and leisure activities, are associated with better functional status in individuals with FTD. We also evaluated the relationship between timing of experiences (early, mid-life, and late-life) and functional status. Thirty-five patients (mean age 61.6±8.7; 74% male; mean disease duration 3.4 ± 2.6; mean MMSE 24.0 ± 5.5) completed the Lifetime of Experiences Questionnaire (LEQ), a comprehensive assessment of lifelong cognitive lifestyle, and the Clinical Dementia Rating Scale (CDR), which was used to assess functional status. Linear regression tested the relationship between cognitive lifestyle and functional status, with age and disease duration included as covariates. Higher total LEQ score was associated with better functional status (lower score on CDR) (β = -0.047, p = 0.009). While Young Adulthood LEQ score was not significantly associated with total CDR (β = -0.047, p = 0.176), both Mid-life (β = -0.117, p = 0.011) and Late-life (β = -0.133, p = 0.013) LEQ score significantly contributed to functional status. Our results indicate that functional status is mediated in part by cognitive lifestyle and that experiences accumulated in mid-life and late-life have a greater effect on functional status at time of diagnosis.

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Executive functioning mediates the link between other neuropsychological domains and daily functioning: a Project FRONTIER study

International Psychogeriatrics ◽

10.1017/s1041610210000967 ◽

2010 ◽

Vol 23 (1) ◽

pp. 107-113 ◽

Cited By ~ 15

Author(s):

Sid E. O'Bryant ◽

Jed Falkowski ◽

Valerie Hobson ◽

Leigh Johnson ◽

James Hall ◽

...

Keyword(s):

Executive Functioning ◽

Functional Status ◽

Mexican American ◽

Rating Scale ◽

Daily Functioning ◽

Clinical Dementia Rating ◽

Immediate Memory ◽

Neuropsychological Status ◽

Health Project ◽

Neuropsychological Assessments

ABSTRACTBackground: The purpose of this study was to examine the mediating impact of executive functioning on the link between other neuropsychological domain scores and informant-based rating of functional status.Methods: Data on 181 participants were analyzed from an ongoing epidemiological study of rural health, Project FRONTIER (mean age = 64.6 ± 13.8 years, 69% women, 42% Mexican American). Executive functioning was assessed by the EXIT25 and other neuropsychological domains were assessed via the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Informant-based rating of functional status was assessed via the Clinical Dementia Rating Scale sum of boxes scores (CDR SB).Results: RBANS Index scores were each significantly (p < 0.05) related to CDR SB scores and EXIT25 scores. EXIT25 score was a significant partial mediator of the link between four RBANS indices (Immediate Memory, Attention, Visuospatial/Construction, Delayed Memory) and CDR SB scores, and a complete mediator of the fifth index (Language).Conclusion: Executive functioning is a mediator of the link between other neuropsychological domains and daily functioning. Neuropsychological assessments that do not measure executive functioning will provide only a partial clinical picture with adults and elders.

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Predeath Grief, Resourcefulness, and Perceived Stress Among Caregivers of Partners With Young-Onset Dementia

Western Journal of Nursing Research ◽

10.1177/0193945918806689 ◽

2018 ◽

Vol 41 (7) ◽

pp. 973-989 ◽

Cited By ~ 2

Author(s):

Karie Ruekert Kobiske ◽

Abir K. Bekhet ◽

Mauricio Garnier-Villarreal ◽

Marilyn Frenn

Keyword(s):

Perceived Stress ◽

Online Survey ◽

Theoretical Framework ◽

Future Research ◽

Resilience Theory ◽

Moderating Effects ◽

Cross Sectional ◽

Young Onset ◽

Young Onset Dementia ◽

The Relationship

More than 200,000 Americans are currently diagnosed with young-onset dementia (YOD). YOD is dementia diagnosed prior to the age of 65. Most persons of YOD are cared for by their partners. Using the theoretical framework of Resilience Theory, this cross-sectional, correlational study examined the moderating effects of personal and social resourcefulness on the relationship between predeath grief and perceived stress among 104 YOD caregiving partners (life partners/spouses) using an online survey platform. Results indicated a large positive correlation between predeath grief and caregiver perceived stress ( r = .65; p < .001). Together predeath grief, personal resourcefulness and social resourcefulness explained 51.5% of the variance in perceived stress. Personal resourcefulness did not moderate the relationship. Social resourcefulness did positively moderate this relationship between predeath grief and perceived stress. These findings allow for a better understanding of the caregiving experience for a partner with YOD and creates opportunities for future research studies.

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Validation of neuropsychological tests for the China Health and Retirement Longitudinal Study Harmonized Cognitive Assessment Protocol

International Psychogeriatrics ◽

10.1017/s1041610219000693 ◽

2019 ◽

Vol 31 (12) ◽

pp. 1709-1719 ◽

Cited By ~ 4

Author(s):

Qinqin Meng ◽

Huali Wang ◽

John Strauss ◽

Kenneth M. Langa ◽

Xinxin Chen ◽

...

Keyword(s):

Longitudinal Study ◽

Episodic Memory ◽

Functional Status ◽

Cognitive Assessment ◽

Rating Scale ◽

Cognitive Status ◽

Clinical Dementia Rating ◽

Community Screening ◽

Assessment Protocol ◽

Neurocognitive Tests

ABSTRACTObjective:To compare and validate neurocognitive tests in the Harmonized Cognitive Assessment Protocol (HCAP) for the China Health and Retirement Longitudinal Study (CHARLS), and to identify appropriate tests to be administered in future waves of CHARLS.Methods:We recruited 825 individuals from the CHARLS sample and 766 subjects from hospitals in six provinces and cities in China. All participants were administered the HCAP-neurocognitive tests, and their informants were interviewed regarding the respondents’ functional status. Trained clinicians administered the Clinical Dementia Rating scale (CDR) to assess the respondents’ cognitive status independently.Results:The testing protocol took an average of 58 minutes to complete. Refusal rates for tests of general cognition, episodic memory, and language were less than 10%. All neurocognitive test scores significantly correlated with the CDR global score (correlation coefficients ranged from 0.139 to 0.641). The Mini-Mental State Examination (MMSE), the Health and Retirement Study (HRS) - telephone interview for cognitive status (TICS), community screening instrument for dementia (CSI-D) for respondent, episodic memory and language tests each accounted for more than 20% of the variance in global CDR score (p < 0.001) in bivariate tests. In the CHARLS subsample, age and education were associated with neuropsychological performance across most cognitive domains, and with functional status.Conclusion:A brief set of the CHARLS-HCAP neurocognitive tests are feasible and valid to be used in the CHARLS sample and hospital samples. It could be applied in the future waves of the CHARLS study, and it allows estimating the prevalence of dementia in China through the population-based CHARLS.

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The relationship between unmet care needs in young-onset dementia and the course of neuropsychiatric symptoms: a two-year follow-up study

International Psychogeriatrics ◽

10.1017/s1041610213001476 ◽

2013 ◽

Vol 26 (12) ◽

pp. 1991-2000 ◽

Cited By ~ 34

Author(s):

Christian Bakker ◽

Marjolein E. de Vugt ◽

Deliane van Vliet ◽

Frans R.J. Verhey ◽

Yolande A. Pijnenburg ◽

...

Keyword(s):

Unmet Needs ◽

Neuropsychiatric Symptoms ◽

The Elderly ◽

Care Needs ◽

Young Onset ◽

Future Care ◽

Camberwell Assessment Of Need ◽

Young Onset Dementia ◽

The Relationship ◽

Level Of Agreement

ABSTRACTBackground:Little is known about care needs in young-onset dementia (YOD) patients, even though this information is essential for service provision and future care planning.We explored: (1) care needs of people with YOD, (2) the level of agreement within patient-caregiver dyads on care needs, and (3) the longitudinal relationship between unmet needs and neuropsychiatric symptoms.Methods:A community-based prospective study of 215 YOD patients-caregiver dyads. Care needs were assessed with the Camberwell Assessment of Need for the Elderly. The level of agreement between patient and caregivers’ report on care needs was calculated using κ coefficients. The relationship between unmet needs and neuropsychiatric symptoms over time, assessed with the Neuropsychiatric Inventory, was explored using linear mixed models.Results:Patients and caregivers generally agreed on the areas in which needs occurred. Only modest agreement existed within patient-caregiver dyads regarding whether needs could be met. Patients experienced high levels of unmet needs in areas such as daytime activities, social company, intimate relationships, and information, leading to an increase in neuropsychiatric symptoms.Conclusions:Our findings indicate that in YOD, there are specific areas of life in which unmet needs are more likely to occur. The high proportions of unmet needs and their relationship with neuropsychiatric symptoms warrant interventions that target neuropsychiatric symptoms as well as the prevention of unmet needs. This underlines the importance of the periodic investigation of care needs, in which patient and caregiver perspectives are considered complementary.

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Association between late-life hypercholesterolemia and progression of dementia severity among older adults

Innovation in Aging ◽

10.1093/geroni/igaa057.3238 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 876-876

Author(s):

Mo-kyung Sin ◽

Yan Cheng ◽

Ali Ahmed ◽

Edward Zamrini

Keyword(s):

Older Adults ◽

Cox Regression ◽

Late Life ◽

Clinical Dementia Rating ◽

Future Studies ◽

Dementia Severity ◽

Kaplan Meier ◽

Point Increase ◽

Race Ethnicity ◽

The Relationship

Abstract Progression of dementia severity varies widely by individuals and multiple factors might influence the progression. The aim of this study was to examine the relationship between late-life hypercholesterolemia and progression of dementia severity in older adults. We used prospectively collected longitudinal data from 2,686 adults aged ≥65 years in the National Alzheimer’s Coordinating Center. Progression of dementia severity was measured using both Clinical Dementia Rating (CDR) - Sum of Boxes (SOB) and Global scores. Kaplan Meier curves were plotted to estimate the association between hypercholesterolemia and progression of dementia severity. We also conducted multivariate Cox regression models to estimate the association of hypercholesterolemia with the outcomes adjusting for age, gender, race, ethnicity, marital status, living status, education, smoking, heart failure, atrial fibrillation, blood pressure, and diabetes. Hypercholesterolemia had significant association with CDR-SOB ≥ 1 point increase (unadjusted HR, 1.23; 95% CI, 1.13-1.35; p<0.001; adjusted HR, 1.17; 95% CI, 1.07-1.28; p<0.001). In addition, hypercholesterolemia had significant association with CDR-Global ≥ 0.5 point increase (unadjusted HR, 1.14; 95% CI, 1.04-1.25; p<0.001; adjusted HR, 1.11; 95% CI, 1.01-1.22 p=0.036). If these findings can be replicated in future studies, future studies need to examine if proper management of cholesterol may reduce the risk of Alzheimer’s dementia in late-life older adults.

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Association Between Late-Life Hypertension and Resilience to Alzheimer Dementia Among Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.1180 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 304-305

Author(s):

Mo-kyung Sin ◽

Yan Cheng

Keyword(s):

Older Adults ◽

Late Life ◽

Braak Stage ◽

Clinical Dementia Rating ◽

Chi Square ◽

Alzheimer Dementia ◽

Student’S T ◽

The Relationship ◽

Untreated Hypertension

Abstract While midlife hypertension is known as one contributing factor for cognitive impairment and Alzheimer dementia in late-life older adults, less is known about the role of late-life hypertension in resilience to Alzheimer dementia. We examined the relationship between late-life hypertension and Alzheimer dementia resilience among older adults using the National Alzheimer’s Coordinating Center data from 2005-2020 (n=3,170). Hypertension, captured within 5 years prior to death, was defined as blood pressure (BP) ≥ 140/90 mmHg in at least two visits and/or ever treated with anti-hypertensive agents. Resilience was defined as positive Alzheimer disease (AD) pathology (CERAD score moderate or severe and BRAAK stage V or VI) from autopsy and Clinical Dementia Rating (CDR) - Sum of Boxes (SOB): 0.5-2.5 or CDR global (0-0.5) from last data point before autopsy. Student’s t-tests and Chi-square tests were conducted to compare patients with and without resilience. A multivariate logistic regression was conducted to estimate the association between late-life hypertension and resilience, adjusting for covariates of demographics and neuropathological characteristics. We had 55 resilient cases among 1,195 positive AD pathology cases. Those resilient were older (88±6.7) and had higher systolic BP (136 ± 18.2 mmHg) than non-resilient (82±7.9 years old, 130±20 mmHg. Untreated hypertension had a protective effect on resilience (adjusted OR: 3.69 (1.10-13.5, p=0.05). Patients with a systolic BP in the range of 135-145 mmHg and a diastolic BP in the range of 65-75 mmHg had the highest resilience possibility. Unlike midlife hypertension, late-life hypertension may have different effect on dementia, prompting further studies.

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Behavioural and Psychological Symptoms in Poststroke Vascular Cognitive Impairment

Behavioural Neurology ◽

10.1155/2014/430128 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 19

Author(s):

Meena Gupta ◽

Abhijit Dasgupta ◽

Geeta Anjum Khwaja ◽

Debashish Chowdhury ◽

Yogesh Patidar ◽

...

Keyword(s):

Cognitive Impairment ◽

Rating Scale ◽

Psychological Symptoms ◽

Vascular Cognitive Impairment ◽

Neuropsychiatric Symptom ◽

Neuropsychiatric Inventory ◽

Clinical Dementia Rating ◽

Behavioural And Psychological Symptoms ◽

Relationship Of ◽

The Relationship

Background.Behavioural and psychological symptoms of dementia (BPSD) cause significant patient and caregiver morbidity in vascular cognitive impairment (VCI).Objectives. To study and compare the occurrence and severity of BPSD between multi-infarct dementia (MID), subcortical ischaemic vascular disease (SIVD), and strategic infarct subtypes of poststroke VCI and to evaluate the relationship of these symptoms with the severity of cognitive impairment.Methods. Sixty patients with poststroke VCI were classified into MID, SIVD, and strategic infarct subtypes. BPSD were studied by the neuropsychiatric inventory (NPI). The severity of cognitive impairment was evaluated by the clinical dementia rating scale (CDR).Results. 95% of cases had at least one neuropsychiatric symptom, with depression being the commonest, irrespective of subtype or severity of VCI. Strategic infarct patients had the lowest frequency of all symptoms. SIVD showed a higher frequency and severity of apathy and higher total NPI scores, compared to MID. Apathy and appetite disturbances occurred more commonly with increasing CDR scores. The total NPI score correlated positively with the CDR score.Conclusion. Depression was the commonest neuropsychiatric symptom in VCI. The neuropsychiatric profiles of MID and SIVD were similar. The frequency and severity of apathy and the net burden of BPSD increased with increasing cognitive impairment.

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Education, leisure activities and cognitive and functional ability of Alzheimer's disease patients: A follow-up study

Dementia & Neuropsychologia ◽

10.1590/s1980-57642013dn70200008 ◽

2013 ◽

Vol 7 (2) ◽

pp. 181-189 ◽

Cited By ~ 8

Author(s):

Margarida Sobral ◽

Constança Paúl

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Disease Progression ◽

Functional Ability ◽

Rating Scale ◽

Leisure Activities ◽

Functional Decline ◽

Clinical Dementia Rating ◽

High Participation ◽

Relevant Variables

ABSTRACT Education and participation in leisure activities appear to be highly relevant variables in Alzheimer's disease (AD) and usually form the basis of the Cognitive Reserve construct. Objective: [A] To determine the association between education, cognitive and functional ability of AD patients; [B] To determine the association between participation in leisure activities and cognitive and functional ability of AD patients; [C] To evaluate the association of education and participation in leisure activities in the course of AD. Methods: Functional and neuropsychological abilities of 120 outpatients with probable AD were evaluated at baseline, at 36 and 54 months. Data collected at baseline included socio-demographics, clinical variables, education and frequency of participation in leisure activities throughout life. All participants and/or caregivers answered the questionnaire, "Participation in leisure activities throughout life" while patients completed the MMSE, the Clinical Dementia Rating scale, neuropsychological tests from the Lisbon Screening for Dementia Assessment, Barthel Index and Lawton and Brody's Index. Results: AD patients with higher levels of education achieved better results on cognitive tests. The participants with higher participation in leisure activities exhibited better results on cognitive and functional tests than those with lower participation. The disease progression was linear and progressed similarly regardless of the level of education of participants. However, the results suggest a slower disease progression in patients with a higher level of participation in leisure activities throughout their lives. Conclusion: AD patients with high education and high participation in leisure activities may benefit from a slower cognitive and functional decline after diagnosis of AD.

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Behaviors Characteristic of Autism Spectrum Disorder in Older Adults With Cognitive Impairment

Innovation in Aging ◽

10.1093/geroni/igaa057.506 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 155-155

Author(s):

Elizabeth Rhodus ◽

Justin Barber ◽

Erin Abner ◽

Shani Bardach ◽

Graham Rowles ◽

...

Keyword(s):

Older Adults ◽

Autism Spectrum Disorder ◽

Cognitive Impairment ◽

Rating Scale ◽

De Novo ◽

Age At Onset ◽

Late Life ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Clinical Dementia Rating

Abstract Autism spectrum disorder (ASD) is commonly recognized by the time of adolescence, but is poorly understood in older adults. The possibility of late-life emergence of ASD has been poorly explored. In order to investigate late-life emergence of behaviors characteristic of ASD in MCI and AD, we surveyed caregivers of 142 older adults with neurodegenerative cognitive impairment using the Gilliam Autism Rating Scale-2. Participants with high autism index ratings (Autism ‘Possible/Very Likely’, n=23) reported significantly (statistically and clinically) younger age at onset of cognitive impairment than those who scored in the Autism ‘Unlikely’ range (n=119): 71.14±10.9 vs. 76.65±8.25 (p = 0.034). Additionally, those in Autism ‘Possible/Very Likely’ group demonstrated advanced severity of cognitive impairment, indicated by Clinical Dementia Rating Scale Sum of Boxes scores. Data demonstrate that ASD behaviors may appear de novo of degenerative dementia and such behaviors are more prevalent in those with early onset dementia. Further work elucidating a connection between ASD and dementia could shed light on subclinical forms of ASD, identify areas of shared neuroanatomic involvement between ASD and dementias, and provide valuable insights that might hasten the development of therapeutic strategies.

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Addenbrooke’s Cognitive Examination III: Psychometric Characteristics and Relations to Functional Ability in Dementia

Journal of the International Neuropsychological Society ◽

10.1017/s1355617718000541 ◽

2018 ◽

Vol 24 (8) ◽

pp. 854-863 ◽

Cited By ~ 21

Author(s):

Matthew So ◽

David Foxe ◽

Fiona Kumfor ◽

Cynthia Murray ◽

Sharpley Hsieh ◽

...

Keyword(s):

Functional Ability ◽

Rating Scale ◽

Cutoff Score ◽

Cognitive Screening ◽

Clinical Dementia Rating ◽

Dementia Patients ◽

Receiver Operator Curve Analysis ◽

Cutoff Scores ◽

The Relationship ◽

Addenbrooke’S Cognitive Examination

AbstractObjectives: The Addenbrooke’s Cognitive Examination (ACE) is a common cognitive screening test for dementia. Here, we examined the relationship between the most recent version (ACE-III) and its predecessor (ACE-R), determined ACE-III cutoff scores for the detection of dementia, and explored its relationship with functional ability. Methods: Study 1 included 199 dementia patients and 52 healthy controls who completed the ACE-III and ACE-R. ACE-III total and domain scores were regressed on their corresponding ACE-R values to obtain conversion formulae. Study 2 included 331 mixed dementia patients and 87 controls to establish the optimal ACE-III cutoff scores for the detection of dementia using receiver operator curve analysis. Study 3 included 194 dementia patients and their carers to investigate the relationship between ACE-III total score and functional ability. Results: Study 1: ACE-III and ACE-R scores differed by ≤1 point overall, the magnitude varying according to dementia type. Study 2: a new lower bound cutoff ACE-III score of 84/100 to detect dementia was identified (compared with 82 for the ACE-R). The upper bound cutoff score of 88/100 was retained. Study 3: ACE-III scores were significantly related to functional ability on the Clinical Dementia Rating Scale across all dementia syndromes, except for semantic dementia. Conclusions: This study represents one of the largest and most clinically diverse investigations of the ACE-III. Our results demonstrate that the ACE-III is an acceptable alternative to the ACE-R. In addition, ACE-III performance has broader clinical implications in that it relates to carer reports of functional impairment in most common dementias. (JINS, 2018, 24, 854–863)

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