PREDICTORS OF GLOBAL COGNITIVE IMPAIRMENT 1 YEAR AFTER SUBARACHNOID HEMORRHAGE

Neurosurgery ◽  
2009 ◽  
Vol 65 (6) ◽  
pp. 1043-1051 ◽  
Author(s):  
Mellanie V. Springer ◽  
J. Michael Schmidt ◽  
Katja E. Wartenberg ◽  
Jennifer A. Frontera ◽  
Neeraj Badjatia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Delayed Cerebral Ischemia ◽  
Cognitive Status ◽  
Cognitively Impaired

Abstract OBJECTIVE We sought to determine the frequency, risk factors, and impact on functional outcome and quality of life (QOL) of global cognitive impairment 1 year after subarachnoid hemorrhage. METHODS We prospectively evaluated global cognitive status 3 and 12 months after hospitalization with the Telephone Interview for Cognitive Status in 232 subarachnoid hemorrhage survivors. Cognitive impairment was defined as a score of 30 or less (scaled 0 = worst, 51 = best). Logistic regression was performed to calculate adjusted odds ratios (AORs) for impairment at 1 year. Basic activities of daily living were evaluated with the Barthel Index, instrumental activities of daily living were assessed with the Lawton scale, and QOL was evaluated with the Sickness Impact Profile. RESULTS The frequency of cognitive impairment was 27% at 3 months and 21% at 12 months. After the effects of age, education, and race/ethnicity were controlled for, risk factors for cognitive impairment at 12 months included anemia treated with transfusion (AOR, 3.4; P = 0.006), any temperature level higher than 38.6°C (AOR, 2.7; P = 0.016), and delayed cerebral ischemia (AOR, 3.6; P = 0.01). Among cognitively impaired patients at 3 months, improvement at 1 year occurred in 34% and was associated with more than 12 years of education and the absence of fever higher than 38.6°C during hospitalization (P = 0.015). Patients with cognitive impairment at 1 year had worse concurrent QOL and less ability to perform instrumental and basic activities of daily living (all P < 0.001). CONCLUSION Global cognitive impairment affects more than 20% of subarachnoid hemorrhage survivors at 1 year, is predicted by fever, anemia treated with transfusion, and delayed cerebral ischemia, and adversely affects functional recovery and QOL.

scholarly journals Association of self-perceived income sufficiency with cognitive impairment among older adults: a population-based study in India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
T. Muhammad ◽  
Shobhit Srivastava ◽  
T. V. Sekher
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Psychological Health ◽  
Daily Living ◽  
Basic Needs ◽  
Well Being ◽  
Asset Ownership ◽  
Increased Risk

Abstract Background Greater cognitive performance has been shown to be associated with better mental and physical health and lower mortality. The present study contributes to the existing literature on the linkages of self-perceived income sufficiency and cognitive impairment. Study also provides additional insights on other socioeconomic and health-related variables that are associated with cognitive impairment in older ages. Methods Data for this study is derived from the 'Building Knowledge Base on Population Ageing in India'. The final sample size for the analysis after removing missing cases was 9176 older adults. Descriptive along with bivariate analyses were presented to show the plausible associations of cognitive impairment with potential risk factors using the chi-square test. Also, binary logistic regression analysis was performed to provide the relationship between cognitive impairment and risk factors. The software used was STATA 14. Results About 43% of older adults reported that they had no source of income and 7.2% had income but not sufficient to fulfil their basic needs. Older adults with income but partially sufficient to fulfil their basic needs had 39% significantly higher likelihood to suffer from cognitive impairment than older adults who had sufficient income [OR: 1.39; OR: 1.21–1.59]. Likelihood of cognitive impairment was low among older adults with asset ownership than older adults with no asset ownership [OR: 0.83; CI: 0.72–0.95]. Again, older adults who work by compulsion (73.3%) or felt mental or physical stress due to work (57.6%) had highest percentage of cognitive impairment. Moreover, older adults with poor self-rated health, low instrumental activities of daily living, low activities of daily living, low subjective well-being and low psychological health were at increased risk for cognitive impairment. Conclusion The study highlights the pressing need for care and support and especially financial incentives in the old age to preserve cognitive health. Further, while planning geriatric health care for older adults in India, priority must be given to financially backward, with no asset ownership, with poor health status, older-older, widowed, and illiterate older individuals, as they are more vulnerable to cognitive impairment.

scholarly journals Activities of Daily Living and Categorization Skills of Elderly with Cognitive Deficit: A Preliminary Study

2021 ◽  
Vol 11 (2) ◽  
pp. 213
Author(s):  
Dulce Romero-Ayuso ◽  
Cristian Cuerda ◽  
Carmen Morales ◽  
Ricardo Tesoriero ◽  
José Matías Triviño-Juárez ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Deductive Reasoning ◽  
Personal Autonomy ◽  
Assessment Process ◽  
Digital Version ◽  
Routine Tasks

Cognitive dysfunction affects the performance of Activities of Daily Living (ADL) and the quality of life of people with these deficits and their caregivers. To the knowledge of the authors, to date, there are few studies that focus on knowing the relationship between personal autonomy and deductive reasoning and/or categorization skills, which are necessary for the performance of the ADL. The aim of this study was to explore the relationships between ADL and categorization skills in older people. The study included 51 participants: 31 patients with cognitive impairment and 20 without cognitive impairment. Two tests were administered to assess cognitive functions: (1) the Montreal Cognitive Assessment (MoCA); and (2) the digital version of Riska Object Classification test (ROC-d). In addition, the Routine Tasks Inventory-2 (RTI-2) was applied to determine the level of independence in activities of daily living. People with cognitive impairment performed poorly in categorization tasks with unstructured information (p = 0.006). Also, the results found a high correlation between cognitive functioning and the performance of ADLs (Physical ADL: r = 0.798; p < 0.001; Instrumental ADL: r = 0.740; p < 0.001), a moderate correlation between Physical ADLs and categorization skills (unstructured ROC-d: r = 0.547; p < 0.001; structured ROC-d: r = 0.586; p < 0.001) and Instrumental ADLs and categorization skills in older people (unstructured ROC-d: r = 0.510; p < 0.001; structured ROC-d: r = 0.463; p < 0.001). The ROC-d allows the assessment of categorization skills to be quick and easy, facilitating the assessment process by OT, as well as the accuracy of the data obtained.

Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage

2008 ◽  
Vol 109 (6) ◽  
pp. 1052-1059 ◽  
Author(s):  
J. Michael Schmidt ◽  
Katja E. Wartenberg ◽  
Andres Fernandez ◽  
Jan Claassen ◽  
Fred Rincon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Cerebral Infarction ◽  
Clinical Symptoms ◽  
External Ventricular Drain ◽  
Delayed Cerebral Ischemia ◽  
Neurological Deterioration ◽  
Modified Rankin Scale ◽  
Poor Grade

Object The authors sought to determine frequency, risk factors, and impact on outcome of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage (SAH). Methods The authors prospectively studied 580 patients with SAH admitted to their center between July 1996 and May 2002. Delayed cerebral ischemia (DCI) from vasospasm was defined as 1) a new focal neurological deficit or decrease in level of consciousness, 2) a new infarct revealed by follow-up CT imaging, or both, after excluding causes other than vasospasm. Outcome at 3 months was assessed using the modified Rankin Scale. Results Delayed cerebral ischemia occurred in 121 (21%) of 580 patients. Of those with DCI, 36% (44 patients) experienced neurological deterioration without a corresponding infarct, 42% (51 patients) developed an infarct in conjunction with neurological deterioration, and 21% (26 patients) had a new infarct on CT without concurrent neurological deterioration. In a multivariate analysis, risk factors for asymptomatic DCI included coma on admission, placement of an external ventricular drain, and smaller volumes of SAH (all p ≤ 0.03). Patients with asymptomatic DCI were less likely to be treated with vasopressor agents than those with symptomatic DCI (64 vs 86%, p = 0.01). After adjusting for clinical grade, age, and aneurysm size, the authors found that there was a higher frequency of death or moderate-to-severe disability at 3 months (modified Rankin Scale Score 4–6) in patients with asymptomatic DCI than in patients with symptomatic DCI (73 vs 40%, adjusted odds ratio 3.9, 95% confidence interval 1.3–12.0, p = 0.017). Conclusions Approximately 20% of episodes of DCI after SAH are characterized by cerebral infarction in the absence of clinical symptoms. Asymptomatic DCI is particularly common in comatose patients and is associated with poor outcome. Strategies directed at diagnosing and preventing asymptomatic infarction from vasospasm in patients with poor-grade SAH are needed.

Critical appraisal of questionnaires to assess functional impairment in individuals with mild cognitive impairment

2016 ◽  
Vol 28 (9) ◽  
pp. 1425-1439 ◽  
Author(s):  
Navaldeep Kaur ◽  
Patricia Belchior ◽  
Isabelle Gelinas ◽  
Nathalie Bier
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Psychometric Properties ◽  
Daily Living ◽  
Functional Independence ◽  
Assessment Tools ◽  
Cosmin Checklist ◽  
Psychometric Studies

ABSTRACTBackground:Mild deficits in instrumental activities of daily living (IADLs) have consistently been reported in the individuals with mild cognitive impairment (MCI). A variety of functional assessment tools, including self-and informant report questionnaires and performance-based measures, have been employed in MCI. Previously, a limited focus has been directed at appraising the quality of questionnaires. The goal of this study was to identify the questionnaires that have been validated in the MCI population. Additionally, the quality of validation studies and psychometric attributes of these questionnaires were appraised.Methods:Relevant articles were systematically searched in PsychINFO, Ovid MEDLINE, and CINAHL against specific eligibility criteria. To evaluate the methodology of the psychometric studies, the COSMIN checklist was employed. Also, the psychometric properties of the assessment tools were evaluated based upon Terwee's criteria.Results:A total of five psychometric studies and questionnaires were critically evaluated. Varying psychometric properties were available for the chosen tools. None of the studies received the best possible rating for their methodological quality. It was found that questionnaires with high discriminative ability to distinguish MCI from other diagnostic groups were: Disability Assessment in Dementia-6 (DAD-6), Functional Activity Questionnaire (FAQ), and Alzheimer's Disease Cooperative Study/Activities of Daily Living scale adapted for MCI patients (ADCS-MCI-ADL-24).Conclusion:Psychometric studies with strong methodological rigor are required in the future. Considering the fact that IADL decline has been associated with dementia, early detection of functional difficulties in MCI needs to be encouraged as it will allow suitable and timely interventions to prolong functional independence of affected individuals.

scholarly journals The Assessment of Quality of Life in Dementia

2003 ◽  
Vol 15 (3) ◽  
pp. 213-218 ◽  
Author(s):  
Siegfried Weyerer ◽  
Martina Schäufele
Keyword(s):  
Quality Of Life ◽  
Activities Of Daily Living ◽  
Behavioral Problems ◽  
Daily Living ◽  
Cognitive Status ◽  
Environmental Interventions ◽  
The Past

In the past decade, pharmacological, behavioral, educational, and environmental interventions for individuals with dementia have addressed a variety of goals: improving cognitive status, delaying the onset of symptoms, reducing behavioral problems such as depression and agitation, and maximizing activities of daily living. It is important not only to ameliorate symptoms but also to evaluate the extent to which an intervention improves the quality of life (QOL) of the person being treated (Logsdon et al., 2002).

scholarly journals COPING WITH ANXIETY, DEPRESSION, BURDEN AND QUALITY OF LIFE IN INFORMAL PRIMARY CAREGIVERS OF COMMUNITY-DWELLING INDIVIDUALS WITH DEMENTIA

2018 ◽  
pp. 1-8
Author(s):  
M. Muscat ◽  
C. Scerri
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Emotional Distress ◽  
Daily Living ◽  
Primary Caregivers ◽  
Community Dwelling ◽  
Anxiety And Depression ◽  
Anxiety Depression

Objective: This study aimed to investigate how informal primary caregivers of individuals with dementia living in the community cope with caring-related measures of anxiety, depression, burden and quality of life. Participants and Design: Participants included 60 informal caregivers (23 males and 37 females) of community-dwelling individuals with dementia who attended a state-run geriatric day hospital in Malta. Caregiver measures included the Hospital Anxiety and Depression Scale, the World Health Organization Quality of Life–BREF and Brief COPE questionnaires, and Zarit Burden Interview. The Mini Mental State Examination and Barthel Index of Activities of Daily Living scores were used to determine the degree of cognitive impairment and performance in activities of daily living of care-recipients. Results: Informal caregivers experienced anxiety and depression with both emotional distress states negatively affecting all quality of life domains. Depression and burden experienced by informal primary caregivers showed a strong association with individuals with dementia-related variables such as age, cognitive impairment and activities of daily living scores. The use of dysfunctional coping strategies was found to be related to caregivers’ emotional distress, low quality of life and burden. Conclusion: The findings indicate that informal primary caregivers experienced anxiety and depression, had a lower quality of life, and feel burdened during their caring role. However, caregivers making use of emotion-focused coping strategies were found to be protected against emotional distress. The results highlight the need of providing support services aimed at promoting the psychological wellbeing of informal carers of community-dwelling individuals with dementia.

scholarly journals Instrumental Activities of Daily Living Scales to Detect Cognitive Impairment and Dementia in Low- and Middle-Income Countries: A Systematic Review

2021 ◽  
pp. 1-24
Author(s):  
Heather Yemm ◽  
Dame Louise Robinson ◽  
Stella-Maria Paddick ◽  
Catherine Dotchin ◽  
Michaela Louise Goodson ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Diagnostic Accuracy ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Middle Income ◽  
Middle Income Countries ◽  
Instrumental Activities ◽  
The Impact ◽  
Low And Middle Income

Background: The largest proportion of people with dementia worldwide live in low- and middle- income countries (LMICs), with dementia prevalence continuing to rise. Assessment and diagnosis of dementia involves identifying the impact of cognitive decline on function, usually measured by instrumental activities of daily living (IADLs). Objective: This review aimed to identify IADL measures which are specifically developed, validated, or adapted for use in LMICs to guide selection of such tools. Methods: A systematic search was conducted (fourteen databases) up to April 2020. Only studies reporting on development, validation, or adaptation of IADL measures for dementia or cognitive impairment among older adults (aged over 50) in LMICs were included. The QUADAS 2 was used to assess quality of diagnostic accuracy studies. Results: 22 papers met inclusion criteria; identifying 19 discrete IADL tools across 11 LMICs. These were either translated from IADL measures used in high-income countries (n = 6), translated and adapted for cultural differences (n = 6), or newly developed for target LMIC populations (n = 7). Seven measures were investigated in multiple studies; overall quality of diagnostic accuracy was moderate to good. Conclusion: Reliability, validity, and accuracy of IADL measures for supporting dementia diagnosis within LMICs was reported. Key components to consider when selecting an IADL tool for such settings were highlighted, including choosing culturally appropriate, time-efficient tools that account for gender- and literacy-bias, and can be conducted by any volunteer with appropriate training. There is a need for greater technical and external validation of IADL tools across different regions, countries, populations, and cultures.

Abstract P237: Measuring Cognition in the Atherosclerosis Risk in Communities (ARIC) Study Cohort: An approach to Account for Informative Attrition

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Lisa M Wruck ◽  
Alvaro Alonso ◽  
Marilyn Albert ◽  
Josef Coresh ◽  
David Couper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Cognitive Status ◽  
Data Management System ◽  
Cognitively Impaired ◽  
Study Cohort ◽  
Supplementary Data ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Elderly Cohort

Introduction: Understanding the role of risk factors associated with accelerated cognitive decline has important public health relevance for the aging US population. To test hypotheses that mid-life cardiovascular (CV) risk factors increase risk of dementia in old age, the Atherosclerosis Risk in Communities (ARIC) cohort was evaluated for dementia in 2011-2013. Anticipating challenges of complete dementia ascertainment in an elderly population, supplementary data sources were collected to aid analysis accounting for potentially informative attrition. Methods: ARIC enrolled 15,792 participants 45-64 years old at baseline (1987-1989) from four US communities and collected baseline CV exposure data. A complete neurocognitive battery including informant interview was completed 2011-2013, yielding an algorithmic diagnosis of dementia, mild cognitive impairment (MCI) or normal cognition. Cognitively impaired and a random sample of cognitively normal were selected for further clinical evaluation. Syndromic diagnoses (dementia/MCI/normal) and etiologic diagnoses were made by a panel of experts using standardized criteria. Standardized protocols, timely reports of reviewer reliability, ongoing training of reviewers and a web-based data management system were developed to ensure reliability, consistency and efficiency of data collection and review. Living participants not attending the visit were asked to complete the Telephone Interview for Cognitive Status (TICS). Based on dementia discharge codes and death codes identified during cohort surveillance, interviewer impression of hearing loss or cognitive impairment or need for a proxy during semi-annual calls, or random sampling, participants refusing the TICS are eligible for proxy dementia interview. Medicare claims are being examined to identify missed dementia discharge codes. Results: Of 11,017 participants alive as of 2011, 6495 (59%) completed the neurocognitive battery; 2937 of these (45%) were selected for, and completed, additional clinical assessments and classification by committee (algorithmic or reviewer diagnosis: dementia 5%, MCI 21%). Of the 4522 participants who did not undergo the neurocognitive battery, 1463 (32%) completed the TICS (dementia 7%), while 1627 of the remaining participants were eligible for proxy calls (903 completed to date, dementia 58%). Conclusions: Participants who were not examined were more likely to be cognitively impaired, highlighting the importance of collecting supplementary data to support analyses of midlife CV risk factors accounting for informative attrition. Collection of exam data in an elderly cohort is difficult and requires a multi-pronged approach, especially for an outcome highly correlated with attrition. The strategy described here could be applied in other settings.

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