scholarly journals Clinical characteristics and diagnostic accuracy of the revised Addenbrooke Cognitive Examination (ACE-R) in older adults with a low educational level

2021 ◽  
Vol 70 (1) ◽  
pp. 45-53
Author(s):  
José Wagner Leonel Tavares Júnior ◽  
Pedro Braga Neto ◽  
Janine de Carvalho Bonfadini ◽  
Lays Bittencourt ◽  
Candida Helena Lopes ◽  
...  
Keyword(s):  
Older Adults ◽  
Diagnostic Accuracy ◽  
Healthy Aging ◽  
Strongly Correlated ◽  
Cognitive Screening ◽  
Spatial Skills ◽  
Immediate Recall ◽  
Visual Spatial ◽  
Visuospatial Skills ◽  
Post Hoc

ABSTRACT Objective: To determine the diagnostic accuracy of the Addenbrooke’s Cognitive Examination Revised (ACE-R) as a cognitive screening tool for older adults with low levels of schooling and healthy aging, MCI and dementia in Brazil. Methods: All participants underwent neurological and psychiatric examinations and were administered a validated version of ACE-R. Results: A total of 85 participants were evaluated; most were females (84.7%, n = 72). The post hoc analysis showed statistical differences in ACE-R total scores between older adults with mild cognitive impairment (MCI) and controls (p < 0.001) and in subitem scores including verbal fluency, language, visuospatial skills and attention (p < 0.001). The visual-spatial skills subitem was the most strongly correlated with schooling level (r = 0.509, p < 0.001), whereas late, immediate recall and recognition memory were not influenced by schooling. The ACE-R had the best diagnostic accuracy in discriminating between MCI and controls = 0.69 (<57.5; 80/66), MD and controls = 0.98 (<50; 100/96), MCI and MD = 0.86 (<49.5; 100/74). Conclusions: ACE-R and Mini-Mental State Examination (MMSE) scores for older adults with MCI and controls were significantly lower than those reported in similar studies. These preliminary findings support the need for establishing reliable cut-off scores for cognitive assessment of older Brazilian adults with low schooling at risk for dementia taking into consideration ecological and local variables.

scholarly journals Modulation of spatial cue processing across the lifespan: a geometric polarization of space restores allocentric navigation strategies in children and older adults

2020 ◽  
Author(s):  
Marcia Bécu ◽  
Denis Sheynikhovich ◽  
Stephen Ramanoël ◽  
Guillaume Tatur ◽  
Anthony Ozier-Lafontaine ◽  
...  
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Healthy Aging ◽  
Spatial Representations ◽  
Spatial Skills ◽  
Spatial Cues ◽  
Head Mounted Display ◽  
Geometric Cues ◽  
Cue Processing ◽  
The Impact

AbstractThe impact of development and healthy aging on spatial cognition has been traditionally attributed to a difficulty in using allocentric strategies and a preference for egocentric ones. An alternative possibility, suggested by our previous works, is that this preference is actually conditioned by the spatial cues (e.g. geometric of landmark cues) present in the environment rather than a strategic choice per se. We tested this prediction by having 79 subjects (children, young and older adults) navigating a Y-maze composed either of landmarks or geometric cues, with an immersive head-mounted display that allows us to record both head and eye movements. Our results show that when the performance is based on landmarks solely, children and older adults exhibit a deficit in using allocentric strategies when compared to young adults. Hence, an inverted U-profile of allocentric strategies was observed across the lifespan. This was not due to a default of attention to the landmarks, as evidenced by analysis of gaze dynamics. When geometric were provided, however, older adults and children used allocentric strategies in the same proportion as young adults. They were, in addition, as efficient and quick to implement the strategy. We thus propose a reinterpretation of the previous data in the literature, whereby reference to geometric cues is the default mode for spatial representations, which is immune to age, whereas spatial representations fail to be anchored on landmarks early in development and later in aging. This new interpretation has the potential to reunify several data from the literature, ranging from spatial cues processing to strategy preference, and including other spatial skills like path integration and route learning.

Diagnostic Accuracy of Usual Cognitive Screening Tests Versus Appropriate Tests for Lower Education to Identify Alzheimer Disease

2020 ◽  
pp. 089198872095854
Author(s):  
Luciane Viola Ortega ◽  
Ivan Aprahamian ◽  
José Eduardo Martinelli ◽  
Mário Amore Cecchini ◽  
João de Castilho Cação ◽  
...  
Keyword(s):  
Older Adults ◽  
Diagnostic Accuracy ◽  
Clinical Sample ◽  
Memory Test ◽  
Reading Test ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Clock Drawing Test ◽  
Black And White ◽  
Colored Figure

Introduction: The accuracy of commonly used screening tests for Alzheimer’s disease (AD) has not been directly compared to those that could be more appropriate for lower schooling. Objective: To compare the diagnostic accuracy of usual screening tests for AD with instruments that might be more appropriate for lower schooling among older adults with low or no literacy. Methods: The study included a clinical sample of 117 elderly outpatients from a Geriatric Clinic classified as literate controls (n = 39), illiterate controls (n = 30), literate AD (n = 30) and illiterate AD (n = 18). The tests were compared as follows: Black and White versus Colored Figure Memory Test; Clock Drawing Test versus Clock Reading Test; Verbal Fluency (VF) animal versus grocery category; CERAD Constructional Praxis versus Stick Design Test. Results: The means of literate and illiterate controls did not differ in the Black and White Figure Memory Test (immediate recall), Colored Figure Memory Test (delayed recall), Clock Reading Test and VF animals and grocery categories. The means of the clinical groups (controls versus AD), in the 2 schooling levels, differed significantly in most of the tests, except for the CERAD Constructive Praxis and the Stick Design Test. Diagnostic accuracy was not significantly different between the compared tests. Conclusion: Commonly used screening tests for AD were as accurate as those expected to overcome the education bias in a sample of older adults with lower or no education.

Short Clinical Assessments Applicable to Busy Practices

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S16) ◽  
pp. 6-9 ◽  
Author(s):  
Ziad Nasreddine
Keyword(s):  
Cognitive Disorders ◽  
Word Recall ◽  
Cognitive Screening ◽  
Spatial Skills ◽  
Research Committee ◽  
Clock Drawing Test ◽  
Clinical Assessments ◽  
Visual Spatial ◽  
Practice Parameters ◽  
Increased Risk

Because biomarkers to detect Alzheimer’s disease (AD) have not yet been validated, physicians must rely on clinical assessments. The Research Committee of the American Neuropsychiatric Association recommended that the ideal cognitive screening instrument have the following characteristics: First, it should take <15 minutes to administer by a clinician at any level of training. Second, it should sample all major cognitive domains, including memory, attention/concentration, executive function, visual-spatial skills, language, and orientation. Third, it should be reliable, having adequate test-retest and inter-rater validity. Finally, it should be able to detect cognitive disorders commonly encountered by neuropsychiatrists.The American Academy of Neurology Practice Parameters from 1994 and 2001 and the Canadian Consensus Guidelines on Dementia from 2007 recommend that physicians screen subjects with suspected dementia or mild cognitive impairment (MCI), since these patients are at increased risk for AD. Currently, there are no data on the utility of screening subjects who are asymptomatic.The most commonly used brief cognitive tests are the Mini-Mental State Examination (MMSE), according to a survey conducted by the International Psychogeriatric Association (IPA) in 2006, followed by the clock-drawing test, the delayed-word recall, the verbal fluency test, the similarities test, and the trail-making test. Clinicians appraised these assessments as the most effective and easiest to administer (Slide 1).

Performance of three cognitive screening tools in a sample of older New Zealanders

2015 ◽  
Vol 27 (6) ◽  
pp. 981-989 ◽  
Author(s):  
G. Cheung ◽  
A. Clugston ◽  
M. Croucher ◽  
D. Malone ◽  
E. Mau ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Cognitive Assessment ◽  
Random Order ◽  
Screening Tools ◽  
Screening Tests ◽  
Future Research ◽  
Clinical Settings ◽  
Strongly Correlated ◽  
Cognitive Screening ◽  
Mild Dementia

ABSTRACTBackground:With the ubiquitous Mini-Mental State Exam now under copyright, attention is turning to alternative cognitive screening tests. The aim of the present study was to investigate three common cognitive screening tools: the Montreal Cognitive Assessment (MoCA), the Rowland Universal Dementia Assessment Scale (RUDAS), and the recently revised Addenbrooke's Cognitive Assessment Version III (ACE-III).Methods:The ACE-III, MoCA and RUDAS were administered in random order to a sample of 37 participants with diagnosed mild dementia and 47 comparison participants without dementia. The diagnostic accuracy of the three tests was assessed.Results:All the tests showed good overall accuracy as assessed by area under the ROC Curve, 0.89 (95% CI = 0.80–0.95) for the ACE-III, 0.84 (0.75–0.91) for the MoCA, and 0.86 (0.77–0.93) for RUDAS. The three tests were strongly correlated: r(84) = 0.85 (0.78–0.90) between the ACE-III and MoCA, 0.70 (0.57–0.80) between the ACE-III and RUDAS; and 0.65 (0.50–0.76) between the MoCA and RUDAS. The data derived optimal cut-off points for were lower than the published recommendations for the ACE-III (optimal cut-point ≤76, sensitivity = 81.1%, specificity = 85.1%) and the MoCA (≤20, sensitivity = 78.4%, specificity = 83.0%), but similar for the RUDAS (≤22, sensitivity = 78.4%, specificity = 85.1%).Conclusions:All three tools discriminated well overall between cases of mild dementia and controls. To inform interpretation of these tests in clinical settings, it would be useful for future research to address more inclusive and potentially age-stratified local norms.

The Impact of Subjective and Objective Hearing Loss on Cognition and Memory in Older Adults

2015 ◽  
Vol 20 (2) ◽  
pp. 49-57 ◽  
Author(s):  
Yvonne Rogalski ◽  
Amy Rominger
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Reading Aloud ◽  
Cognitive Testing ◽  
Professional Collaboration ◽  
Cognitive Screening ◽  
Speech Language Pathologist ◽  
Text Passage ◽  
The Impact ◽  
Audiologic Evaluation

For this exploratory cross-disciplinary study, a speech-language pathologist and an audiologist collaborated to investigate the effects of objective and subjective hearing loss on cognition and memory in 11 older adults without hearing loss (OAs), 6 older adults with unaided hearing loss (HLOAs), and 16 young adults (YAs). All participants received cognitive testing and a complete audiologic evaluation including a subjective questionnaire about perceived hearing difficulty. Memory testing involved listening to or reading aloud a text passage then verbally recalling the information. Key findings revealed that objective hearing loss and subjective hearing loss were correlated and both were associated with a cognitive screening test. Potential clinical implications are discussed and include a need for more cross-professional collaboration in assessing older adults with hearing loss.

scholarly journals Multidirectional Overground Robotic Training Leads to Improvements in Balance in Older Adults

Robotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 101
Author(s):  
Lara A. Thompson ◽  
Mehdi Badache ◽  
Joao Augusto Renno Brusamolin ◽  
Marzieh Savadkoohi ◽  
Jelani Guise ◽  
...  
Keyword(s):  
Older Adults ◽  
Healthy Aging ◽  
Robotic System ◽  
Control Group ◽  
Support Surface ◽  
Training Methods ◽  
Robotic Training ◽  
Balance Confidence ◽  
Balance Ability ◽  
Abc Scale

For the rapidly growing aging demographic worldwide, robotic training methods could be impactful towards improving balance critical for everyday life. Here, we investigated the hypothesis that non-bodyweight supportive (nBWS) overground robotic balance training would lead to improvements in balance performance and balance confidence in older adults. Sixteen healthy older participants (69.7 ± 6.7 years old) were trained while donning a harness from a distinctive NaviGAITor robotic system. A control group of 11 healthy participants (68.7 ± 5.0 years old) underwent the same training but without the robotic system. Training included 6 weeks of standing and walking tasks while modifying: (1) sensory information (i.e., with and without vision (eyes-open/closed), with more and fewer support surface cues (hard or foam surfaces)) and (2) base-of-support (wide, tandem and single-leg standing exercises). Prior to and post-training, balance ability and balance confidence were assessed via the balance error scoring system (BESS) and the Activities specific Balance Confidence (ABC) scale, respectively. Encouragingly, results showed that balance ability improved (i.e., BESS errors significantly decreased), particularly in the nBWS group, across nearly all test conditions. This result serves as an indication that robotic training has an impact on improving balance for healthy aging individuals.

676 Age is only a number: Treatment modality preferences in a randomized controlled trial of CBTI in older adults

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A264-A264
Author(s):  
Norah Simpson ◽  
Isabelle Tully ◽  
Jessica Dietch ◽  
Joshua Tutek ◽  
Rachel Manber
Keyword(s):  
Older Adults ◽  
Treatment Modality ◽  
Clinical Characteristics ◽  
Internet Use ◽  
Baseline Data ◽  
Stepped Care ◽  
Treatment Preference ◽  
Post Hoc ◽  
Modality Preference ◽  
Insomnia Severity

Abstract Introduction Use of telemedicine platforms for conducting CBTI has the potential to reach more patients than in person treatment alone. While CBTI has been shown to be effective in older adults, questions about proficiency with technology and preference for treatment modality have not been addressed. Methods Baseline data from participants in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study were used. Analyses compared CBTI treatment modality preference (in person, online [video platform], no preference) across the following variables: insomnia severity (Insomnia Severity Index; ISI), depression (Geriatric Depression Scale; GDS), cognitive functioning (telephone-based cognitive screen) and internet proficiency (IP; assessing comfort with and frequency of internet use). Data collected prior to the pandemic-shut down (March 2020) were utilized for the primary analysis of treatment preference; n=71, mean age = 62.5 (SD = 8.1); 64.8% female; treatment preferences: in person (33.8%), no preference (25.4%), online (40.8%). A secondary analysis compared IP data from participants with baseline data from pre-pandemic (Nov 2019-Feb 2020, n=71), early pandemic (March-June 2020, n=28), and late pandemic (the most recent four months of enrollment, July 2020-Nov 2020, n=40) periods. Results Pre-pandemic, age was not significantly associated with treatment modality preference, nor any baseline clinical characteristics or demographic variables (p’s &gt;.01). Only ‘comfort’ and ‘comfort+frequency’ scores from the internet proficiency measure differed significantly between treatment preference groups (p’s&lt;.002). Post-hoc analyses revealed the online group had significantly higher comfort and comfort+frequency scores than the in person group (p’s&lt;. 003). Comparing data from pre-pandemic, early pandemic, and late pandemic, frequency of internet use and comfort+frequency with internet use differed across groups (p’s &lt;.004). Post-hoc comparisons revealed frequency of internet use scores were higher in the late pandemic compared to pre-pandemic (p=.003). Conclusion These findings suggest that comfort using technology, but not age or clinical characteristics, is associated with treatment modality preference for patients with insomnia who are enrolled in a technology-based clinical trial of CBTI. As proficiency in use of technology increases, for example, during and following the pandemic, one can expect that telemedicine will be an increasingly viable approach to providing CBTI among older adults. Support (if any) 1R01AG057500

Participatory development of the food literacy intervention “GUSTO” for older adults in Germany

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Zastrow ◽  
K Neher ◽  
H Hassel
Keyword(s):  
Older Adults ◽  
Focus Group ◽  
Focus Groups ◽  
Everyday Life ◽  
Healthy Aging ◽  
Participatory Approach ◽  
Target Group ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Food Literacy

Abstract Background Healthy aging is one of the major challenges currently faced by an aging population. Food literacy (FL) refers to the ability to apply knowledge and practical skills regarding healthy and sustainable nutrition into everyday life. The project “GUSTO” is sponsored by the Bavarian State Ministry of Health and Care and aims to contribute to enjoyable aging by developing the nutritional skills of people aged 65 and over. This community-based program comprises independent working groups of older adults guided by peer moderators. The FL intervention is developed in cooperation with the target group. Methods The nutritional situation of older adults was first established through a literature research. The results of this research were compared to the “self-perceived food literacy scale” by Poelman et al. (2018) and the “nutritional framework for literacy courses” by Johannsen et al. (2019). The resulting data provided a basis for focus group discussions carried out in six municipalities, supported by local practice partners. In six guided focus group discussions, a number of recurring themes were identified and summarized. Results The focus groups consisted of a total of 44 people between 62 and 88 years of age (average age: 73.1 ± 6.1 years). 22.7 % were men. The group discussions revealed resources used and barriers encountered in terms of FL and interests of older adults. It was evident that, due to the high density of information available, the participants found it difficult to identify reliable information and to implement it in their everyday life. At the request of the focus groups, topics such as the best before date and the use of food waste were added to the intervention. Conclusions Older adults find it challenging to identify reliable nutritional information and implement it in their everyday life. With the help of the participatory approach outlined in this study, target group-related issues can be identified and taken into account in the intervention. Key messages Older adults can be involved in the development of an FL intervention. A participatory approach allows target group-related issues and specific needs to be taken into account in the intervention.

scholarly journals Rates of Cognitive and Functional Impairments in Older Adults Residing in a Continuing Care Senior Housing Community

2021 ◽  
pp. 1-12
Author(s):  
Ryan Van Patten ◽  
Zanjbeel Mahmood ◽  
Tanya T. Nguyen ◽  
Jacqueline E. Maye ◽  
Ho-Cheol Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Functional Capacity ◽  
Independent Living ◽  
Visual Learning ◽  
Cognitive Test ◽  
Continuing Care ◽  
Cognitive Screening ◽  
Functional Impairments ◽  
Senior Housing ◽  
The Mean

Abstract Objective: The current cross-sectional study examined cognition and performance-based functional abilities in a continuing care senior housing community (CCSHC) that is comparable to other CCSHCs in the US with respect to residents’ demographic characteristics. Method: Participants were 110 older adult residents of the independent living unit. We assessed sociodemographics, mental health, neurocognitive functioning, and functional capacity. Results: Compared to normative samples, participants performed at or above expectations in terms of premorbid functioning, attention span and working memory, processing speed, timed set-shifting, inhibitory control, and confrontation naming. They performed below expectation in verbal fluency and verbal and visual learning and memory, with impairment rates [31.4% (>1 SD below the mean) and 18.49% (>1.5 SD below the mean)] well above the general population (16% and 7%, respectively). Within the cognitive test battery, two tests of delayed memory were most predictive of a global deficit score. Most cognitive test scores correlated with performance-based functional capacity. Conclusions: Overall, results suggest that a subset of older adults in the independent living sector of CCSHCs are cognitively and functionally impaired and are at risk for future dementia. Results also argue for the inclusion of memory tests in abbreviated screening batteries in this population. We suggest that CCSHCs implement regular cognitive screening procedures to identify and triage those older adults who could benefit from interventions and, potentially, a transition to a higher level of care.

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