scholarly journals Correlating Dementia Severity Rating Scale and Schonberg Index Mortality Risk Scores to Aid Caregiver Medical Decision-Making

2020 ◽  
Vol 3 ◽  
Author(s):  
Myranda Grismore ◽  
Nicole Fowler
Keyword(s):  
Decision Making ◽  
Cognitive Impairment ◽  
Life Expectancy ◽  
Medical Decision Making ◽  
Rating Scale ◽  
Medical Decision ◽  
Prognostic Information ◽  
Severity Rating ◽  
Dementia Severity ◽  
The Relationship

Background/Hypothesis:  The 16 million unpaid caregivers serving individuals with Alzheimer’s disease and related dementias (ADRD) are more likely to participate in medical decision-making than caregivers of older adults with other chronic conditions. Their decisions may reflect the patient’s severity of cognitive impairment and life expectancy. Analysis of the relationship between these two factors is needed to improve the prognostic information provided to caregivers. ADRD severity can be measured using the Dementia Severity Rating Scale (DSRS), a validated, informant-based multiple-choice questionnaire that assesses functional and cognitive abilities. Life expectancy can be estimated using the Schonberg Index (SI), a validated, predictive mortality index. We hypothesize that DSRS and SI scores will be correlated.    Methods:  A retrospective analysis of data from 230 dyads enrolled in the Decisions about Cancer Screening in Alzheimer’s Disease (DECAD) study was performed. The DECAD study is an ongoing randomized controlled trial enrolling dyads of older women with ADRD and their caregivers to test the benefits of a mammography decision aid. In the study, caregivers completed the DSRS and SI questions. DSRS and SI scores were compared using linear regression analysis. Additionally, 20 DECAD interviews were qualitatively evaluated to explore themes of medical decision-making among ADRD caregivers.    Results:  DSRS scores and SI scores were weakly correlated, yielding an R2 value of 0.1. Interviews revealed that caregivers most frequently considered physician advice, comorbidity status, and patient preferences in decision-making. 67% of moderate ADRD caregivers and 36% of mild ADRD caregivers cited cognitive impairment severity as an influential factor.    Conclusions/Implications:  Further analysis controlling for time since diagnosis will better establish the relationship between DSRS and SI scores. The resulting increase in accuracy of ADRD prognostic information will aid physicians and caregivers in medical decision-making. Furthermore, understanding what influences caregiver decisions will allow for the provision of improved guidance from physicians. 

scholarly journals The Relationship Between Dementia Severity & Caregiver Preferences for Decision Making Role Regarding Mammography

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 992-992
Author(s):  
Molly Frank ◽  
Seho Park ◽  
Kathleen Lane ◽  
Alexia Torke ◽  
Mara Schonberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Decision Making ◽  
Rating Scale ◽  
Medical Decision ◽  
Diagnose Breast Cancer ◽  
Dementia Severity ◽  
Increased Risk ◽  
The Relationship

Abstract The incidence of Alzheimer’s disease and related dementias (ADRD) and breast cancer increases with age. Despite being one of the most effective ways to diagnose breast cancer early, mammography in ADRD patients comes with an increased risk of treatment complications and false-positive results. Family caregivers are often involved in the decision-making process, and this study evaluates the relationship between dementia severity and caregiver preferences when making decisions about mammography with the patient alone, and with the patient and doctor. We included 181 caregivers from the Decisions about Cancer screening in Alzheimer’s Disease trial, which uses the Dementia Severity Rating Scale (DSRS) to assess dementia severity and a modified Control Preferences Scale (CPS) to assess each caregiver’s preferred decision-making approach. Multinomial logistic regression models evaluated the relationship between DSRS and CPS categories (active, passive, and collaborative), while controlling for the caregivers’ age, sex, race, education, and relationship to patient. Model 1 examined the caregivers’ preferred role with the patient, and it found a significant association between increased dementia severity and preference for a collaborative approach (p<0.001) or passive approach (p<0.05) compared to an active approach. Model 2 did not find a significant association between dementia severity and the caregivers’ preferred role when making decisions with the patient and doctor; however, those with increased age and education were more likely to prefer an active role. The association between dementia severity, caregiver characteristics, and decision-making preferences supports the need for approaches to support ADRD caregivers with medical decision making.

Medical decision-making capacity in patients with mild cognitive impairment

Neurology ◽  
2007 ◽  
Vol 69 (15) ◽  
pp. 1528-1535 ◽  
Author(s):  
O. Okonkwo ◽  
H. R. Griffith ◽  
K. Belue ◽  
S. Lanza ◽  
E. Y. Zamrini ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decision Making Capacity

Medical decision-making in neurodegenerative disease: Mild AD and PD with cognitive impairment

Neurology ◽  
2005 ◽  
Vol 65 (3) ◽  
pp. 483-485 ◽  
Author(s):  
H. R. Griffith ◽  
M. P. Dymek ◽  
P. Atchison ◽  
L. Harrell ◽  
D. C. Marson
Keyword(s):  
Decision Making ◽  
Cognitive Impairment ◽  
Neurodegenerative Disease ◽  
Medical Decision Making ◽  
Medical Decision

scholarly journals The Relationship Between Family Caregivers’ Anticipatory Grief and Severity of Dementia

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Nicole Gavin ◽  
Mu Shan ◽  
Nicole Fowler
Keyword(s):  
Multiple Regression ◽  
Rating Scale ◽  
Primary Objective ◽  
Anticipatory Grief ◽  
Subjective Burden ◽  
Severity Rating ◽  
Dementia Severity ◽  
Acceptance And Commitment ◽  
Clinically Significant ◽  
The Relationship

Background/Objective: Anticipatory grief is the process of experiencing normal bereavement before the physical death of a significant person. To date, anticipatory grief has been related to higher levels of caregiver depression, anxiety, subjective burden, and poorer problem solving. Additionally, higher levels anticipatory grief are observed in caregivers of those with Alzheimer’s Disease and Related Dementias (ADRD) compared to caregivers of other conditions. The primary objective of this analysis is to determine the relationship between caregiver anticipatory grief and dementia severity, as measured by the Anticipatory Grief Scale (AGS) and Dementia Severity Rating Scale (DSRS), respectively. Methods: Multiple regression analyses were performed on data for ADRD caregivers (n=56) enrolled in the IU Telephone Acceptance and Commitment Therapy for Caregivers (TACTICs) trial; an RCT testing an ACT intervention for ADRD caregiver anxiety. Inclusion criteria included identifying as the primary caregiver of an ADRD patient and clinically significant anxiety (GAD7 score >10). Results: The average age of caregivers was 61.9 years, 41.1% were spouses, 83.9% were white and 14.3% were black. Mean anticipatory grief scores were notably higher (84.6) compared to the previously reported means across the literature. Multiple regression models showed a caregivers’ anticipatory grief is not significantly associated with the patients’ dementia severity as measured by the Dementia Severity Rating Scale (t=0.87). Results also revealed that higher levels of caregiver burden, as measured by the Zarit Burden Index, are significantly associated with more anticipatory grief (t=< 0.1). Conclusion and Potential Impact: Understanding these relationships contributes to better understanding ADRD caregivers, identifying “high-risk” caregivers, and informing future interventions and care.

Decisions and attitudes regarding participation and proxy in clinical trials among patients with impaired cognitive function

Dementia ◽  
2017 ◽  
Vol 18 (6) ◽  
pp. 2049-2061
Author(s):  
S Stormoen ◽  
IM Tallberg ◽  
O Almkvist ◽  
M Eriksdotter ◽  
E Sundström
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Decision Making ◽  
Clinical Trials ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
High Risk ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decision Making Capacity

Background Medical decision-making capacity is impaired in Alzheimer’s disease and mild cognitive impairment. Medical decision-making capacity depends on many different cognitive functions and varies due to situation and cognitive, social, and emotional status of the patient. Our aim was to analyze dementia patients’ capacity to estimate risks and benefits in different clinical trials and determine how cognitive decline affects their attitude toward possible participation and proxy consent. Methods Groups: Alzheimer’s disease (n = 20), mild cognitive impairment (n = 21) and healthy controls (n = 33). Two hypothetical clinical trials, a standardized interview and three visual analogue scales were used to investigate decisions, estimations, reasoning, and attitudes. Results A general positive attitude toward participation in clinical trials was shown among all groups. Both patients and controls motivated possible participation as “own-benefit” in the low-risk trial and to “help-others” in the high-risk trial. Individuals who accepted to participate in the high-risk trial scored lower in medical decision-making capacity in comparison to participants who would not have participated (p < .01). Patients in the Alzheimer’s disease but not mild cognitive impairment and healthy control groups underestimated risks and overestimated benefits in the high-risk/low-benefit trial (p < .05). A family member was most frequently chosen as possible proxy (91%). Conclusions Medical decisions and research consent should be interpreted with caution in patients who are already in early stages of dementia, as the patients’ acceptance to participate in high-risk trials may be due an insufficient decisional capacity and risk analysis, accelerated by a general desire to make good to society. We emphasize the use of a standardized tool to evaluate medical decisional capacity in clinical research.

Sign in / Sign up

Export Citation Format

Share Document