Informant-Reported Discrimination, Dementia, and Cognitive Impairment in Older Brazilians

2021 ◽  
pp. 1-9
Author(s):  
Jose M. Farfel ◽  
Lisa L. Barnes ◽  
Ana Capuano ◽  
Maria Carolina de Moraes Sampaio ◽  
Robert S. Wilson ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Sex Education ◽  
The Elderly ◽  
Structured Interview ◽  
Racially Diverse ◽  
Clinical Dementia Rating ◽  
Community Based ◽  
Poor Cognitive Function ◽  
Diagnosis Of Dementia ◽  
Everyday Discrimination

Background: Self-reported discrimination is a source of psychosocial stress that has been previously associated with poor cognitive function in older African Americans without dementia. Objective: Here, we examine the association of discrimination with dementia and cognitive impairment in racially diverse older Brazilians. Methods: We included 899 participants 65 years or older (34.3% Black) from the Pathology, Alzheimer’s and Related Dementias Study (PARDoS), a community-based study of aging and dementia. A structured interview with informants of the deceased was conducted. The interview included the Clinical Dementia Rating (CDR) Scale for the diagnosis of dementia and cognitive impairment proximate to death and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a second measure of cognitive impairment. Informant-reported discrimination was assessed using modified items from the Major and Everyday Discrimination Scales. Results: Discrimination was reported by informants of 182 (20.2%) decedents and was more likely reported by informants of Blacks than Whites (25.3% versus 17.6%, p = 0.006). Using the CDR, a higher level of informant-reported discrimination was associated with higher odds of dementia (OR: 1.24, 95% CI 1.08 –1.42, p = 0.002) and cognitive impairment (OR: 1.21, 95% CI: 1.06 –1.39, p = 0.004). Similar results were observed using the IQCODE (estimate: 0.07, SE: 0.02, p = 0.003). The effects were independent of race, sex, education, socioeconomic status, major depression, neuroticism, or comorbidities. Conclusion: Higher level of informant-reported discrimination was associated with higher odds of dementia and cognitive impairment in racially diverse older Brazilians.

The Use and Cost of Community Care Services by Elders with Unimpaired Cognitive Function, with Cognitive Impairment/No Dementia and with Dementia

1997 ◽  
Vol 16 (4) ◽  
pp. 665-681 ◽  
Author(s):  
Evelyn Shapiro ◽  
Robert B. Tate
Keyword(s):  
Cognitive Impairment ◽  
Daily Living ◽  
Community Care ◽  
Independent Predictor ◽  
Living Arrangement ◽  
The Elderly ◽  
Mental Functioning ◽  
Care Services ◽  
Diagnosis Of Dementia ◽  
Cognitive Impairment No Dementia

ABSTRACTData from the Manitoba Study of Health and Aging were used to compare the utilization and direct costs of formal community care services among the elderly diagnosed as persons with no cognitive impairment, with cognitive impairment/no dementia and with dementia. The results of the analyses indicate that, in addition to living arrangement and limitation on basic and instrumental activities of daily living, mental function diagnosis is an independent predictor of community care use. A diagnosis of dementia increases the likelihood of community care use over those with unimpaired mental functioning, whereas cognitive impairment without dementia does not. The three diagnostic groups differ in the type of services used. Standardization by age, sex and the other variables which significantly affect the need for community care can help a program improve its ability to project realistic cost estimates.

scholarly journals Prevalence of dementia according to DSM–III–R and ICD–10

2001 ◽  
Vol 179 (3) ◽  
pp. 250-254 ◽  
Author(s):  
Steffi G. Riedel-Heller ◽  
Anja Busse ◽  
Conny Aurich ◽  
Herbert Matschinger ◽  
Matthias C. Angermeyer
Keyword(s):  
Age Groups ◽  
The Elderly ◽  
Structured Interview ◽  
Population Based ◽  
Alzheimer Type ◽  
Dementia Diagnosis ◽  
Case Definitions ◽  
Diagnosis Of Dementia ◽  
Icd 10 ◽  
Prevalence Of Dementia

BackgroundThe prevalence of dementia diagnosis according to ICD–10 and DSM–III–R in population surveys remains poorly understood.AimsTo report and compare prevalence rates according to DSM–III–R and ICD–10.MethodA population-based sample (n=1692, age 75+ years) was investigated by a Structured Interview for Diagnosis of Dementia of Alzheimer Type, Multiinfarct Dementia and Dementia of other Aetiology according to DSM–III–R and ICD–10 (SIDAM).ResultsWhereas 17.4% (95% CI=15.9–19.5) of individuals aged 75+ years suffer from dementia according to DSM–III–R, only 12.4% (95% CI=10.6–14.2) are diagnosed as having dementia according to ICD–10. The results revealed lower ICD–10 rates in all investigated age groups. The largest differences appear in the oldest of the elderly.ConclusionsThe ICD–10 sets a higher threshold for dementia diagnosis. Larger differences in the eldest age groups might reflect difficulties in applying case definitions, especially in those beyond 90 years old.

scholarly journals The Number Symbol Coding Task: A brief measure of executive function to detect dementia and cognitive impairment

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242233 ◽  
Author(s):  
James E. Galvin ◽  
Magdalena I. Tolea ◽  
Claudia Moore ◽  
Stephanie Chrisphonte
Keyword(s):  
Cognitive Impairment ◽  
Executive Function ◽  
Problem Solving ◽  
Comprehensive Evaluation ◽  
Clinical Care ◽  
Executive Dysfunction ◽  
Structured Interview ◽  
Assessment Tools ◽  
Quality Data ◽  
Clinical Dementia Rating

Introduction Alzheimer’s disease and related dementias (ADRD) affect over 5.7 million Americans and over 35 million people worldwide. Detection of mild cognitive impairment (MCI) and early ADRD is a challenge to clinicians and researchers. Brief assessment tools frequently emphasize memory impairment, however executive dysfunction may be one of the earliest signs of impairment. To address the need for a brief, easy-to-score, open-access test of executive function for use in clinical practice and research, we created the Number Symbol Coding Task (NSCT). Methods This study analyzed 320 consecutive patient-caregiver dyads who underwent a comprehensive evaluation including the Clinical Dementia Rating (CDR), patient and caregiver versions of the Quick Dementia Rating System (QDRS), caregiver ratings of behavior and function, and neuropsychological testing, with a subset undergoing volumetric magnetic resonance imaging (MRI). Estimates of cognitive reserve were calculated using education, combined indices of education and occupation, and verbal IQ. Psychometric properties of the NSCT including data quality, data distribution, floor and ceiling effects, construct and known-groups validity, discriminability, and clinical profiles were determined. Results The patients had a mean age of 75.3±9.2 years (range 38-98y) with a mean education of 15.7±2.8 years (range 6-26y) of education. The patients had a mean CDR-SB of 4.8±4.7 (range 0–18) and a mean MoCA score of 18.6±7.1 (range 1–30). The mean NSCT score was 30.1±13.8 and followed a normal distribution. All healthy controls and MCI cases were able to complete the NSCT. The NSCT showed moderate-to-strong correlations with clinical and neuropsychological measures with the strongest association (all p’s < .001) for measures with executive components (e.g., Judgement and Problem Solving box of the CDR, Decision Making and Problem Solving domain of the QDRS, Trailmaking B, and Cognigram Attention and Executive Composite Scores). Women slightly outperformed men, and individuals with lower educational attainment and lower education-occupation indices had lower NSCT scores. Decreasing NSCT scores corresponded to older age, worse cognitive scores, higher CDR sum of boxes scores, worse caregiver ratings of function and behavior, worse patient and informant QDRS ratings, and smaller hippocampal volumes and hippocampal occupancy scores. The NSCT provided excellent discrimination (AUC: .866; 95% CI: .82-.91) with a cut-off score of 36 providing the best combination of sensitivity (0.880) and specificity (0.759). Combining the NSCT with patient QDRS and caregiver QDRS ratings improved discrimination (AUC: .908; 95% CI: .87-.94). Discussion The NSCT is a brief, 90-second executive task that incorporates attention, planning and set-switching that can be completed by individuals into the moderate-to-severe stages of dementia. The NSCT may be a useful tool for dementia screening, case-ascertainment in epidemiological or community-based ADRD studies, and in busy primary care settings where time is limited. Combining the NSCT with a brief structured interview tool such as the QDRS may provide excellent power to detect cognitive impairment. The NSCT performed well in comparison to standardized scales of a comprehensive cognitive neurology evaluation across a wide array of sociodemographic variables in a brief fashion that could facilitate its use in clinical care and research.

scholarly journals Features associated with cognitive impairment and dementia in a community-based sample of illiterate elderly aged 75+ years: The Pietà study

2014 ◽  
Vol 8 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Henrique Cerqueira Guimarães ◽  
Jorge Luiz Cascardo ◽  
Rogério Gomes Beato ◽  
Maira Tonidandel Barbosa ◽  
Thais Helena Machado ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Protective Factor ◽  
Brain Aging ◽  
Apoe Genotype ◽  
The Elderly ◽  
Elderly Subjects ◽  
Community Based ◽  
Cross Sectional ◽  
E4 Allele ◽  
Ischemic Attack

ABSTRACT A higher level of educational attainment constitutes a protective factor against cognitive decline in the elderly. Nevertheless, the elements underpinning this association are yet not fully understood. Objective: The primary aim of this study was to compare cognitively impaired illiterate elderly subjects with cognitively preserved counterparts, according to demographics, comorbidities, lifetime habits and APOE genotype. Methods: This is a cross-sectional analysis of the illiterate subset of participants (n=174) from the Pietà study, a community-based survey of successful brain aging conducted in Caeté (MG), Brazil. Subjects were categorized into three diagnostic groups: cognitively normal (CN), cognitive impairment no-dementia (CIND) and dementia. The groups were then compared according to selected variables. Results: Subjects with dementia were older and had an increased prevalence of reported stroke or transient ischemic attack. The three groups did not differ in relation to demographics, prevalence of comorbidities, socioeconomic level, previous occupation profile and APOE-e4 allele frequency. Qualitatively evaluated lifetime habits, such as alcohol consumption, smoking and physical activity engagement were also similar across groups. Conclusion: No associations were found between cognitive impairment/dementia and the variables evaluated in this community-based sample of illiterate elderly.

scholarly journals Association Between Iron-Related Protein Lipocalin 2 and Cognitive Impairment in Cerebrospinal Fluid and Serum

2021 ◽  
Vol 13 ◽  
Author(s):  
Sofia Pereira das Neves ◽  
Ricardo Taipa ◽  
Fernanda Marques ◽  
Patrício Soares Costa ◽  
Joel Monárrez-Espino ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cognitive Impairment ◽  
Sex Education ◽  
Health Care Professionals ◽  
The Elderly ◽  
Lipocalin 2 ◽  
Related Protein ◽  
Cross Sectional ◽  
Potential Marker ◽  
Cross Sectional Design

A worldwide increase in longevity is bringing novel challenges to public health and health care professionals. Cognitive impairment in the elderly may compromise living conditions and precede Alzheimer’s disease (AD), the most prevalent form of dementia. Therefore, finding molecular markers associated with cognitive impairment is of crucial importance. Lipocalin 2 (LCN2), an iron-related protein, has been suggested as a potential marker for mild cognitive impairment (MCI) and AD. This study aimed at investigating the association between LCN2 measured in serum and cerebrospinal fluid (CSF) with cognitive impairment. A cross-sectional design based on two aging cohorts was used: individuals diagnosed with subjective cognitive complaints (SCC), MCI, and AD from a Swedish memory clinic-based cohort, and individuals diagnosed with SCC and AD from a Portuguese cohort. Binary logistic [for the outcome cognitive impairment (MCI + AD) in the Swedish cohort and AD in the Portuguese cohort] and multinomial logistic (for the outcomes MCI and AD) regression analyses were used. No associations were found in both cohorts when controlling for sex, education, and age. This explanatory study suggests that the association between serum and CSF LCN2 concentrations with cognitive impairment reported in the literature must be further analyzed for confounders.

The validity of brief screening cognitive instruments in the diagnosis of cognitive impairment and dementia after first-ever stroke

2006 ◽  
Vol 18 (2) ◽  
pp. 295-305 ◽  
Author(s):  
Velandai Srikanth ◽  
Amanda G. Thrift ◽  
Jayne L. Fryer ◽  
Michael M. Saling ◽  
Helen M. Dewey ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Operating Characteristic ◽  
The Elderly ◽  
Weighted Sum ◽  
Stroke Patients ◽  
Community Based ◽  
In Series ◽  
Few Data ◽  
State Examination ◽  
Brief Screening

Introduction: Brief cognitive tests such as the Mini-mental State Examination (MMSE) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) have been used to detect cognitive impairment and dementia in studies of stroke patients. However, there are few data on their validity for such use. We have evaluated their validity in detecting cognitive impairment not dementia (CIND) and dementia in a community-based sample of first-ever stroke patients.Methods: The standardized MMSE (S-MMSE) and the 16-item IQCODE were administered to 79 patients 1 year after a first-ever stroke. CIND and dementia were diagnosed independently using a comprehensive cognitive battery. The performances of the two tests were evaluated using receiver operating characteristic (ROC) analyses. Combined performance was evaluated when their scores were used in parallel (the “or rule”), in series (the “and rule”) or as a weighted sum (the “weighted sum rule”).Results: Both tests were extremely poor at detecting CIND individually and in combination. For dementia, at traditional cut-points, the S-MMSE (≤23) was insensitive (0.50, 95% CI 0.16–0.84) and the IQCODE (≥3.30) nonspecific (0.63, 95% CI 0.51–0.75). An acceptable balance between sensitivity and specificity was achieved for dementia using the “or rule” combination, but with only modest positive predictive value.Conclusions: The S-MMSE and the IQCODE were individually poor at detecting CIND and dementia after a nonaphasic first-ever stroke. The combination was useful in detecting dementia but it does not replace the need for detailed neuropsychological tests.

scholarly journals Vascular Parkinsonism and cognitive impairment: literature review, Brazilian studies and case vignettes

2012 ◽  
Vol 6 (3) ◽  
pp. 137-144 ◽  
Author(s):  
Thiago Cardoso Vale ◽  
Maira Tonidandel Barbosa ◽  
Paulo Caramelli ◽  
Francisco Cardoso
Keyword(s):  
Cognitive Impairment ◽  
Lewy Bodies ◽  
The Elderly ◽  
Pseudobulbar Palsy ◽  
Vascular Parkinsonism ◽  
Community Based ◽  
Diffuse White Matter ◽  
Case Vignettes ◽  
Elderly Cohort ◽  
Brazilian Studies

ABSTRACT Vascular Parkinsonism (VP) is a form of secondary Parkinsonism resulting from cerebrovascular disease. Estimates of the frequency of VP vary greatly worldwide; 3% to 6% of all cases of Parkinsonism are found to have a vascular etiology. In a Brazilian community-based study on Parkinsonism, 15.1% of all cases were classified as VP, the third most common form, with a prevalence of 1.1% in an elderly cohort. Another Brazilian survey found a prevalence of 2.3% of VP in the elderly. VP is usually the result of conventional vascular risk factors, particularly hypertension, leading to strategic infarcts of subcortical gray matter nuclei, diffuse white matter ischaemic lesions and less commonly, large vessel infarcts. Patients with VP tend to be older and present with gait difficulties, symmetrical predominant lower-body involvement, poor levodopa responsiveness, postural instability, falls, cognitive impairment and dementia, corticospinal findings, urinary incontinence and pseudobulbar palsy. This article intends to provide physicians with an insight on the practical issues of VP, a disease potentially confounded with vascular dementia, idiopathic Parkinson's disease, dementia with Lewy bodies and other secondary causes of Parkinsonism.

scholarly journals Memory complaints at primary care in a middle-income country: clinical and neuropsychological characterization

2021 ◽  
Vol 15 (1) ◽  
pp. 88-97
Author(s):  
Marcos Leandro Pereira ◽  
Thiago Henrique Ferreira de Vasconcelos ◽  
Amanda Aparecida Rocha de Oliveira ◽  
Sarah Bárbara Campagnolo ◽  
Sarah de Oliveira Figueiredo ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Functional Assessment ◽  
The Elderly ◽  
Structured Interview ◽  
Subjective Cognitive Decline ◽  
Middle Income ◽  
Clock Drawing Test ◽  
Memory Complaints ◽  
Diagnosis Of Dementia ◽  
With Memory

ABSTRACT. There are different causes of memory complaints in the elderly, such as subjective cognitive decline (SCD), mild cognitive impairment (MCI) or dementia. Objective: 1) To characterize individuals with memory complaints in a mid-sized city in Brazil, through clinical, cognitive and functional assessment; 2) to compare SCD individuals with MCI and dementia patients in terms of clinical and cognitive variables. Methods: We consecutively included individuals aged ≥50 years, with memory complaints (spontaneous or inquired). Subjects who scored ≥25 on the Memory Complaint Questionnaire or who had spontaneous memory complaints were selected. Participants underwent a semi-structured interview, the Mini-Mental State Examination, Figure Memory Test for visual episodic memory, Clock Drawing Test, Category Fluency (Animals), Neuropsychiatric Inventory, and functional assessment. Individuals were classified as SCD, MCI or dementia. We did not include individuals with previous diagnosis of dementia. Results: The final sample consisted of 91 subjects (73.6% women; mean age 67.6±9.8 years): 14.3% had spontaneous complaints and 85.7% had inquired complaints. The most common comorbidities were hypertension (69.2%), diabetes (36.3%), and dyslipidemia (24.2%). Low levels of vitamin B12 and hypothyroidism were found in 26.4 and 16.5%, respectively. Regarding cognitive diagnosis, 16.5% of the sample were classified as SCD, 49.4% as MCI and 34.1% as dementia. MCI and dementia were identified in five (38.5%) and seven (53.4%) patients with spontaneous complaint, respectively. Conclusions: MCI and dementia are frequently underdiagnosed. Potential reversible causes of cognitive decline are common. The diagnosis of dementia is highly frequent among individuals with spontaneous memory complaints.

scholarly journals Demographic Factors and Cognitive Function Assessments Associated with Mild Cognitive Impairment Progression for the Elderly

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Hong-yun Qin ◽  
Xu-dong Zhao ◽  
Bing-gen Zhu ◽  
Cheng-ping Hu
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Demographic Data ◽  
Depression Scale ◽  
Demographic Factors ◽  
The Elderly ◽  
Income Level ◽  
Hamilton Depression Scale ◽  
Clinical Dementia Rating

Objectives. In this study, we aimed to conduct a 6-year follow-up and acquire a large sample dataset to analyze the most important demographic factors and cognitive function scale variables associated with mild cognitive impairment (MCI) progression for an elderly cohort (age ≥ 60 years old). Patients and Methods. We analyzed the subjects who had participated in a survey in 2011 and were successfully contacted in the later survey in 2017. For each subject, the basic demographic information was recorded, including sex, age, education level, marital status, working status, income level, and physical mental illness history. Cognitive assessments were performed using the following scales if possible: (1) the mini-mental state examination (MMSE) scale, (2) Montreal cognitive assessment (MoCA), (3) the clinical dementia rating (CDR) scale, and (4) Hamilton Depression Scale (HAMD-17). Results. The progression outcomes were different between sexes, among age brackets, education degrees, occupations types, and income levels; different progression groups had distinct children numbers (p<0.001), heights (p<0.05), and body weights (p<0.01); the positive ends six years later were positively related to better performance in the MoCA and MMSE scales (progressed vs stable p<0.01). Moreover, we constructed some indicators using age, MoCA, and MMSE scores, which showed an efficiency in predicting the progression outcomes. Conclusions. In conclusion, the MCI progression outcomes were associated with sex, age, education degrees, occupations types, income level, children number, height, and weight. MoCA and MMSE scales are supporting tools to predict the progression outcomes, especially combined with the demographic data.

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