scholarly journals COGNITION, FUNCTIONAL STATUS AND FRAILTY AMONG THE OLDEST OLD

2021 ◽  
Author(s):  
Beatriz Franco de Santana ◽  
Flávia Arbex Borim ◽  
Deusivania Silva Falcão ◽  
Meire Cachioni ◽  
Samila Tavares Batistoni ◽  
...  
Keyword(s):  
Functional Status ◽  
Rating Scale ◽  
Oldest Old ◽  
Functional Activities ◽  
Dementia Severity ◽  
Impaired Cognition ◽  
Dementia Rating Scale ◽  
Normal Cognition ◽  
Physiological Systems

Background: Frailty is defined as a recognizable state of increased vulnerability resulting from age-associated decline of function in various physiological systems. Objective: To assess possible associations between cognition, function status and frailty in a sample of oldest old with performance below cut off scores for dementia in the MMSE. Methods: Sociodemographic, cognitive, functional status and frailty data were obtained from 130 individuals.Frailty was defined by Fried’s frailty phenotype.Functional status was measured by the Functional Activities Questionnaire.The Cognitive Dementia Rating scale was applied to assess dementia severity. Results: In all,28% were male and 72% female,mean age of 82.4 years(SD=5.3).40% were illiterate and 94% had held jobs based on manual activity.In the sample 54.6% had functional impairment.Among participants with normal cognition and functional status,6.1% were frail,8.4% pre-frail and 7.6% robust,among those with impaired cognition and preserved functional status,13% were frail,6.9% pre-frail and 0.7% robust;among those with impaired cognition and functional status,30,7% were frail,19.2% pre-frail and 4.6% robust;and among those with preserved cognition and impaired functional status,0% were frail or robust and 2.3% pre-frail. Conclusion: Participants with impaired cognition and functional status included the largest number of frail and pre-frail participants. These results suggest that impaired cognition and functional status are associated with frailty among the oldest old.

scholarly journals Greater Precision when Measuring Dementia Severity: Establishing Item Parameters for the Clinical Dementia Rating Scale

2012 ◽  
Vol 34 (2) ◽  
pp. 128-134 ◽  
Author(s):  
Deborah A. Lowe ◽  
Steve Balsis ◽  
Tyler M. Miller ◽  
Jared F. Benge ◽  
Rachelle S. Doody
Keyword(s):  
Rating Scale ◽  
Clinical Dementia Rating ◽  
Dementia Severity ◽  
Item Parameters ◽  
Dementia Rating Scale

scholarly journals Psychometric Properties of the Clinical Dementia Rating Scale Sum of Boxes in Parkinson’s Disease

2020 ◽  
pp. 1-9
Author(s):  
Julia Gallagher ◽  
Jacqueline Rick ◽  
Sharon X. Xie ◽  
Pablo Martinez-Martin ◽  
Eugenia Mamikonyan ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Rating Scale ◽  
Clinical Dementia Rating ◽  
Functional Changes ◽  
Dementia Rating Scale ◽  
Normal Cognition ◽  
Domain Scores

Background: A composite measure that assesses both cognitive and functional abilities in Parkinson’s disease (PD) would be useful for diagnosing mild cognitive impairment (MCI) and PD dementia (PDD) and as an outcome measure in randomized controlled trials. The Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) was designed to assess both cognition and basic-instrumental activities of daily living in Alzheimer’s disease but has not yet been validated in PD. Objective: To validate the CDR-SOB as a composite cognitive-functional measure for PD patients, as well as to assess its sensitivity to change. Methods: The CDR-SOB and a comprehensive cognitive and functional battery was administered to 101 PD patients at baseline (39 normal cognition [NC], 41 MCI and 21 PDD by expert consensus panel), and re-administered to 64 patients after 1-2 years follow-up (32 NC and 32 cognitive impairment [CI] at baseline). Results: Cross-sectionally, CDR-SOB and domain scores were correlated with corresponding neuropsychological or functional measures and were significantly different between cognitive subgroups both at baseline and at follow-up. In addition, CDR-SOB ROC curves distinguished between normal cognition and dementia with high sensitivity, but did not distinguish well between NC and MCI. Longitudinal changes in the CDR-SOB and domain scores were not significant and were inconsistent in predicting change in commonly-used cognitive and functional tests. Conclusion: The CDR-SOB detects dementia-level cognitive impairment in PD but may not be appropriate for predicting longitudinal combined cognitive-functional changes in patients without significant cognitive impairment at baseline.

The Mattis Dementia Rating Scale in Nursing Home Octogenarians and Nonagenarians: Effects of Age and Education

1997 ◽  
Vol 10 (3) ◽  
pp. 114-118 ◽  
Author(s):  
Alexandre Bennett ◽  
Jodi Nadler ◽  
Melanie Spigler ◽  
Luba Rafalson ◽  
Susy Abraham ◽  
...  
Keyword(s):  
Nursing Home ◽  
Standardized Tests ◽  
Test Performance ◽  
Rating Scale ◽  
Oldest Old ◽  
Neuropsychological Test ◽  
Nursing Home Residents ◽  
Published Data ◽  
Mattis Dementia Rating Scale ◽  
Dementia Rating Scale

Despite their increasing representation in the population, little is known about the neuropsychological test performance of the oldest old, particularly those who live in residential settings. Limited published data and clinical experience suggest that this group is more likely to perform in the impaired range on standardized tests when cutoffs developed with younger groups are used. We examined the Dementia Rating Scale (DRS) performance of 82 nondemented nursing home residents, aged 80 to 99, with a mean education level of 11 years. Using published norms and cutoffs, a large percentage of this sample performed in the impaired range, particularly on the initiation and conceptualization subtests and on the total score. Education, but not age, was significantly related to performance in this sample. Percentages of patients misclassified were substantial in all groups, but were higher in those with less than 13 years of education. Using a lower total-score cutoff of 110 reduced the percentage of misclassifications markedly. We recommend the development and use of revised cutoff scores for the evaluation of very elderly nursing home residents.

Reliable change on the Dementia Rating Scale

2007 ◽  
Vol 13 (04) ◽  
Author(s):  
OTTO PEDRAZA ◽  
GLENN E. SMITH ◽  
ROBERT J. IVNIK ◽  
FLOYD B. WILLIS ◽  
TANIS J. FERMAN ◽  
...  
Keyword(s):  
Rating Scale ◽  
Reliable Change ◽  
Dementia Rating Scale

scholarly journals Informal Caregiving in Amyotrophic Lateral Sclerosis (ALS): A High Caregiver Burden and Drastic Consequences on Caregivers’ Lives

2021 ◽  
Vol 11 (6) ◽  
pp. 748
Author(s):  
Pavel Schischlevskij ◽  
Isabell Cordts ◽  
René Günther ◽  
Benjamin Stolte ◽  
Daniel Zeller ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Functional Status ◽  
Disease Severity ◽  
Caregiver Burden ◽  
Rating Scale ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Daily Routine ◽  
Work Lives ◽  
Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that causes progressive autonomy loss and need for care. This does not only affect patients themselves, but also the patients’ informal caregivers (CGs) in their health, personal and professional lives. The big efforts of this multi-center study were not only to evaluate the caregivers’ burden and to identify its predictors, but it also should provide a specific understanding of the needs of ALS patients’ CGs and fill the gap of knowledge on their personal and work lives. Using standardized questionnaires, primary data from patients and their main informal CGs (n = 249) were collected. Patients’ functional status and disease severity were evaluated using the Barthel Index, the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and the King’s Stages for ALS. The caregivers’ burden was recorded by the Zarit Burden Interview (ZBI). Comorbid anxiety and depression of caregivers were assessed by the Hospital Anxiety and Depression Scale. Additionally, the EuroQol Five Dimension Five Level Scale evaluated their health-related quality of life. The caregivers’ burden was high (mean ZBI = 26/88, 0 = no burden, ≥24 = highly burdened) and correlated with patients’ functional status (rp = −0.555, p < 0.001, n = 242). It was influenced by the CGs’ own mental health issues due to caregiving (+11.36, 95% CI [6.84; 15.87], p < 0.001), patients’ wheelchair dependency (+9.30, 95% CI [5.94; 12.66], p < 0.001) and was interrelated with the CGs’ depression (rp = 0.627, p < 0.001, n = 234), anxiety (rp = 0.550, p < 0.001, n = 234), and poorer physical condition (rp = −0.362, p < 0.001, n = 237). Moreover, female CGs showed symptoms of anxiety more often, which also correlated with the patients’ impairment in daily routine (rs = −0.280, p < 0.001, n = 169). As increasing disease severity, along with decreasing autonomy, was the main predictor of caregiver burden and showed to create relevant (negative) implications on CGs’ lives, patient care and supportive therapies should address this issue. Moreover, in order to preserve the mental and physical health of the CGs, new concepts of care have to focus on both, on not only patients but also their CGs and gender-associated specific issues. As caregiving in ALS also significantly influences the socioeconomic status by restrictions in CGs’ work lives and income, and the main reported needs being lack of psychological support and a high bureaucracy, the situation of CGs needs more attention. Apart from their own multi-disciplinary medical and psychological care, more support in care and patient management issues is required.

Abstract TMP46: Is There an Effect of Statins on Ischemic Stroke Functional Outcomes in the Oldest Old?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Matthew Alcusky ◽  
Anne L Hume ◽  
Kate L Lapane
Keyword(s):  
Ischemic Stroke ◽  
Functional Status ◽  
Functional Outcomes ◽  
Acute Treatment ◽  
Functional Dependence ◽  
Oldest Old ◽  
Health Benefit ◽  
Neuroprotective Effects ◽  
Data Set ◽  
Statin Use

Background: The net health benefit of statin use in the oldest patients remains controversial. Preclinical models and previous clinical studies have suggested statins may exhibit neuroprotective effects in stroke, however evidence in the very old remains limited. Our objective was to compare changes in functional status before and after acute ischemic stroke (AIS) between statin users and non-users in a national cohort. Methods: A patient’s first hospitalization for AIS from 04/01/11 to 12/31/2012 was selected from Medicare Part A claims. Patients with a pre-hospitalization nursing home Minimum Data Set assessment and a post-hospitalization assessment in a skilled nursing facility were included. Pre-stroke statin exposure was defined using Part D claims. Functional status was measured continuously and categorically (dependent:<20, partially dependent(PD):20-59, assisted independent(AI):60-100) using Shah’s modified Barthel Index (mBI). Multivariable logistic regression examined the association of statins with a minimum clinically important mBI decrease of 10 points among non-dependent patients. Results: Among 10,203 patients with an assessment before hospitalization, 7.2% died, and 48.7% were included (mean age: 83.6±9.6; 74.5% women). Statin use was common (36.5%), while acute treatment was infrequent (thrombolysis: 4.9%; thrombectomy: 0.1%). The distribution of functional dependence, PD, and AI shifted from 17.3%, 56.1%, and 26.7% at baseline to 49.7%, 44.4%, and 5.9% post-stroke, respectively. A consistent association with 10-point mBI decline was observed for statin exposure among all non-dependent (OR: 0.8; 95%CI: 0.7-1.0) and within strata of PD (OR:0.8; 95%CI: 0.7-1.0) and AI patients (OR: 0.8; 95%CI: 0.5-1.3). In contrast, acute treatment was more strongly associated with function in AI (OR: 0.5; 95%CI: 0.2-1.0) versus PD patients (OR: 1.0; 95%CI: 0.7-1.5). Conclusion: In this high-burden population, our results are suggestive of a possible protective association for pre-stroke statin exposure. Further research is needed to examine temporal and dose-response relationships between statin exposure and functional outcomes across diverse patient populations.

scholarly journals Disease Progression in Frontotemporal Dementia and Alzheimer Disease: The Contribution of Staging Scales

2020 ◽  
pp. 089198872094423
Author(s):  
Thaís Bento Lima-Silva ◽  
Eneida Mioshi ◽  
Valéria Santoro Bahia ◽  
Mário Amore Cecchini ◽  
Luciana Cassimiro ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Disease Progression ◽  
Frontotemporal Dementia ◽  
Rating Scale ◽  
Severe Disease ◽  
Primary Progressive Aphasia ◽  
Behavioral Changes ◽  
Clinical Dementia Rating ◽  
Dementia Rating Scale ◽  
Disease Stages

Introduction: There is a shortage of validated instruments to estimate disease progression in frontotemporal dementia (FTD). Objectives: To evaluate the ability of the FTD Rating Scale (FTD-FRS) to detect functional and behavioral changes in patients diagnosed with the behavioral variant of FTD (bvFTD), primary progressive aphasia (PPA), and Alzheimer disease (AD) after 12 months of the initial evaluation, compared to the Clinical Dementia Rating scale−frontotemporal lobar degeneration (CDR-FTLD) and the original Clinical Dementia Rating scale (CDR). Methods: The sample consisted of 70 individuals, aged 40+ years, with at least 2 years of schooling, 31 with the diagnosis of bvFTD, 12 with PPA (8 with semantic variant and 4 with non-fluent variant), and 27 with AD. The FTD-FRS, the CDR, and the 2 additional CDR-FTLD items were completed by a clinician, based on the information provided by the caregiver with frequent contact with the patient. The Addenbrooke Cognitive Examination-Revised was completed by patients. After 12 months, the same protocol was applied. Results: The FTD-FRS, CDR-FTLD, and CDR detected significant decline after 12 months in the 3 clinical groups (exception: FTD-FRS for PPA). The CDR was less sensitive to severe disease stages. Conclusions: The FTD-FRS and the CDR-FTLD are especially useful tools for dementia staging in AD and in the FTD spectrum.

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

2010 ◽  
Vol 23 (1) ◽  
pp. 107-113 ◽  
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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