Relationship of Purpose in Life to Dementia in Older Black and White Brazilians

Objectives: To test the hypothesis that higher level of purpose in life is associated with lower likelihood of dementia and mild cognitive impairment (MCI) in older Brazilians. Methods: As part of the Pathology, Alzheimer’s and Related Dementias Study (PARDoS), informants of 1,514 older deceased Brazilians underwent a uniform structured interview. The informant interview included demographic data, the Clinical Dementia Rating scale to diagnose dementia and MCI, the National Institute of Mental Health Diagnostic Interview Schedule for depression, and a 6-item measure of purpose in life, a component of well-being. Results: Purpose scores ranged from 1.5 to 5.0 with higher values indicating higher levels of purpose. On the Clinical Dementia Rating Scale, 940 persons (62.1%) had no cognitive impairment, 121 (8.0%) had MCI, and 453 (29.9%) had dementia. In logistic regression models adjusted for age at death, sex, education, and race, higher purpose was associated with lower likelihood of MCI (odds ratio = .58; 95% confidence interval [CI]: .43, .79) and dementia (odds ratio = .49, 95% CI: .41, .59). Results were comparable after adjusting for depression (identified in 161 [10.6%]). Neither race nor education modified the association of purpose with cognitive diagnoses. Conclusions: Higher purpose in life is associated with lower likelihood of MCI and dementia in older black and white Brazilians.

The link between social and emotional isolation and dementia in older black and white Brazilians

ABSTRACT Objective: To examine the link between social and emotional isolation and likelihood of dementia among older black and white Brazilians. Design: Cross-sectional clinical–pathological cohort study. Setting: Medical center in Sao Paulo, Brazil. Participants: As part of the Pathology, Alzheimer’s and Related Dementias Study, we conducted uniform structured interviews with knowledgeable informants (72% children) of 1,493 older (age > 65) Brazilian decedents. Measurements: The interview included measures of social isolation (number of family and friends in at least monthly contact with decedent), emotional isolation (short form of UCLA Loneliness Scale), and major depression plus the informant portion of the Clinical Dementia Rating Scale to diagnose dementia and its precursor, mild cognitive impairment (MCI). Results: Decedents had a median social network size of 8.0 (interquartile range = 9.0) and a median loneliness score of 0.0 (interquartile range = 1.0). On the Clinical Dementia Rating Scale, 947 persons had no cognitive impairment, 122 had MCI, and 424 had dementia. In a logistic regression model adjusted for age, education, sex, and race, both smaller network size (odds ratio [OR] = 0.975; 95% confidence interval [CI]: 0.962, 0.989) and higher loneliness (OR = 1.145; 95% CI: 1.060, 1.237) were associated with higher likelihood of dementia. These associations persisted after controlling for depression (present in 10.4%) and did not vary by race. After controlling for depression, neither network size nor loneliness was related to MCI. Conclusion: Social and emotional isolation are associated with higher likelihood of dementia in older black and white Brazilians.

Performance of Mattis dementia rating scale-Chinese version in patients with mild cognitive impairment and Alzheimer’s disease

Background To identify the applicability of the Chinese Version of Mattis Dementia Rating Scale (DRS-CV). Methods The DRS-CV was administered to 483 participants, including 136 normal controls, 167 patients with mild cognition impairment (MCI), and 180 patients with Alzheimer’s disease (AD). Receiver Operating Characteristic (ROC) curve was used to evaluate the sensitivity and specificity of the scale. Results The scores of DRS-CV were ranked in the order of NC > MCI > mild AD > moderate AD group. Memory was the sensitive function affected at a relatively earlier stage of AD. ROC curve analysis indicated the DRS-CV total score and memory subscale showed excellent sensitivity and specificity in the discrimination between MCI from mild AD and mild AD from moderate AD, but poor sensitivity and specificity in the discrimination between MCI and NC. Conclusion The DRS-CV is useful to the early diagnosis and severity of AD, not to the early identification of MCI.

COGNITION, FUNCTIONAL STATUS AND FRAILTY AMONG THE OLDEST OLD

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.

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

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.

Validity of the Clinical Dementia Rating Scale Sum of Boxes in Staging and Detection of Cognitive Impairment in Mexican Americans

Objective: We evaluated the utility of the Clinical Dementia Rating Sum of Boxes score (CDR-SB) in staging and detecting amnestic-mild cognitive impairment (a-MCI) and Alzheimer’s disease (AD) among Mexican Americans. Methods: Receiver operator curves were generated to evaluate the validity of the CDR-SB in staging and detecting a-MCI and AD in 1,073 Mexican Americans (758 controls, 163 a-MCI, and 152 AD). Results: Optimal ranges of the CDR-SB were 0, 0.5-4, 4.5-8.0, 8.5-13 and 13.5-18 for staging the global CDR score of 0, 0.5, 1, 2, and 3, respectively. The CDR-SB ≥ 0.5 differentiated the a-MCI patients from the controls (sensitivity 100% and specificity 99.5%) and ≥ 2.0 distinguished the AD from a-MCI patients (sensitivity 83.6% and specificity 87.1%). These cutoffs were also appropriate for patients with ≤6 years of education. Conclusion: The CDR-SB is useful to detect and stage a-MCI and AD in Mexican Americans with diverse education levels.

Normative data for middle-aged Brazilians in the Mattis Dementia Rating Scale

ABSTRACT. Despite the advances in the diagnosis of dementia, neuropsychological assessment remains an important tool. The Mattis Dementia Rating Scale (DRS) was designed to evaluate people with suspected dementia and allows for the analysis of different cognitive domains. Considering the numerous cases of early-onset dementia, specific reference standards aimed at the middle-aged population are necessary. Objective: To provide normative data for the middle-aged Brazilian population in DRS and to investigate the influence of education level, age, sex, and intelligence quotient (IQ) on the results. Methods: Overall, 120 healthcare professionals and caregivers from a hospital, who were healthy, aged between 45 and 64 years, and had at least four years of formal education, were included in the study. They were equally divided into six groups. In each age group (45–54 and 55–64 years), there were three educational levels: 4–7, 8–11, and 12 or more (12+) years of formal education. The results are presented as mean values, standard deviations, and percentiles. Comparisons between groups were carried out for age, sex, and education level. Age, years of formal education, and IQ were also analyzed as continuous variables by Spearman's correlation. Results: Concerning education level, the comparison between groups showed differences in the results for the total scale and subscales, except for the Construction subscale. No differences were found for age and sex. Correlations observed for years of formal education and IQ were similar. No correlation was found for age. Conclusions: The present study contributes to the evaluation of dementia concerning people younger than 65 years of age and reinforces the importance of education in the interpretation of the scores.