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1.
Int J Aging Hum Dev ; : 914150241253253, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38755952

RESUMO

The makeup of the US population of older adults continues to become more diverse as numbers from ethnic subgroups increase. However, these subgroups are generally underrepresented in research focused on Alzheimer's disease and related dementias (ADRD). This paper examines barriers to recruitment for older Asian Americans, to underpin potential strategies for future research, with particular emphasis on recruitment of Vietnamese Americans. The paper discusses three recommended strategies: implementing appropriate recruitment outreach methods, establishing and maintaining community partnerships, and adopting flexible and convenient assessment methods. All three complementary approaches may be applied to improve Vietnamese American aging research participation. This has the potential to promote early intervention, foster longevity, ameliorate health disparities, and reduce healthcare burdens for this population.

2.
Alzheimers Dement ; 19(10): 4599-4608, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-36939111

RESUMO

INTRODUCTION: Remote screening for cognitive impairment associated with Alzheimer's disease (AD) has grown in importance with the expected rise in prevalence of AD in an aging population and with new potential treatment options. METHODS: The Telephone Interview for Cognitive Status (TICS) and new telephone adaptation of the Montreal Cognitive Assessment (T-MoCA) were administered to participants independently classified through in-person clinical evaluation as cognitively normal (CN; n = 167), mild cognitive impairment (MCI; n = 25), or dementia (n = 23). Cerebrospinal fluid AD biomarkers were measured (n = 79). RESULTS: TICS and T-MoCA were highly correlated (r = 0.787; P < 0.001): groups differed on both (CN

Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Humanos , Idoso , Doença de Alzheimer/epidemiologia , Peptídeos beta-Amiloides , Testes Neuropsicológicos , Disfunção Cognitiva/epidemiologia , Testes de Estado Mental e Demência , Telefone , Cognição , Biomarcadores
3.
Int Psychogeriatr ; 32(5): 585-599, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31309906

RESUMO

OBJECTIVES: To examine factors that influence decision-making, preferences, and plans related to advance care planning (ACP) and end-of-life care among persons with dementia and their caregivers, and examine how these may differ by race. DESIGN: Cross-sectional survey. SETTING: 13 geographically dispersed Alzheimer's Disease Centers across the United States. PARTICIPANTS: 431 racially diverse caregivers of persons with dementia. MEASUREMENTS: Survey on "Care Planning for Individuals with Dementia." RESULTS: The respondents were knowledgeable about dementia and hospice care, indicated the person with dementia would want comfort care at the end stage of illness, and reported high levels of both legal ACP (e.g., living will; 87%) and informal ACP discussions (79%) for the person with dementia. However, notable racial differences were present. Relative to white persons with dementia, African American persons with dementia were reported to have a lower preference for comfort care (81% vs. 58%) and lower rates of completion of legal ACP (89% vs. 73%). Racial differences in ACP and care preferences were also reflected in geographic differences. Additionally, African American study partners had a lower level of knowledge about dementia and reported a greater influence of religious/spiritual beliefs on the desired types of medical treatments. Notably, all respondents indicated that more information about the stages of dementia and end-of-life health care options would be helpful. CONCLUSIONS: Educational programs may be useful in reducing racial differences in attitudes towards ACP. These programs could focus on the clinical course of dementia and issues related to end-of-life care, including the importance of ACP.


Assuntos
Planejamento Antecipado de Cuidados , Cuidadores/psicologia , Demência/terapia , Conhecimentos, Atitudes e Prática em Saúde , Assistência Terminal/psicologia , Idoso , Idoso de 80 Anos ou mais , Atitude , Estudos Transversais , Demência/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
4.
J Gerontol Nurs ; 46(8): 17-27, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32491183

RESUMO

Today, biomedical advancements allow older adults, including those with dementia, to live longer, with most living at home with a lay caregiver. Recent research details the stressful role of caregiving to persons with dementia (PWD). The current qualitative phenomenological study describes the lived experience of caregivers caring for PWD, including their experience with palliative care. A community sample of lay caregivers (N = 11) underwent recorded individual interviews. Interviews were analyzed following van Manen's approach to isolate thematic statements. Most caregivers were older (mean age = 71, SD = 9.6; range = 53 to 84 years) and female (n = 10). Study themes included: (a) Uncertainty: The Slippery Slope, (b) The Sense of Loneliness, (c) Complexities of Frustration, and (d) On the Other Side of the Spectrum. Findings show these caregivers are dealing with a dynamic range of feelings about their experiences. Opportunities exist for health care professionals to discuss such feelings and refer caregivers to supportive services, including palliative care. [Journal of Gerontological Nursing, 46(8), 17-27.].


Assuntos
Sobrecarga do Cuidador/psicologia , Cuidadores/psicologia , Demência/enfermagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/psicologia , Pesquisa Qualitativa
5.
Int J Geriatr Psychiatry ; 34(5): 738-744, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30729576

RESUMO

OBJECTIVE: Compromised functional abilities in older adults with dementia with Lewy bodies (DLB) represent a significant burden to families and frequently lead to institutionalization. Contributing factors to this compromise are poorly understood. METHODS: Using data collected at a first study visit, multiple regression modeling was used to examine the associations between Braak staged Alzheimer disease (AD) pathology, Apolipoprotein E (ApoE) status, Parkinsonian gait, cognition, and functional status from a cohort of 102 cases with an autopsy-confirmed diagnosis of dementia stemming from combined Lewy body and AD pathology. RESULTS: On average, 60% of functional activities were compromised per case. Worse functional status was associated with older age at first study visit, compromised cognitive status, and Parkinsonian gait after controlling for gender, mental status, and other covariates. Worse cognitive status predicted worse functional status in both the low and high Braak groups. CONCLUSIONS: Older persons with DLB presenting with moderately compromised cognition and Parkinsonian gait should be expected to have impaired functional abilities. Providing these patients with supportive environments may help them to remain independent for longer periods of time.


Assuntos
Doença de Alzheimer/fisiopatologia , Cognição/fisiologia , Marcha/fisiologia , Doença por Corpos de Lewy/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/metabolismo , Doença de Alzheimer/patologia , Apolipoproteínas E/metabolismo , Autopsia , Encéfalo/patologia , Estudos de Coortes , Feminino , Humanos , Corpos de Lewy , Masculino , Transtornos dos Movimentos/fisiopatologia , Análise de Regressão
6.
Alzheimer Dis Assoc Disord ; 32(2): 120-124, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29319601

RESUMO

OBJECTIVE: To compare ability of 2 measures of delayed memory (word list, story paragraph) to discriminate Normal Control (NC) subjects from those with amnestic mild cognitive impairment (aMCI). METHODS: Demographic, neuropsychological, and diagnostic data contributed by 34 Alzheimer's Disease Centers to the National Alzheimer's Coordinating Center characterized 2717 individuals with a diagnosis of either NC (n=2205) or aMCI (n=512). The Montreal Cognitive Assessment-Memory Index Score (MoCA-MIS) assessed delayed word recall, and the Craft Story 21, delayed story recall. Logistic regression and receiver operator characteristic curves controlling for age, sex, and education assessed the ability of each test to differentiate NCs from subjects with aMCI. RESULTS: The MoCA-MIS had significantly better sensitivity and specificity (area under the receiver operator characteristic curve 0.83 vs. 0.80, P=0.004). At sensitivity 80%, the specificity of the MoCA-MIS was 69.1%, compared with 62.8% for the Craft Story. CONCLUSIONS: These data suggest that the MoCA-MIS, a recall score from items within the MoCA, is better at discriminating NCs from subjects with aMCI than the Craft Story. Word recall may be an efficient alternative to paragraph recall for diagnostic screening within clinical practice and research settings.


Assuntos
Disfunção Cognitiva/diagnóstico , Testes de Estado Mental e Demência/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Rememoração Mental/fisiologia , Testes Neuropsicológicos/estatística & dados numéricos , Sensibilidade e Especificidade
7.
Am J Geriatr Psychiatry ; 23(6): 622-32, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25217186

RESUMO

Psychological and psychosocial resources, including resilience and social support, have traditionally been studied in the context of the stress paradigm and, more recently, in the context of successful aging. This study used moderated mediation analyses to examine the role of perceived stress in the relationships between physical and mental health functioning and self-rated successful aging (SRSA) and whether differences between people in level of resilience and social support changes the role of perceived stress in these relationships. A cross-sectional study of 1,006 older adults (mean age: 77 years) completed scales addressing SRSA, physical and mental health functioning, perceived stress, resilience, and social support. Results indicated that the strength of relationships between both physical and mental health functioning and SRSA were reduced after accounting for variation in level of perceived stress. The role of perceived stress in the association between mental health functioning and SRSA was found to be stronger among participants with the highest levels of resilience, and the influence of perceived stress on the degree of relationship between physical health functioning and SRSA was stronger among those with greatest social support. These findings suggest that interventions to reduce perceived stress may help break the link between disability and poor well-being in older adults. The findings further suggest that the impact of such interventions might differ depending on psychological resources (i.e., resilience) for mental health disabilities and external resources (i.e., social support) for those with physical health problems. The complex interplay of these factors should be taken into account in clinical settings.


Assuntos
Envelhecimento/psicologia , Nível de Saúde , Resiliência Psicológica , Apoio Social , Estresse Psicológico/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino
8.
Alzheimers Dement ; 10(2): 171-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23850331

RESUMO

BACKGROUND: The relative contributions of cognitive, motor, and behavioral deficits to the impairment of physical or instrumental activities of daily living (ADLs) may differ in patients with dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). METHODS: Multiple linear regression analyses were used to identify the amount of variability in physical self-maintenance and instrumental ADL ratings predicted by cognitive, motor, and behavioral indices separately for patients with autopsy-diagnosed DLB (n = 39) or AD (n = 39). RESULTS: Motor dysfunction accounted for significant variance in physical ADLs in DLB (R(2) change = 0.17), whereas behavioral (R(2) change = 0.23) and motor dysfunction (R(2) change = 0.13) accounted for significant variance in AD. Motor (R(2) change = 0.32) and cognitive (R(2) change = 0.10) dysfunction accounted for significant variance in instrumental ADLs in DLB, whereas cognitive (R(2) change = 0.36) and behavioral (R(2) change = 0.12) dysfunction accounted for significant variance in AD. CONCLUSIONS: Cognitive, motor, and behavioral deficits contribute differently to ADL changes in DLB and AD. Thus, treatments designed to ameliorate a certain aspect of AD or DLB (e.g., cognitive dysfunction) may have a larger impact on everyday functioning in one disorder than the other.


Assuntos
Doença de Alzheimer/complicações , Sintomas Comportamentais/etiologia , Transtornos Cognitivos/etiologia , Doença por Corpos de Lewy/complicações , Transtornos dos Movimentos/etiologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/diagnóstico , Testes Neuropsicológicos , Análise de Regressão
9.
Am J Geriatr Psychiatry ; 21(9): 925-8, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23567387

RESUMO

OBJECTIVE: To investigate the relationship between subjective memory complaints (SMC) and the stress hormone cortisol using diurnal measures in older, cognitively intact subjects. METHODS: This cross-sectional study conducted at a university research center included 64 volunteers (with or without SMC) with a mean age of 78.6 (±6.3) years and diagnosis of cognitively normal based on objective neuropsychological testing. Measures of diurnal salivary cortisol, depressive symptoms, episodic memory performance, level of anxiety, and apolipoprotein E (APOE) e4 allele status were obtained. RESULTS: In multivariate logistic regression analyses with SMC as outcome, averaged postpeak cortisol, the cortisol awakening response, and depressive symptoms were significant predictors, whereas gender, memory performance, anxiety, and APOE-e4 status were not. CONCLUSIONS: Significant associations between SMC and diurnal measures of cortisol in cognitively intact elderly suggest that hypothalamic-pituitary-adrenal axis dysfunction may contribute to early neuropathologic changes in older adults who complain of memory decline undetected on neuropsychological testing.


Assuntos
Ritmo Circadiano/fisiologia , Depressão/psicologia , Hidrocortisona/análise , Transtornos da Memória/psicologia , Memória Episódica , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Apolipoproteínas E/genética , Estudos Transversais , Humanos , Sistema Hipotálamo-Hipofisário/fisiopatologia , Modelos Logísticos , Transtornos da Memória/genética , Transtornos da Memória/fisiopatologia , Análise Multivariada , Sistema Hipófise-Suprarrenal/fisiopatologia , Saliva/química , Autorrelato
10.
Am J Geriatr Psychiatry ; 21(6): 509-19, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23567425

RESUMO

OBJECTIVE: To compare patients with autopsy-confirmed Alzheimer disease (AD) and dementia with Lewy bodies (DLB) on the frequency of behaviors related to frontal system dysfunction and the association of these behaviors with dementia severity. METHODS: We performed a cross-sectional survey of a longitudinal cohort at a university research center for AD on a volunteer sample of 19 DLB and 38 AD participants with autopsy-confirmed diagnoses, similar in age (DLB: 77.3, AD: 77.5), education (DLB: 15.2, AD: 14.7), and Mini-Mental State Examination (MMSE) score (DLB: 20.6, AD: 20.5), with impairment ranging from mild deficits to moderate dementia. The Frontal Systems Behavior Scale (FrSBe)-Family Rating Form assessing patient apathy, disinhibition, and executive dysfunction by a knowledgeable informant was used. RESULTS: A two-way analysis of variance with the FrSBe total as the dependent variable revealed a significant MMSE by diagnosis interaction (F(1,53) = 9.34, p = 0.004). Mean FrSBe total for AD patients showed significant impairment across the range of dementia severity, whereas it was relatively preserved for DLB patients in the early stage of disease. The interaction term showed the same pattern for the executive dysfunction (F(1,53) = 7.62, p = 0.008), disinhibition (F(1,53) = 4.90, p = 0.031), and apathy (F(1,53) = 9.77, p = 0.003) subscales. CONCLUSION: Although frontal behavioral symptoms in AD patients were present regardless of stage of dementia, DLB patients showed significant frontal dysfunction only in later stages. Results suggest that frontal subcortical circuits associated with behaviors assessed by the FrSBe are affected early in AD but not until later stages in DLB. Assessing specific behaviors related to frontal systems, coupled with stage of cognitive decline, may aid in clinical differentiation of AD and DLB.


Assuntos
Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/psicologia , Lobo Frontal/fisiopatologia , Doença por Corpos de Lewy/fisiopatologia , Doença por Corpos de Lewy/psicologia , Idoso , Apatia , Estudos Transversais , Função Executiva , Feminino , Humanos , Inibição Psicológica , Masculino , Testes Neuropsicológicos , Índice de Gravidade de Doença , Avaliação de Sintomas
11.
Exp Aging Res ; 39(4): 371-81, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23875836

RESUMO

UNLABELLED: BACKGROUND/STUDY CONTEXT: Temporal sequence learning is a critical aspect of episodic memory that may be dependent on the temporal and frontal lobes. Because amnestic mild cognitive impairment (aMCI) and normal aging may result in changes within the temporal and frontal lobes, the present study investigated temporal sequence learning in patients with aMCI, cognitively normal older adults, and young adults. METHODS: On each trial of a temporal sequence task, circles appeared one at a time at the end of each arm of a computerized radial eight-arm maze. Participants were asked to reproduce the temporal sequence by placing numbered circles (1 to 8) on the arms of the eight-arm maze. Participants were presented with the same fixed sequence on each trial until the sequence was replicated without any errors, or until 15 trials were presented. RESULTS: Individuals with aMCI required significantly more trials to learn the temporal sequence compared with older adults (p < .05). Older adults required significantly more trials to learn the sequence than young adults (p < .05). Older adults and individuals with aMCI committed significantly more Trial 1 errors (p < .05) than young adults; however, there were no significant differences between the aMCI and older adult groups on Trial 1. CONCLUSION: The results suggest that temporal sequence learning deficits are detectable in aMCI. These deficits may disrupt a number of cognitive processes, such as episodic memory, that are important for the execution of daily activities. The results suggest that although temporal sequence learning declines with normal aging, this decline is greater in individuals who have a diagnosis of aMCI and are at higher risk for developing Alzheimer's disease.


Assuntos
Envelhecimento/psicologia , Disfunção Cognitiva/psicologia , Memória Episódica , Adulto , Idoso , Feminino , Humanos , Masculino , Rememoração Mental , Adulto Jovem
12.
J Alzheimers Dis ; 94(1): 201-203, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37334611

RESUMO

Alzheimer's disease (AD) clinical research depends on engaging and enrolling appropriate research participants to address specific scientific questions. Investigators, however, are beginning to recognize the importance of participant study partners who contribute to AD research in multiple ways, including their contributions to the diagnostic process through observations of participant cognition and daily functioning. These contributions justify increased efforts to understand factors that impede or facilitate their willingness to remain in this role in longitudinal studies and clinical trials. Study partners, including those from diverse, underrepresented communities, are stakeholders significantly invested in AD research that benefits all living with the disease.


Assuntos
Doença de Alzheimer , Humanos , Doença de Alzheimer/diagnóstico , Cognição , Estudos Longitudinais
13.
Alzheimer Dis Assoc Disord ; 26(3): 260-6, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22037597

RESUMO

Increased susceptibility of the aging brain to both chronic stress and incipient dementia-related neuropathology may accelerate cognitive decline. We investigated associations between chronic stress and diagnostic change in 62 individuals (mean age, 78.7 y) participating in an Alzheimer disease research center longitudinal study. The subjects, diagnosed at baseline as cognitively normal (CN) or with mild cognitive impairment (MCI), were followed for an average of 2.5 years. Senior neurologists, blind to detailed measures of stress and cognition, assigned diagnoses annually. Logistic regression analyses assessed the accuracy with which measures of stress (event-based ratings, cortisol levels) predicted the conversion to MCI and dementia. Eleven individuals with MCI at baseline received a dementia diagnosis during follow-up. Sixteen converted from cognitively normal to MCI. Prolonged, highly stressful experiences were associated with conversion from MCI to dementia. The cortisol awakening response, with age and education, was associated with a diagnostic change to MCI. Cortisol measures were not associated with the progression from MCI to dementia, and there was no association between stressful experiences and the change to MCI. Mechanisms associated with the transition from normal cognition to MCI may differ from those associated with a diagnostic change to dementia. These findings could facilitate the identification of interventional strategies to reduce the risk of decline at different stages of susceptibility.


Assuntos
Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Demência/diagnóstico , Demência/psicologia , Estresse Psicológico/complicações , Idoso , Progressão da Doença , Feminino , Humanos , Hidrocortisona/análise , Masculino
14.
Am J Alzheimers Dis Other Demen ; 37: 15333175211064756, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34986661

RESUMO

Coupled with aging, chronic stress experienced by dementia caregivers often leads to deteriorating health. Comparing caregivers and non-caregivers, we tested whether depression and loneliness mediate the relationship between caregiver status and a measure of chronic stress, the Perceived Stress Scale. Seventy-six cognitively normal older adults (mean age 72.7) were identified as caregivers or non-caregivers based on the functional independence of a paired family member. Caregivers reported more perceived stress, depression, and loneliness than non-caregivers. Using multiple mediation analyses, we found that loneliness and depression mediated the relationship of caregiver status with perceived stress. The loneliness effect on perceived stress was both direct and via its relationship with depressive symptoms. The findings suggest loneliness as a likely point of intervention to reduce caregiver stress. Initiatives to enable caregivers to maintain or develop social relationships apart from caregiver responsibilities may mitigate stress and its negative impact on mental and physical health.


Assuntos
Cuidadores , Demência , Idoso , Depressão , Humanos , Solidão , Estresse Psicológico
15.
Neurology ; 98(5): e506-e517, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34810247

RESUMO

BACKGROUND AND OBJECTIVE: Patients with earlier age at onset of sporadic Alzheimer disease (AD) are more likely than those with later onset to present with atypical clinical and cognitive features. We sought to determine whether this age-related clinical and cognitive heterogeneity is mediated by different topographic distributions of tau-aggregate neurofibrillary tangles (NFTs) or by variable amounts of concomitant non-AD neuropathology. METHODS: The relative distribution of NFT density in hippocampus and midfrontal neocortex was calculated, and α-synuclein, TAR DNA binding protein 43 (TDP-43), and microvascular copathologies were staged, in patients with severe AD and age at onset of 51-60 (n = 40), 61-70 (n = 41), and >70 (n = 40) years. Regression, mediation, and mixed effects models examined relationships of pathologic findings with clinical features and longitudinal cognitive decline. RESULTS: Patients with later age at onset of AD were less likely to present with nonmemory complaints (odds ratio [OR] 0.46 per decade, 95% confidence interval [CI] 0.22-0.88), psychiatric symptoms (ß = -0.66, 95% CI -1.15 to -0.17), and functional impairment (ß = -1.25, 95% CI -2.34 to -0.16). TDP-43 (OR 2.00, 95% CI 1.23-3.35) and microvascular copathology (OR 2.02, 95% CI 1.24-3.40) were more common in later onset AD, and α-synuclein copathology was not related to age at onset. NFT density in midfrontal cortex (ß = -0.51, 95% CI -0.72 to -0.31) and midfrontal/hippocampal NFT ratio (ß = -0.18, 95% CI -0.26 to -0.10) were lower in those with later age at onset. Executive function (ß = 0.48, 95% CI 0.09-0.90) and visuospatial cognitive deficits (ß = 0.97, 95% CI 0.46-1.46) were less impaired in patients with later age at onset. Mediation analyses showed that the effect of age at onset on severity of executive function deficits was mediated by midfrontal/hippocampal NFT ratio (ß = 0.21, 95% CI 0.08-0.38) and not by concomitant non-AD pathologies. Midfrontal/hippocampal NFT ratio also mediated an association between earlier age at onset and faster decline on tests of global cognition, executive function, and visuospatial abilities. DISCUSSION: Worse executive dysfunction and faster cognitive decline in people with sporadic AD with earlier rather than later age at onset is mediated by greater relative midfrontal neocortical to hippocampal NFT burden and not by concomitant non-AD neuropathology.


Assuntos
Doença de Alzheimer , Neocórtex , Idade de Início , Doença de Alzheimer/patologia , Autopsia , Humanos , Neocórtex/patologia , Emaranhados Neurofibrilares/patologia , Proteínas tau/metabolismo
16.
Alzheimers Dement (Amst) ; 13(1): e12188, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34027018

RESUMO

INTRODUCTION: Participants from a longitudinal cohort study were surveyed to evaluate the practical feasibility of remote cognitive assessment. METHODS: All active participants/informants at the University of California San Diego Alzheimer's Disease Research Center were invited to complete a nine-question survey assessing technology access/use and willingness to do cognitive testing remotely. RESULTS: Three hundred sixty-nine of 450 potential participants/informants (82%) completed the survey. Overall, internet access (88%), device ownership (77%), and willingness to do cognitive testing remotely (72%) were high. Device access was higher among those with normal cognition (85%) or cognitive impairment (85%) than those with dementia (52%), as was willingness to do remote cognitive testing (84%, 74%, 39%, respectively). Latinos were less likely than non-Latinos to have internet or device access but were comparable in willingness to do remote testing. DISCUSSION: Remote cognitive assessment using interactive video technology is a practicable option for nondemented participants in longitudinal studies; however, additional resources will be required to ensure representative participation of Latinos.

17.
Mov Disord ; 25(13): 2229-33, 2010 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-20721924

RESUMO

The goal of this study was to explore whether the Montreal Cognitive Assessment (MoCA), a new screening instrument, would be more sensitive to mild to moderate cognitive impairment in Huntington's disease (HD) than an established screening measure, the Mini Mental State Exam (MMSE). Our reasoning for this query is that the MoCA includes a broader range of test items and an additional assessment of executive functioning and attention compared with the MMSE. Using the receiver operating characteristic (ROC) analysis to examine performance of HD and control groups on both tests on overall scores and scores from various subdomains (i.e., visuospatial abilities) revealed that the MoCA achieved higher sensitivity without sacrificing specificity in many domains relative to the MMSE.


Assuntos
Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Doença de Huntington/complicações , Entrevista Psiquiátrica Padronizada , Testes Neuropsicológicos , Adulto , Área Sob a Curva , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC
18.
Mov Disord ; 25(9): 1163-9, 2010 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-20629124

RESUMO

The importance of designating criteria for diagnosing dementia lies in its implications for clinical treatment, research, caregiving, and decision-making. Dementia diagnosis in Huntington's disease (HD) is often based on criteria developed for Alzheimer's disease requiring memory loss. However, it is likely that other cognitive deficits contribute to functional impairment in HD before memory declines. The goal is to identify cognitive deficits that contribute to functional impairment to support dementia criteria that reflect HD neuropathology. Eighty-four HD mutation-positive subjects completed neuropsychological tests and the Unified Huntington's Disease Rating Scale Functional Independence Scale (FIS). Functional impairment was defined as 80 or below on the FIS. Speed of processing, initiation, and attention measures accounted for 70.0% of the variance in FIS ratings (linear regression) and correctly classified 91.7% of subjects as functionally impaired or intact (logistic regression). Measures of memory, motor impairment except dysarthria, neuroleptic use, and depressed mood did not improve prediction. A definition of HD dementia that includes cognitive impairment in at least two areas of cognition but does not require a memory deficit, in the context of impaired functional abilities and a deteriorating course, more accurately reflects HD neuropathology and could lead to improved research methods and patient care.


Assuntos
Transtornos Cognitivos/etiologia , Doença de Huntington/complicações , Adulto , Idoso , Transtornos Cognitivos/diagnóstico , Transtorno Depressivo/etiologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Testes Neuropsicológicos/estatística & dados numéricos , Adulto Jovem
19.
Alzheimers Res Ther ; 12(1): 78, 2020 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-32605603

RESUMO

BACKGROUND: Growing awareness of Alzheimer's disease (AD) has prompted a demand for quick and effective ways to screen for memory loss and cognitive decline in large numbers of individuals in the community. Periodic Memory Screening Day events provide free, brief cognitive screening aimed at those 65 years and older, and can serve as an opportunity to gauge participants' attitudes towards AD research and recruit them into ongoing research projects. METHODS: Over 6 single-day events in 2 years, more than 574 individuals were individually screened using the MoCA and a story recall task (immediate and delayed), given feedback about their performance, and introduced to AD research and opportunities to participate. RESULTS: Screening classified 297 individuals (52.0%) as having "No Decline," 192 (33.6%) as "Possible decline," and 82 (14.4%) as "Likely decline." Those with "Likely decline" were older and less educated, had more memory concerns, were more likely to be men, and were less likely to have a positive family history of dementia than those with "No Decline." Subsequent validation of screening procedures against a full clinical evaluation showed 72% classification accuracy with a skew towards over-calling Possible and Likely decline and thereby guiding questionable individuals to a more thorough evaluation. Of those screened, 378 (66%) agreed to additional research and consented to being listed in a research registry, and a majority (70-85%) of those consenting reported they were amenable to various AD research procedures including lumbar puncture, MRI, and autopsy. Overall, 19.1% of those screened met inclusion criteria for ongoing studies and were successfully recruited into AD research. CONCLUSIONS: Conducting a few concentrated community memory screening events each year may help meet the public's demand for brief assessment of memory concerns and can be a relatively effective and efficient recruitment strategy for AD research.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Idoso , Doença de Alzheimer/diagnóstico , Humanos , Estudos Longitudinais , Masculino , Memória , Transtornos da Memória/diagnóstico , Testes Neuropsicológicos
20.
J Int Neuropsychol Soc ; 15(5): 662-70, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19635179

RESUMO

The current study examined temporal order memory in preclinical Huntington's disease (pre-HD). Participants were separated into less than 5 years (pre-HD near) and more than 5 years (pre-HD far) from estimated age of clinical diagnosis. Participants completed a temporal order memory task on a computerized radial eight-arm maze. On the study phase of each trial, participants viewed a random sequence of circles appearing one at a time at the end of each arm. On the choice phase, participants viewed two circles at the end of the study phase arms and chose the circle occurring earliest in the sequence. The task involved manipulations of the temporal lag, defined as the number of arms occurring in the sample phase sequence between the two choice phase arms. Research suggests that there is more interference for temporally proximal stimuli relative to temporally distal stimuli. There were no significant differences between the pre-HD far group and controls on the temporal order memory task. The pre-HD near group demonstrated significant impairments relative to the other groups on closer temporal lags, but were normal on the furthest temporal lag. Therefore, temporal order memory declines with increased temporal interference in pre-HD close to estimated diagnosis of HD.


Assuntos
Doença de Huntington/complicações , Doença de Huntington/diagnóstico , Transtornos da Memória/etiologia , Percepção do Tempo/fisiologia , Adulto , Análise de Variância , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos
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