Promoting the use of enduring powers of attorney in older adults: a literature review.

This review aims to identify factors that facilitate the establishment of enduring powers of attorney (EPOAs), and those that create a barrier to their establishment. The primary aim was to provide guidance about how to encourage future planning while people are cognitively able to make such important decisions. A detailed search of the literature was conducted to identify research looking at the motivating factors behind putting future-planning strategies in place. The literature highlighted a number of broad areas motivating the establishment of EPOAs, including: demographic factors; intrapersonal and personality factors; health and psychological factors; cognitive factors; and socio-emotional factors. While a number of factors play a role in determining whether or not a person establishes an EPOA, the factor most malleable to change is the awareness and knowledge of older adults and their families regarding the utility of EPOAs.

Predictors of financial capacity performance in older adults using the Financial Competence Assessment Inventory.

BACKGROUND: Declines in financial capacity in later life may arise from both neurocognitive and/or psychiatric disorders. The influence of socio-demographic, cognitive, health, and psychiatric variables on financial capacity performance was explored. METHODS: Seventy-six healthy community-dwelling adults and 25 older patients referred for assessment of financial capacity were assessed on pertinent cognitive, psychiatric, and financial capacity measures, including Addenbrooke's Cognitive Examination - Revised (ACE-R), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), selected Neuropsychiatric Inventory (NPI) items, Financial Competence Assessment Inventory (FCAI), and Social Vulnerability Scale (SVS). RESULTS: The internal consistency of the debt management subscale of the FCAI was relatively poor in our sample. Financial capacity performance differed between controls and patients. In our sample, performance on the FCAI was predicted by Mini-Mental State Examination, IQCODE, and GAI, but not by ACE-R, GDS, NPI items, or SVS (adjusted R(2) = 0.7059). CONCLUSIONS: Anxiety but not depression predicted financial capacity performance, possibly reflecting relatively low variance of depressive symptoms in this sample. Current cognitive decline as measured by the informant-rated IQCODE was more highly correlated to financial capacity than either educational attainment or ACE-R scores. Lack of significance of ACE-R data may reflect the instrument's decreased sensitivity to domains relevant to financial capacity, compared with more detailed neuropsychological assessment tools. The FCAI displayed fairly robust psychometric properties apart from the debt management subscale.

Cognitive effects of chemotherapy-induced menopause in breast cancer.

This study examined whether chemotherapy-induced menopause affects cognitive functioning in women with early breast cancer. The neuropsychological performance of 121 breast cancer patients (age M=49.62, SD=8.11, range=25.25-67.92) treated with chemotherapy was assessed pre-chemotherapy, as well as 1, 6, and 18 months post-chemotherapy completion. Linear mixed modeling was used to evaluate the data. Type of menopause (pre, chemotherapy-induced, and post menopause) was found to significantly interact with cognitive performance on two cognitive variables. Specifically, chemotherapy-induced menopausal women did not show any significant changes in performance on an abstract reasoning task, while the pre-menopausal and post-menopausal groups significantly improved over time. A significant interaction on a test of finger dexterity and coordination was also found, although inspection of the results indicated that this was due to a significant improvement in the pre-menopausal groups at 6 months post chemotherapy. After chemotherapy most cognitive variables showed improvements over time, although two indicators of verbal memory showed significant declines immediately after chemotherapy, with improvement by 18 months post completion. The current study found little evidence to suggest that chemotherapy-induced menopause broadly affects cognitive functioning after treatment administration. However, longer follow-up assessments are warranted to assess the long-term effects of combined chemotherapy and endocrine treatment.

Predictors of cognitive decline after chemotherapy in breast cancer patients.

The objective of this study is to identify whether decline in cognitive functioning after chemotherapy in women with breast cancer is associated with health/disease, treatment, and psychological variables. Neuropsychological performance, health/disease, and treatment-related information of 136 women with breast cancer (age M = 49.38; SD = 7.92; range = 25.25-67.92) was assessed pre-chemotherapy and 1-month post-chemotherapy. The Reliable Change Index corrected for practice (RCIp) identified women whose performance significantly declined, while Pearson correlations assessed the relationship between cognitive change and predictor variables. A total of 16.9% of women showed significant decline post-chemotherapy, with affected domains including verbal learning and memory, abstract reasoning, and motor coordination. Decline in hemoglobin levels and increased anxiety over the course of chemotherapy was found to significantly predict impairment in multiple cognitive measures. Change in specific cognitive measures was significantly associated with baseline fatigue, depression, and functional well-being (r = 0.23 to 0.33; p = .01 to < .001). Although the effects are small, there is evidence that psychological and health factors may increase vulnerability to cognitive dysfunction after chemotherapy for breast cancer. Significant associations reported in this study may be useful in the identification and treatment of at-risk individuals.

Is cognitive functioning detrimentally affected after early, induced menopause?

OBJECTIVE: Investigations into the cognitive effects of surgically and chemically induced menopause are frequently combined with naturally occurring menopause and hormone therapy. However, there is some evidence that women who undergo surgical menopause may experience more cognitive decline post surgery as well as more benefit from subsequent hormone therapy use than women who experience naturally occurring menopause. Little is known about the effects of chemically induced menopause on cognitive function. The aim of this review was to examine whether premature menopause affects cognitive functioning. DESIGN: PubMed, MEDLINE, and PsychINFO searches of the literature published from 1988 to 2007 pertaining to the understanding of the relationships between induced menopause and cognitive dysfunction were reviewed. Those combining induced menopause with natural menopause, those involving a disease process (eg, dementia), and animal studies were excluded. RESULTS AND CONCLUSIONS: Although smaller prospective studies have found that surgical menopause is associated with specific deficits in the memory (visual and verbal) and verbal fluency domains, larger randomized, controlled trials have generally found no effect of surgical menopause on cognitive functioning. The effects of chemical menopause are harder to assess as only three prospective trials have explicitly investigated the effect of induced menopause in the context of breast cancer treatment, and the results remain inconclusive. However, as surgical and chemical menopause both comprise the abrupt withdrawal of estrogen, there is the potential that this process may exert neurobiological effects that are different from those occurring with natural menopause and further prospective investigations comprising pre- and postsurgical/chemotherapy neuropsychological assessments are warranted.