Self-perceived problems in daily activities and strategy building in people with different stages of dementia.

BACKGROUND: People with dementia experience severe problems in their daily lives. However, little is known about self-perceived problems in the course of dementia. The aim of our study was to assess self-perceived problems with daily activities as well as individually developed strategies of older people of different cognitive status. METHODS: Semi-structured interviews were conducted with 25 participants (mean age 67.6 years, 56% female, 24% healthy, 28% mild dementia, 48% severe dementia). Questions addressed problems in daily activities, their occurrence and the behaviour toward them, and their developed strategies. Information was summarized quantitatively and evaluated using the chi-squared and Kruskal-Wallis tests. RESULTS: Self-perceived problems included awareness of physical and cognitive deficits in managing daily life, disturbing factors, and lost autonomy. Increased cognitive impairment was associated with more problems in daily life, even though people with severe dementia seemed not to recognize them. The most frequently reported strategies included orderliness, doing things immediately, and the use of external aids. While healthy people and those with mild dementia developed strategies, those with severe dementia reported only few strategies. CONCLUSION: Our findings indicate that self-perceived problems in daily life and strategy development are strongest in mild dementia, while people with more severe dementia tend to perceive no problems at all while correctly reflecting their current state of dependency. Importantly, despite memory loss during early stages of dementia, strategies are still being developed. Accordingly, strategies for daily living should be taught in early dementia to sustain an independent lifestyle.

Validity of Cognitive Assessment Tools for Older Adult Hispanics: A Systematic Review.

OBJECTIVES: A higher prevalence and incidence of dementia is found in Hispanic/Latino older adults. Therefore, valid instruments are necessary to assess cognitive functioning in this population group. Our aim was to review existing articles that have examined and reported on the validity of cognitive assessment tools in Hispanic/Latino population groups in the United States. DESIGN: Systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis. MEASUREMENTS: We systematically searched in the PubMed and Web of Science databases and assessed the quality of the search results using the Standards for the Reporting of Diagnostic Accuracy Studies. We included evidence from within the United States as well as from Spanish-speaking countries of origin (Mexico, Central and South America, and the Caribbean). RESULTS: The literature search revealed 27 studies with adequate quality that investigated 13 instruments. The Mini-Mental Status Examination (MMSE) was the most frequently investigated instrument in Hispanic/Latino groups in the United States with high sensitivity for dementia but also with significant differences for ethnicity and education. The Addenbrooke Cognitive Examination-Revised, Montreal Cognitive Assessment, 10/66 short diagnostic schedule, clock-drawing test, Phototest, Eurotest, and Executive Battery 25 had good diagnostic performance in Spanish-speaking countries. The naming test and verbal fluency tests have a higher risk of misclassifying US Hispanics/Latinos who have dementia. CONCLUSION: Evidence on validity suggests that the MMSE may be an appropriate cognitive assessment tool for Hispanics. More research is needed to confirm the validity of cognitive tools to assess Hispanic/Latino groups for Alzheimer's disease and other related dementias in the United States to reduce current trends of culturally biased under- or overdiagnosis of cognitive impairments. J Am Geriatr Soc 68:882-888, 2020.