Informant Questionnaire On Cognitive Decline In The Elderly Research Articles

The association of premorbid conditions with 6-month mortality in acutely admitted ICU patients over 80 years

BackgroundPremorbid conditions influence the outcome of acutely ill adult patients aged 80 years and over who are admitted to the ICU. The aim of this study was to determine the influence of such premorbid conditions on 6 month survival.MethodsProspective cohort study in 242 ICUs from 22 countries including patients 80 years or above, admitted over a 6 months period to an ICU between May 2018 and May 2019. Only emergency (acute) ICU admissions in adult patients ≥ 80 years of age were eligible. Patients who were admitted after planned/elective surgery were excluded. We measured the Clinical Frailty Scale (CFS), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), disability with the Katz activities of daily living (ADL) score, comorbidities and a Polypharmacy Score (CPS).ResultsOverall, the VIP2 study included 3920 patients. During ICU stay 1191 patients died (30.9%), and another 436 patients (11.1%) died after ICU discharge but within the first 30 days of admission, and an additional 895 patients died hereafter but within the first 6 months after admission (22.8%). The 6 months mortality was 64%. The median CFS was 4 (IQR 3–6). Frailty (CFS ≥ 5) was present in 26.6%. Cognitive decline (IQCODE above 3.5) was found in 30.2%. The median IQCODE was 3.19. A Katz ADL of 4 or less was present in 27.7%. Patients who surviving > 6 months were slightly younger (median age survivors 84 with IQR 81–86) than patients dying within the first 6 months (median age 84, IQR 82–87, p = 0.013), were less frequently frail (CFS > 5 in 19% versus 34%, p < 0.01) and were less dependent based on their Katz activities of daily living measurement (median Katz score 6, IQR 5–6 versus 6 points, IQR 3–6, p < 0.01).ConclusionsWe found that Clinical Frailty Scale, age, and SOFA at admission were independent prognostic factors for 6 month mortality after ICU admission in patients age 80 and above. Adding other geriatric syndromes and scores did not improve the model. This information can be used in shared-decision making.ClinicalTrials.gov: NCT03370692.

Development of a web application for cognitive and functional assessment for dementia screening for Thai population

AbstractBackgroundTools for web‐based testing to detect cognitive impairment are still underdeveloped in Thailand. Our aim was to generate a web‐based instrument to assess cognitive and functional abilities and to explore its ability for diagnosis of dementia and MCI.MethodWe have developed a web application for cognitive and functional assessment to detect cognitive impairment. We hoped that subjects or family members could use this web‐based tests at home as self‐screening. These web‐based tests included an electronic version of the Thai Mental State Examination (e‐TMSE), a clock drawing test, a category verbal fluency test, a short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and Thai activities of daily living scale (Thai ADL). Correlations, receiver operator curves (ROCs), sensitivity, and specificity were analyzed using SPSS (version 18).ResultA total of 198 participants (69% female, mean age 66.7 ± 10 years). 57.1% had education of more than 6 years. Forty‐four were Major Neurocognitive Disorder, fifty‐eight were Mild Neurocognitive Disorder (MCI), and ninety‐six were normal controls. The e‐TMSE correlated with both paper‐pencil based TMSE(r = 0.80,p&lt;0.001) as well as clock drawing test (r = 0.470 p&lt;0.001). There were also statistically significant high correlations between digital and paper &amp; pencil tests (e.g, category verbal fluency test, A short form of the IQCODE, and ADL). For diagnosis of dementia, e‐TMSE achieved an AUC of 0.84 (95% bootstrapped CI [0.78, 0.90]. The cut‐off score ≤23 offered sensitivity and specificity of 88.6% and 70.1% respectively. For diagnosis of dementia with the combination of 5 e‐tests, the AUC was 0.832 (p&lt;0.001), while for MCI diagnosis, the AUC was 0.615 (p = 0.013). The area under the ROC of the IQCODE combined with ADL scale test was 0.907 (p&lt;0.001).ConclusionWe demonstrated that our web application that included: e‐TMSE, clock drawing test, category verbal fluency test, IQCODE and Thai‐ADL scale showed good correlation between digital vs paper‐pencil tests. Individual e‐test and combination of them can offer self screening for MCI and dementia.

Predictive ability of the IQCODE items for detection of cognitive decline and dementia in aging adults with Down syndrome

AbstractBackgroundThere is evidence of a genetic association between Down Syndrome (DS) and early progression of Alzheimer’s disease (AD). Few brief instruments have been validated for the screening of dementia in this population. Previously, we showed that the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) may be useful for cognitive screening in adults with DS1. Nonetheless, the adaptation of certain items to account for the presence of intellectual deficiency may increase diagnostic accuracy. The aim of the present study is to evaluate the predictive ability of IQCODE items for adults with DS.MethodUnivariate and multivariate logistic regressions were used to assess the effects of the 26 IQCODE items on the diagnosis of cognitive decline (prodromal dementia or dementia versus stable cognition) according to the Cambridge Examination for Mental Disorders of Older People with DS and Others with Intellectual Disabilities, CAMDEX‐DS. The study comprised 92 participants with DS aged ≥35 years. The accuracy of the final multivariate model was evaluated using receiver operator characteristics (ROC) curve.ResultAssociations were found between all IQCODE items and diagnosis, except for two items (handling money for shopping and financial matters). Multivariate logistic regression using the CAMDEX‐DS diagnosis as dependent and the items of IQCODE as predictors, showed that four items remained in the model (remembering: members of family and friends, day and month, things they learned when they were younger, and adjusting to change in routine). Participants who presented more difficult with these items were, respectively, 84.1, 86.1, 10.1 and 23.6 times more likely to have a diagnosis of prodromal dementia or dementia. Using the estimated probability of these 4 items, we found an area under the ROC curve of 0.961.ConclusionThe IQCODE items showed good ability to discriminate subjects with cognitive decline as indicated by the CAMDEX‐DS. The use of 4 of the IQCODE items proved to suffice to discriminate between diagnostic groups. We will next perform an adaptation and validation study to warrant the “IQCODE‐DS” as a reliable, brief test for the cognitive screening in this population.

Association between cognitive function and dusty weather: a propensity score matching study

BackgroundWith a rapidly aging global population, the health of older adults is a national priority for countries across the world. Dusty weather has been demonstrated to be a potential risk factor of cognitive function among the elderly population. However, there is a paucity of studies exploring the associations between dusty weather and cognitive function among the older in China.MethodsData on individual characteristics were obtained from the China Health and Retirement Longitudinal Survey (CHARLS) 2018, whereas data on air pollution were sourced from environmental monitoring stations in China. Cognitive function, including general cognitive function, episodic memory, and linguistic competence, was assessed by self- or informant-questionnaires. We used propensity score matching and linear regression to investigate the relationship between dusty weather and cognitive function. Sensitivity analyses were conducted to test the robustness of the results.ResultsThis study included 8,604 participants older than 60 years old. After controlling air pollutant weather, dusty weather was demonstrated to be positively associated with a decline in cognitive function (Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), 4.0, 95% confidence interval (CI): 3.11, 4.89; Mini‐Mental State Exam (MMSE), 0.63, 95% CI: 0.34, 0.92). Results of sensitivity analysis showed that our research findings are robust.ConclusionOlder adults living in dusty weather regions suffered a higher level of cognitive impairment, and such adverse effects were more substantial among females compared with their male counterparts. Targeted health interventions to help older adults living in regions where dusty weather occurs frequently are suggested to be proposed.

Feasibility Testing of Neurobic Exercise Intervention in Older Adults with Mild Cognitive Impairment

Objective: To explore the feasibility of neurobic exercise intervention among older adults with mild cognitive impairment (MCI). Material and Methods: This pilot study used a two-group pre-post test, with a follow-up design. Older adults with MCI were randomly assigned to the intervention group (n=10) or the control group (n=10). Measurements included: the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the Common Objects Memory Test (COMT). Acceptability was assessed using a satisfaction and helpfulness rating scale and open-ended questions. Results: The intervention group had a significant reduction in IQCODE relative change score, indicating improvement in cognitive decline, and had a significantly higher COMT relative change score, indicating improvement in cognitive performance at 3 and 6 weeks. Participants reported high satisfaction with the overall activities, and rated the intervention helpful. Conclusion: The neurobic exercise intervention was feasible and acceptable for Thai community-dwelling older adults.

Examining the influence of marital status on cognitive risk in a nationally representative sample of adults in India

AbstractBackgroundInfluence of marital status on cognitive risk remains understudied in India with 17.7% of the global population.MethodsTo examine the influence of marital status (categorized as married, never married, widowed and other which included partnered, separated or divorced) on cognitive risk and to what extent marital status is a protective factor for cognitive decline. For this observational study design, we merged nationally representative harmonized Longitudinal Aging Study of India (LASI) and the harmonized Diagnostic Assessment of Dementia (LASI‐DAD) for 4096 adults 45 years and older and their spouses regardless of age from 2017 to 2019. We accounted for multistage, stratified, area probability cluster design of the complex survey using appropriate weights. The primary outcome was cognitive impairment based on cognition score without number series based on word recall, cognition tests and Jorm IQ code &lt; 3.9 or &gt; 3.9 or higher. The cognitive impairment was constructed as a 0/1 dummy variable coded 0 if the respondent was at low‐risk (mid‐tertile) or very low‐risk (top‐tertile) and coded 1 if the respondent was high‐risk (bottom‐tertile). We assessed proportion at risk for cognitive impairment by marital status and used chi‐square test to test significance at p&lt;0.05 level. We ran logistic regression model on weighted population to examine the odds ratio of cognitive risk by marital status.ResultsOur weighted population was 4,716 adults, 64.0% were married, 0.93% were never married, 33.3% were widowed, and 1.8% were other. Those married had the lowest proportion of cognitive risk (43.0%) while never married had the highest proportion of cognitive risk (71.0%), followed by widowed (59.6%) and other (55.0%). In logistic regression, in comparison to married adults, cognitive risk was three times more likely for never married adults, AOR 3.17 [95% CI, 1.55‐6.48], and nearly two times more likely for widowed, AOR 1.58 [95% CI, 1.33‐1.88].ConclusionMarital status likely functions as a social determinant of cognitive decline in the Indian context. These findings are relevant to U.S. and other countries as the harmonized LASI, is a sister study of the harmonized U.S. Health and Retirement Study and data can be leveraged using cross‐country comparisons.

Late-life onset psychotic symptoms and incident cognitive impairment in people without dementia: Modification by genetic risk for Alzheimer's disease.

Late-life onset psychosis is associated with faster progression to dementia in cognitively normal people, but little is known about its relationship with cognitive impairment in advance of dementia. Clinical and genetic data from 2750 people ≥50 years of age without dementia were analyzed. Incident cognitive impairment was operationalized using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and psychosis was rated using the Mild Behavioral Impairment Checklist (henceforth MBI-psychosis). The whole sample was analyzed before stratification on apolipoprotein E (APOE) ε4 status. In Cox proportional hazards models, MBI-psychosis had a higher hazard for cognitive impairment relative to the No Psychosis group (hazard ratio [HR]: 3.6, 95% confidence interval [CI]: 2.2-6, p < 0.0001). The hazard for MBI-psychosis was higher in APOE ε4 carriers and there was an interaction between the two (HR for interaction: 3.4, 95% CI: 1.2-9.8, p = 0.02). Psychosis assessment in the MBI framework is associated with incident cognitive impairment in advance of dementia. These symptoms may be particularly important in the context of APOE genotype.

Assessing cognitive decline in Vietnamese older adults using the Montreal Cognitive Assessment-Basic (MoCA-B) and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) during the COVID-19 pandemic: A feasibility study

Objectives: The lack of cognitive assessment tools suitable for people with minimal formal education is a barrier to identify cognitive impairment in Vietnam. Our aims were to (i) evaluate the feasibility of conducting the Montreal Cognitive Assessment-Basic (MoCA-B) and Informant Questionnaire On Cognitive Decline in the Elderly (IQCODE) remotely on the Vietnamese older adults, (ii) examine the association between the two tests, (iii) identify demographic factors correlated with these tools. Methods: The MoCA-B was adapted from the original English version, and a remote testing procedure was conducted. One hundred seventy-three participants aged 60 and above living in the Vietnamese southern provinces were recruited via an online platform during the COVID-19 pandemic. Results: IQCODE results showed that the proportions of rural participants classified as having mild cognitive impairment and dementia were substantially higher than those in urban areas. Levels of education and living areas were associated with IQCODE scores. Education attainment was also the main predictor of MoCA-B scores (30% of variance explained), with an average of 10.5 points difference between those with no formal education and those who attended university. Conclusions: It is feasible to administer the IQCODE and MoCA-B remotely in the Vietnamese older population. Education attainment played a stronger role in predicting MoCA-B scores than IQCODE, suggesting the influence of this factor on MoCA-B scores. Further study is needed to develop socio-culturally appropriate cognitive screening tests for the Vietnamese population.

Effectiveness of neurobic exercise program on memory performance in community-dwelling older adults with mild cognitive impairment: A randomized controlled crossover trial.

Mild cognitive impairment (MCI) is an early stage of cognitive decline in individuals who are still able to perform their activities of daily living. They are at increased risk of developing dementia. Improving and maintaining cognitive functions are essential goals for older people with MCI to delay or prevent the transition to dementia. This study investigated the effect of the neurobic exercise program on memory performance among community-dwelling older adults with MCI. A single-blind, randomized, controlled, two-period crossover design was used. Thirty-two older adults who met the study criteria were randomly assigned to one of two sequence groups, A (n =16) and B (n = 16). Group A received three weeks of neurobic exercise, followed by a three-week washout period, and then three weeks of the traditional brain exercise program. Group B received the treatments in the reverse order but otherwise in a similar manner. Two aspects of memory performance were evaluated: subjective memory and objective memory. Blinded evaluators measured the outcomes four times at baseline, post-intervention (week 3), follow-up stage (week 7), and the end of the study (week 9). Descriptive statistics, independent t-tests, and repeated measures ANOVA were employed for data analyses. For subjective memory, rmANOVA revealed a significant difference of within-subject (F1.437, 43.113 = 9.324, p <0.05) and interaction effect (time*group) (F1.437, 43.113 = 12.313, p <0.05) and also showed significant differences of within-subject (F1.794,53.811 = 28.931, p < .05) and interaction effect (time*group) (F1.794, 53.811 = 31.190, p <0.05) for objective memory. The study results revealed that the participants in both groups had significantly lower mean scores on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), indicating better or improved subjective memory. They also had significantly higher mean scores on the Common Objects Memory Test (COMT) after receiving the neurobic exercise program, indicating improvement in cognitive performance. The neurobic exercise intervention could improve subjective and objective memory among community-dwelling older adults with MCI more than those who received the traditional brain exercise program. Therefore, the neurobic exercise program can be used by nurses and multidisciplinary teams to enhance memory performance among older adults with MCI. Thai Clinical Trials Registry (TCTR) 20210326003.

Does Your Loved One With Cognitive Symptoms Need to See a Doctor? Check It Online.

Widespread access to emerging information and communication technologies (ICT) allows its use for the screening of diseases in the general population. At the initiative of the Spanish Confederation of Associations of Families of People with Alzheimer’s disease and other dementias (CEAFA), a website (http://www.problemasmemoria.com) has been created that provides information about Alzheimer’s disease and includes questionnaires to be completed by family or friends concerned about memory problems of a relative. A cross-sectional, randomized, multicenter study was performed to evaluate feasibility, validity, and user satisfaction with an electronic method of completion vs. the current method of paper-based questionnaires for clinically dementia screening completed by the informants: the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the Alzheimer’s disease-8 screening test (AD8). A total of 111 pairs were recruited by seven memory clinics. Informants completed IQCODE and AD8 questionnaires both in their paper and electronic versions. The correlation between paper and electronic versions was significantly positive for IQCODE (r = 0.98; p < 0.001) and AD8 (r = 0.96; p < 0.001). The execution time did not differ significantly, and participants considered their use equally easy. This study shows that an electronic version of the IQCODE and AD8 questionnaires is suitable for its online use via the internet and achieves the same results as the traditional paper versions.

Cognitive Decline and Self Rated Health Among Older Adults in Lebanon

Several studies examined the factors associated with self-rated health (SRH), but few studied the relationship between cognitive decline and SRH. The aim of this study was to explore the association between cognitive decline and SRH of Lebanese older adults. This is a secondary analysis of data collected for a cross-sectional study conducted in 2013 to assess prevalence of dementia among a selected representative sample of community older adults aged 65 years and above living in two governorates, Beirut and Mount Lebanon. 419 older adults with no dementia who answered the SRH question and had data on cognitive decline were included in this study. Cognitive decline was measured using the Arabic validated Informant Questionnaire on Cognitive Decline in the elderly (IQCODE). Results show that around 43% reported moderate/bad SRH and 8.8% suffered from cognitive decline. Adjusting for nine confounders, our results showed that the odds of reporting moderate/bad SRH among older adults with cognitive decline was 2.91 times than that of those with no cognitive decline (p-value=0.016). As a conclusion, this study findings suggest that SRH is strongly correlated with cognitive decline. Health care providers in primary care centers, neurologists, and geriatricians can use the SRH question as a preliminary screen of older adults’ cognitive functions.

Microcephaly measurement in adults and its association with clinical variables.

ABSTRACTOBJECTIVE To establish a microcephaly cut-off size in adults using head circumference as an indirect measure of brain size, as well as to explore factors associated with microcephaly via data mining.METHODS In autopsy studies, head circumference was measured with an inelastic tape placed around the skull. Total brain volume was also directly measured. A linear regression was used to determine the association of head circumference with brain volume and clinical variables. Microcephaly was defined as head circumference that were two standard deviations below the mean of significant clinical variables. We further applied an association rule mining to find rules associating microcephaly with several sociodemographic and clinical variables.RESULTS In our sample of 2,508 adults, the mean head circumference was 55.3 ± 2.7cm. Head circumference was related to height, cerebral volume, and sex (p < 0.001 for all). Microcephaly was present in 4.7% of the sample (n = 119). Out of 34,355 association rules, we found significant relationships between microcephaly and a clinical dementia rating (CDR) > 0.5 with an informant questionnaire on cognitive decline in the elderly (IQCODE) ≥ 3.4 (confidence: 100% and lift: 5.6), between microcephaly and a CDR > 0.5 with age over 70 years (confidence: 42% and lift: 2.4), and microcephaly and males (confidence: 68.1% and lift: 1.3).CONCLUSION Head circumference was related to cerebral volume. Due to its low cost and easy use, head circumference can be used as a screening test for microcephaly, adjusting it for gender and height. Microcephaly was associated with dementia at old age.

Discrepancy in Fluid and Crystallized Intelligence: An Early Cognitive Marker of Dementia from the LASI-DAD Cohort

Background: Cognitive aging is a complex phenomenon, which comprises various cognitive skills, broadly categorized into fluid and crystallized intelligence. Crystallized intelligence (gc) tends to be maintained, as opposed to fluid intelligence (gf), which tends to decline rapidly with age. The association of the two with cognitive decline remains a matter of conjecture requiring further research. Aim: The aim of the study was to identify the variables of gc and gf from a population data of Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) study and investigate its relationship with the onset of cognitive impairment using discrepancy analysis against neuropsychological tests. Methods: This analysis of data from LASI-DAD study was carried out on a sample of 3,223 participants. They were assessed on extensive thirteen cognitive tests and one subjective test of cognition. Standardized score was used for discrepancy analysis. Fluid ability minus crystallized ability was used to assess the cognitive impairment. Any statistical significance with the score difference >0.99 SD was defined as a presence of cognitive decline. Hindi Mental Status Examination (HMSE) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) were used as gold standard. Results: With increased discrepancy score, each cognitive parameter score declined which was found to be statistically significant. In HMSE (Normal = 25.81 ± 3.39; Impaired = 23.17 ± 3.54; p = <0.001), there was a drop of 2 point scores in identifying cognitive impairment in the population sample as per the gold standard. A similar trend was evident in other neurocognitive domains as well. Conclusion: Crystallized-fluid intelligence discrepancy analysis has a strong potential in predicting the onset of cognitive decline ahead of time, facilitating early intervention.

Screening for Dementia and Cognitive Decline in Adults With Down Syndrome: A Novel Approach Using the Informant Questionnaire on Cognitive Decline in the Elderly.

The aim was to examine the psychometric properties of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a diagnostic tool to screen for dementia in aging individuals with Down syndrome (DS). This was a cross-sectional study of 92 individuals with DS 30 y or above of age) evaluated with the IQCODE. Using the informant questionnaire of the Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities, we divided the subjects into 3 diagnostic groups: stable cognition; prodromal dementia; and dementia. The ability of the IQCODE to discriminate between diagnostic groups was analyzed by calculating the areas under the receiver operator characteristic curves (AUCs). The optimal IQCODE cutoffs were 3.14 for dementia versus stable cognition (AUC=0.993; P<0.001) and 3.11 for prodromal dementia+dementia versus stable cognition (AUC=0.975; P<0.001), with sensitivity/specificity/accuracy of 100%/96.8%/97.3%, and 93.3%/91.9%/92.4%, respectively. The IQCODE showed a weak-to-moderate correlation with cognitive performance (P<0.05). The IQCODE is a useful tool to screen for cognitive decline in individuals with DS and is suitable for use in a primary care setting.

Three-year trajectories in functional limitations and cognitive decline among Dutch 75+ year olds, using nine-month intervals

BackgroundUsing longitudinal panel data, we aimed to identify three-year trajectories in cognitive and physical functioning among Dutch older adults, and the characteristics associated with these trajectories.MethodsWe used Group-based Trajectory Modelling with mortality jointly estimated to identify trajectories, using a scale composed of 6 Activities of Daily Living (ADL) as a measure of physical functioning, and the short mini mental status examination (sMMSE) or the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a measure of cognitive functioning. Data came from 574 Dutch adults aged 75+, collected in five nine-month measurement waves (2015–2018) for the Longitudinal Aging Study Amsterdam.ResultsFor physical functioning five trajectories were identified: ‘high’, ‘moderate’, ‘steeply declining’, ‘gradually declining’, and ‘continuously low’; and for cognitive functioning: ‘high’, ‘moderate’, ‘declining’, and ‘low’. Living in an institution, and being lower educated increased the probability of the two continuously low functioning trajectories, whereas old age and multimorbidity increased the probability of low physical functioning, but multimorbidity decreased the probability of low cognitive functioning. Associations for steeply declining physical functioning were absent. Being older and having multimorbidity increased the probability of gradually declining physical functioning and declining cognitive functioning. A higher prevalence of lung- and heart disease, cancer, and rheumatic disease was found in the gradually declining physical functioning group; and a higher prevalence of diabetes, cerebrovascular accidents, and cancer was found in the declining cognitive functioning group. High and moderate physical functioning and high cognitive functioning were characterized by being younger, community-dwelling, and higher educated. Having multimorbidity negatively predicted high and moderate physical functioning, but was not associated with high and moderate cognitive functioning.ConclusionsThis study identified trajectories comparable to studies that used longer time intervals, showing the consistent presence of heterogeneity in both physical and cognitive trajectories. Co-modelling mortality resulted in bigger group sizes for the more adverse trajectories. The favourable trajectories, containing most of the participants, were mostly characterized by absence of disease. The prevalence of chronic diseases differed between the declining trajectories, suggesting that certain diseases tend to induce cognitive decline rather than physical decline, and vice versa.

Utility of IQCODE (Informant Questionnaire on Cognitive Decline in the Elderly) in Diagnosing Dementia in Malayalam Speaking Population.

Among screening instruments used to diagnose dementia by interviewing the caregivers rather than the patients, Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) is widely used. To adapt and validate IQCODE in a Malayalam-speaking population and to study the utility of IQCODE in diagnosing dementia. Cross-sectional study conducted as a two-phase survey on individuals aged ≥55 years availing dementia care services at three tertiary care hospitals and a dementia clinic in Kerala, India. In the first phase, modifications were made in the questionnaire (IQCODE) in accordance with local social and cultural practices. The questionnaire was then translated to Malayalam and back-translated to English. In the second phase, this was administered to healthy elderly subjects and close caretakers of dementia patients. These patients underwent neuropsychology evaluation consisting of mini-mental state examination (MMSE) and Addenbrooke's cognition examination-Malayalam (ACE-M), and the statistical correlation between mean IQCODE scores and ACE-M scores was assessed using ANOVA test. A total of 396 patients with dementia were included in the study. The mean age group was 72.54 ± 7.11 years. The mean IQCODE score was 3.93 ± 0.68, and the mean ACE-M score was 39.96 ± 23.41. It has a statistically significant correlation with the total score of MMSE and ACE-M scales, confirming its utility as a good screening instrument. The IQCODE could be adapted and translated to Malayalam without making any major changes in its content and has good acceptance among this cohort of hospital-based subjects.

The experience of apathy in dementia: A qualitative study

AbstractBackgroundThe presence of apathy is associated with less favourable outcomes in dementia, including more rapid functional and cognitive decline, greater disease severity and increased mortality. We aimed to explore and gain an understanding into how people with dementia experience apathy, and consequently suggest effective interventions to help them and their carers.Method12 participants (6 dyads of 6 people with dementia and their family carers) were recruited from memory cafés, social groups, seminars and Patient and Public Involvement (PPI) meetings. People with dementia and their carers were interviewed separately and simultaneously. Quantitative data was collected using the following validated scales: Apathy Evaluation Scale (AES), short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Montreal Cognitive Assessment (MOCA), Cornell Scale for Depression in Dementia (CSSD) and Hospital Anxiety and Depression (HAD). The interviews were semi‐structured, focusing on the subjective interpretation of apathy and impact on behaviour, habits, hobbies, relationships, mood and activities of daily living. Interviews were recorded and transcribed and analysed using interpretative phenomenological analysis (IPA) which generated codes and patterns, which were collated into themes.ResultThe participants with dementia had mild to moderate degrees of cognitive impairment, with a range between 9‐22 (out of 30) on the MOCA. They reported moderate levels of apathy on the AES.Four superordinate themes were identified, three of which highlighted the challenging aspects of apathy: “Losing one’s sense of self”; “Feeling like a burden” and “Hindered by invisible obstacles”. One theme: ''What keeps me going’’, described the positive aspects of the individuals’ efforts to overcome apathy and remain connected with the world and people around them.ConclusionThis study is the first to illustrate and conceptualise the subjective experience of apathy in dementia, portraying it as a more complex and active phenomenon than the traditional view of apathy being simply negative and hopeless. Our study reveals a struggle against cognitive difficulties, fear of failure and invisible obstacles, with individuals desperate to remain connected, and appreciative of their carers’ efforts to help them. Apathy and its effects warrant more attention from clinicians, researchers and others involved in dementia care.

Efficacy of cognitive stimulation therapy virtual program for older adults with dementia in COVID-19 isolation.

BackgroundCognitive stimulation virtual therapy (CSVT) is an evidence‐based psychosocial intervention for people with mild‐to‐moderate dementia due to various etiological factors.ObjectiveThe aim of the present study was to assess the efficacy of a cognitive stimulation virtual therapy CSVT program, in individuals who have vascular or Alzheimer dementia in COVID‐19 isolation.MethodsOlder adults with mild vascular or Alzheimer dementia (N = 20) were assigned to one of two programs: one group (N = 10) attended during six months, two sessions per week program of the cognitive stimulation virtual therapy CSVT program, while the other, active control group (N = 10) took part in alternative activities. The following tests were applied to their primary caregivers. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and quality of life (Quality of Life (QoL)ResultsCompared with the active controls, the cognitive stimulation virtual therapy CSVT program showed a greater improvement in general cognitive functioning after the intervention (i.e. score increase on the IQCODE test). A trend towards improvement was also identified in short term/working memory and perceived quality of life (Quality of life (QoL) of elderly with dementia). The primary caregivers also perceived an improvement in mood, stress, anxiety and quality of sleep after the start of the virtual therapy during COVID‐19 isolation.ConclusionThe present results support the efficacy of cognitive stimulation virtual therapy CSVT program in people with dementia during COVID‐19 isolation.

Translation and adaption of short version of IQCODE into Hausa and its psychometric evaluation among outpatients older adults

PurposeThis study aims at translating and adapting a common and widely used proxy rated cognitive screening tool – Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) into Hausa language and also to evaluate the instrument’s psychometric properties.Design/methodology/approachIQCODE was translated and adapted using a qualitative process involving experts and the adapted version was then evaluated against a gold standard (Diagnostic and Statistical Manual of Mental Disorder V criteria for neurocognitive disorders) with older adults subjects (N = 100), while its reliability (internal consistency) was also evaluated. Descriptive statistics of mean and frequencies, and inferential statistic of receiver operating curve analysis and Cronbach’s alpha coefficient were used for data analysis at an alpha level set at 0.05.FindingsThe Hausa IQCODE has a sensitivity value of 73.3%, specificity value of 71.8% and optimal cut-off values of between 3.2 and 3.3. For his adapted instrument the area under the Curve (AUC) curve is 0.79 (95% CI: 0.663–0.919; std. err: 0.066; P = 0.000), and Cronbach’s alpha value of 0.819 was obtained indicating that the adapted instrument has good internal consistency.Research limitations/implicationsThe adapted IQCODE is a valid and reliable proxy based cognitive screening tool for the older adult Hausa speakers in Maiduguri. However, clinician and researcher might want to consider different optimal cut-off points when using this tool to screen or to monitor cognitive changes among older adults.Originality/valueThis research paper translated and adapted Hausa IQCODE into Hausa language. And it gives information on the validity and reliability of the adapted tool alongside with new optimal cut-off for cognitive screening by proxy among older adult patients in Nigeria.

Identification of Mortality Predictors among Elderly Patients Admitted to Geriatrics and Gerontology Department, Ain Shams University Hospitals

Abstract Background Elderly persons are prone to frequent hospitalization for a longer period of time. It has been reported that approximately 5% of elderly die during hospital stay, whereas 20%– 30% die within one year following hospital discharge. Many factors including aging-associated diseases, chronic diseases, drug abuse, poly pharmacy, functional disability, feeding problems, prolonged length of hospital stay are associated with increasing mortality risk. In addition, symptoms and signs are significantly variable in the elderly and usually atypically represented. Objective To identify predictive factors associated with in-hospital mortality in elderly patients admitted to Ain Shams University Geriatric hospital wards and intermediate care unit. Methods A prospective cohort study of all Egyptian elderly patients (aged 60 years old or above) admitted at Geriatric Hospital (general ward and intermediate care unit), Ain Shams University Hospitals (Cairo, Egypt), over a period of 6 months (from April 2019 to September 2019). Patients were subjected to structured interview questionnaire including data pertaining socio-demographic data, past medical history, relevant physical examination, Short-form of Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and SOFA score. Association between different risk factors and mortality rate was done to identify the most significant predictive factors leading to mortality in elderly in order to implement specific geriatric interventions in the future to prevent such fatal consequences. Results The present study included 140 patients, of whom 73 (52.1%) were females and 67 (47.8%) were males. Nearly, 80% of the studied sample were discharged, while 20% died during hospitalization. The most common pre-morbid conditions were hypertension (58.6%), diabetes mellitus (40%), gastrointestinal tract diseases (40.7%), cerebrovascular strokes (37.8%) and ischemic heart disease (35.7%). On admission, the mean SOFA score of the discharged group was (6±2.8) while the mean score of the deceased group was (8.9± 3.6). Evaluation of the general characteristics of the discharged and deceased groups revealed that the mortality rate is significantly associated with male gender (p = 0.018), depressive disorders (p &amp;lt; 0.001), hepatic diseases (p = 0.008), gastrointestinal tract diseases (p = 0.048), length of hospital stay (p = 0.001) and initial SOFA score on admission to acute care setting (p &amp;lt; 0.001). Conclusion Predictors of mortality during hospitalization of elderly patients include; male gender, depression, hepatic diseases, GIT diseases, length of hospital stay and initial SOFA score on admission. These factors must be evaluated to identify the potential candidates for specific geriatric interventions and specific plan of care.