Physical Self-Maintenance Scale Scores Research Articles

Incidence and risk factors of depression in patients with metabolic syndrome.

Many studies have explored the relationship between depression and metabolic syndrome (MetS), especially in older people. China has entered an aging society. However, there are still few studies on the elderly in Chinese communities. To investigate the incidence and risk factors of depression in MetS patients in mainland China and to construct a predictive model. Data from four waves of the China Health and Retirement Longitudinal Study were selected, and middle-aged and elderly patients with MetS (n = 2533) were included based on the first wave. According to the center for epidemiological survey-depression scale (CESD), participants with MetS were divided into depression (n = 938) and non-depression groups (n = 1595), and factors related to depression were screened out. Subsequently, the 2-, 4-, and 7-year follow-up data were analyzed, and a prediction model for depression in MetS patients was constructed. The prevalence of depression in middle-aged and elderly patients with MetS was 37.02%. The prevalence of depression at the 2-, 4-, and 7-year follow-up was 29.55%, 34.53%, and 38.15%, respectively. The prediction model, constructed using baseline CESD and Physical Self-Maintenance Scale scores, average sleep duration, number of chronic diseases, age, and weight had a good predictive effect on the risk of depression in MetS patients at the 2-year follow-up (area under the curve = 0.775, 95% confidence interval: 0.750-0.800, P < 0.001), with a sensitivity of 68% and a specificity of 74%. The prevalence of depression in middle-aged and elderly patients with MetS has increased over time. The early identification of and intervention for depressive symptoms requires greater attention in MetS patients.

QOL-04. CHANGES IN FUNCTIONAL CONNECTIVITY AFTER SURGERY ARE ASSOCIATED WITH DECLINE IN FUNCTIONAL INDEPENDENCE IN PATIENTS WITH ELOQUENT GLIOMA

Abstract It is unknown whether patient independence following resection of eloquent glioma is associated with postoperative functional connectomic changes. Fifteen patients with left perisylvian glioma underwent resting-state fMRI and neuropsychological evaluation before and about 1 month after resection. Functional independence was measured with the Physical Self-Maintenance Scale (PSMS) and the Instrumental Activities of Daily Living scale (IADL). Manual dexterity testing (Grooved Pegboard; N = 13), neurologic motor exam (N = 12), and performance status (KPS; N = 14) were also obtained. Graph theoretical analysis was used to calculate functional brain network properties. Postoperative need for assistance in at least 1 activity on the IADL increased from baseline in 80% of patients, most commonly in Transportation (67%), followed by Shopping (60%), Financial Management (47%), Cooking (47%), Medication Management (33%), and Phone Use (33%). Overall need for assistance (Total IADL score) significantly increased postoperatively (Mdn change = 4, p = .006). Need for assistance on the PSMS only increased in 27% of patients, with rates less than 15% across all functions. Total PSMS scores did not differ pre- and postoperatively (Mdn change = 0). KPS scores worsened in 40% of patients. None had gross motor worsening, though fine manual dexterity declined in 7% for the left and 23% for the right hand. Increased connectomic properties were significantly associated (Spearman ρ) with greater need for assistance on the IADL [Local Efficiency: Total (.72), Shopping (.71), Cooking (.64), Financial Management (.64); Clustering Coefficient: Phone Use (.63); Betweenness Centrality: Phone Use (.63); all p &amp;lt; .01]. PSMS and IADL ratings were not associated with KPS, manual dexterity, pre/postoperative FLAIR volume, or extent of resection. This study demonstrated that increases in certain functional connectomic properties after surgery are associated with greater need for assistance in instrumental activities in the postoperative period. Connectivity increases have also been associated with poorer cognitive outcome in this population, though specific properties involved may differ.

Comparison of caregiver burden between dementia with Lewy bodies and Alzheimer's disease.

Caring for patients with dementia with Lewy bodies (DLB) would be more stressful for their caregivers than those with Alzheimer's disease (AD). In this study, we compared levels of caregiver burden and the possible influential factors on the caregiver burden between DLB and AD. Ninety-three DLB patients and 500 AD patients were selected from the Kumamoto University Dementia Registry. Caregiver burden, neuropsychiatric symptoms, basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were assessed by the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI), the Neuropsychiatric Inventory (NPI), the Physical Self-Maintenance Scale (PSMS), and the Lawton IADL scale, respectively. Despite the comparable Mini-Mental State Examination score, the J-ZBI score was significantly higher in the DLB group than the AD group (P = 0.012). A stepwise multiple regression analysis revealed that IADL score (β = -0.23, P = 0.049), PSMS score (β = -0.31, P = 0.010), disinhibition (β = 0.22, P = 0.008), and anxiety (β = 0.19, P = 0.027) were significantly associated with J-ZBI score in DLB. In AD, caregiver's relationship with patient (child) (β = 0.104, P = 0.005), caregiver's gender (female) (β = 0.106, P = 0.004), IADL score (β = -0.237, P < 0.001), irritability (β = 0.183, P < 0.001), apathy (β = 0.132, P = 0.001), agitation (β = 0.118, P = 0.007), and aberrant motor behaviour (β = 0.107, P = 0.010) were associated with caregiver burden. Caring for DLB patients caused a higher degree of caregiver burden than AD patients in the same level of cognitive decline. The factors responsible for the caregiver's burden were different between DLB and AD. The caregiver burden for DLB patients was associated with the disability of basic ADL, IADL impairment, anxiety and disinhibition.

Usage and adherence of antidementia drugs in a memory clinic cohort in Chongqing, Southwest China.

To investigate the use and adherence of antidementia drugs in elderly patients with dementia from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University. Patients were recruited from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University from December 2010 to December 2018. Medical charts were reviewed, including diagnosis, dosage of antidementia medicines, neuropsychological testing scores, and the further questionnaires were conducted via face-to-face or telephone, included duration of treatment, types of antidementia drugs, and reasons for treatment discontinuation. The data from 422 patients were analysed retrospectively for this study. Three hundred and fifteen were diagnosed with Alzheimer's disease (AD), 67 with mild cognitive impairment (MCI), and 40 with other types of dementia. From the 422 patients, 26.8% were treated with original donepezil (n = 113), 11.6% with generic donepezil (n = 49), 24.6% with memantine (n = 104), 13.3% with huperzine A (n = 56), and 23.7% with a combination of drugs (n = 100). However, 73% of patients discontinued treatment within 1 year of initiation. Patients treated for more than 36 months (37.8%) were more likely to choose combined medication, as compared with patients treated for less than 36 months. Patients with less than 9 years of education (odds ratio (OR): 2.394; 95% CI: 1.508-3.801) were more likely to discontinue treatment than patients with more than 9 years of education. Patients with elevated physical self-maintenance scale (PSMS) scores (OR: 1.195; 95% CI: 1.086-1.316) had a high risk of discontinuation. Overall treatment compliance is relatively poor in memory clinics in Chongqing. Our study demonstrates that higher education may lead to better treatment adherence in dementia care. Combination therapy may increase treatment time. However, poorer PSMS scores are a significant risk factor for treatment discontinuation.

Effects of neuropsychiatric symptoms of dementia on reductions in activities of daily living in patients with Alzheimer's disease.

In patients with Alzheimer's disease (AD), cognitive impairments cause a progressive reduction in Activities of Daily Living (ADL). Neuropsychiatric symptoms (NPS) also appear in most patients; however, the association between NPS and reductions in ADL remains unclear. The present study evaluated whether NPS influence such reductions using two different ADL measures in patients with AD. Among 546 consecutive outpatients who visited the memory clinic at the Jikei University Kashiwa Hospital, we recruited 208 patients with AD and investigated the correlations between either the Physical Self-Maintenance Scale (PSMS) score or the Instrumental ADL (IADL) level, and each of the Behavioral Pathology in AD (Behave-AD) subscales. To clarify the causal relationships of these correlations, we then verified the associations between statistically significant demographic variables and the Behave-AD subscales as well as the two ADL scales (PSMS score and IADL percentage) using a general linear model. Neither the PSMS nor the IADL results were significantly influenced by the aberrant motor behaviors score. However, the IADL was significantly influenced by the Mini-Mental State Exam (MMSE) score. Furthermore, diurnal rhythm disturbances and the interaction between diurnal rhythm disturbances score and the MMSE score significantly influenced the PSMS results. Basic ADL reductions may be influenced by diurnal rhythm disturbances, in addition to cognitive impairments in patients with AD. Furthermore, the interaction between the diurnal rhythm disturbances score and cognitive function may also influence basic ADL. Geriatr Gerontol Int 2020; ••: ••-••.

Cognitively-Related Basic Activities of Daily Living Impairment Greatly Increases the Risk of Death in Alzheimers Disease.

IntroductionSome Alzheimer’s disease (AD) patients die without ever developing cognitively impaired basic activities of daily living (basic ADL), which may reflect slower disease progression or better compensatory mechanisms. Although impaired basic ADL is related to disease severity, it may exert an independent risk for death. This study examined the association between impaired basic ADL and survival of AD patients, and proposed a multistate approach for modeling the time to death for patients who demonstrate different patterns of progression of AD that do or do not include basic ADL impairment.Methods1029 patients with probable AD at the Baylor College of Medicine Alzheimer’s Disease and Memory Disorders Center met the criteria for this study. Two complementary definitions were used to define development of basic ADL impairment using the Physical Self-Maintenance Scale score. A weighted Cox regression model, including a time-dependent covariate (development of basic ADL impairment), and a multistate survival model were applied to examine the effect of basic ADL impairment on survival.ResultsAs expected decreased ability to perform basic ADL at baseline, age at initial visit, years of education, and sex were all associated with significantly higher mortality risk. In those unimpaired at baseline, the development of basic ADL impairment was also associated with a much greater risk of death (hazard ratios 1.77–4.06) over and above the risk conferred by loss of MMSE points. A multi-state Cox model, controlling for those other variables quantified the substantive increase in hazard ratios for death conferred by the development of basic ADL impairment by two definitions and can be applied to calculate the short term risk of mortality in individual patients.ConclusionsThe current study demonstrates that the presence of basic ADL impairment or the development of such impairments are important predictors of death in AD patients, regardless of severity.

Living alone in Alzheimer's Disease – the influence of functional impairment

Background: A large number of individuals with Alzheimer’s disease (AD) live alone and receive little or no help from family members, which implies an additional pressure on the increasing societal costs of dementia care. Their adult children, if any, might have very limited ability to assist by providing informal help because of social structural changes, such as full-time work for most women and sometimes a place of residence located far away from the parents’ home. About half of the informal help received has been reported to consist of surveillance, diversion from repetitive or dangerous activities, and management of behavioral disturbances. Lack of help in monitoring these expressions of AD might lead to safety issues for individuals who live alone. Moreover, difficulties in detecting increasing impairments in their cognitive and functional abilities could affect negatively the opportunities of solitary-living individuals to receive necessary formal help. Living alone with dementia is also a strong factor for nursing home placement. This study aimed to describe the cognitive and functional abilities of solitary-living AD patients, as well as the potential predictors of usage of community-based home help services (HHS). Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, open, nonrandomized, multicenter study that was undertaken the investigation of the long-term effectiveness of cholinesterase inhibitor (ChEI) treatment from various perspectives, such as cognition, activities of daily living (ADL), and usage of community-based services. Among the 1,258 outpatients with a clinical diagnosis of probable or possible AD in the SATS, 1,021 had mild-to-moderate AD (Mini-Mental State Examination (MMSE) score, 10–26) at the start of ChEI therapy (baseline). Three hundred fifty-five (35%) of these individuals were living alone at the baseline, with or without HHS, and were included in the current study. Patients were assessed regarding cognitive ability (MMSE), functional capacity (Instrumental Activities of Daily Living (IADL) scale and Physical Self-Maintenance Scale (PSMS)), and the amount of HHS (hours/week), at baseline and every 6 months for a total period of 3 years. Binary logistic regression was used to determine the individuals’ characteristics that affected the use of HHS at baseline. The following potential predictors were investigated: gender, APOE 4 carrier status, years of education, illness duration, age, number of medications, and cognitive and functional abilities at baseline. Results: At the start of ChEI therapy, 267 (75%) of the solitary-living patients were in the mild stage of AD (MMSE score, 20–26). HHS was used by 85 (32%) of the mild and 48 (55%) of the moderate (MMSE, 10–19) AD patients (P < 0.001). The mean hours of HHS used per week was 5.7 (95% confidence interval (CI), 5.0–6.5); no difference in this parameter was detected among the disease stages. The IADL capacity was already markedly impaired at baseline: 50–65% of the individuals were dependent on assistance to perform these activities (IADL score, 2–5). Regarding basic ADL, most patients were able to manage themselves independently, with the exception of physical ambulation (almost 60% of individuals needed some assistance; PSMS score, 2–5). A significant difference in mean IADL score at the start of ChEI treatment was observed between the mild and moderate AD patients: 14.6 points (95% CI, 13.9–15.2) vs 19.2 points (95% CI, 18.1–20.3; P < 0.001). The corresponding PSMS scores were 7.5 points (95% CI, 7.2–7.7) vs 8.9 points (95% CI, 8.2–9.6; P < 0.001). No difference in age or number of medications at baseline was found among the disease stages. In a logistic regression model, the variables IADL score (OR, 1.27; 95% CI, 1.17–1.38; P < 0.001) and number of medications at baseline (OR, 1.19; 95% CI, 1.07–1.33; P = 0.002) correctly classified 80.2% of the patients with AD regarding whether they used HHS at the start of ChEI therapy. After 3 years of ChEI treatment, 89 AD patients (25%) were still living alone in their own home. Of those, 65 individuals used a mean of 9.5 hours (95% CI, 7.8–11.3) of HHS per week. The cognitive ability of the solitary-living patients varied appreciably, but 80–90% could not carry out IADL tasks independently. In addition, more than 50% of the individuals needed assistance in performing the basic ADL items of grooming and physical ambulation. Conclusions: A substantial number of AD patients, predominantly females, with severe cognitive and functional impairments live alone, which might lead to safety risks for these vulnerable individuals. The amount of HHS used did not reflect disease severity. Functional, but not cognitive, ability predicted the need for home help, suggesting that HHS meets the needs related to cognitive deterioration to a lesser extent. Increased knowledge about how community-based services can better accommodate the care needs of recipients with cognitive impairment is essential. (Less)

Early- versus late-onset Alzheimer's disease: 3-year outcomes of cholinesterase inhibitor treatment in routine clinical practice

Background: Alzheimer’s disease (AD) is an insidiously progressive neurodegenerative disorder that is characterized by multiple cognitive impairments and gradual loss of independence in carrying out activities of daily living (ADL). Currently, the predominant therapy for mild-to-moderate AD is cholinesterase inhibitors (ChEIs), which have been shown to have positive effects on symptoms compared with placebo in randomized clinical trials. There is an increased interest in dominantly inherited and early-onset AD, and in new treatments aimed at blocking the course of the disease. Therapies that are expected to modify disease progression should be assessed thoroughly over many years, and advances in understanding of the expected long-term outcomes for individuals with different ages at the onset of AD require well-designed observational studies. This study aimed to identify potential differences in clinical characteristics, longitudinal outcomes, and endpoints in patients with early- vs late-onset AD in routine clinical practice. Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, open, nonrandomized multicenter study for the assessment of ChEI treatment in a routine clinical setting. In total, 1,258 outpatients with a clinical diagnosis of probable or possible AD were included. Of these, 1,021 participants were defined as having mild-to-moderate AD (Mini-Mental State Examination (MMSE) score, 10–26) and were enrolled in the present study. The age at AD onset was estimated by a clinician who specialized in dementia disorders. The age at onset was younger than 65 years in 143 individuals (14%) and 65 years or older in 874 (4 missing data). Patients were assessed using cognitive tests (MMSE and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog)) and functional capacity scales (Instrumental Activities of Daily Living scale (IADL) and Physical Self-Maintenance Scale (PSMS)) at baseline, after 2 months (MMSE only), and every 6 months for 3 years. Eventual dates of nursing home placement and death were recorded. Results: The presence of apolipoprotein E (APOE) e4-alleles was more frequent among the early-onset AD patients (2 e4-alleles, 29%; 1 e4-allele, 46%; 0 e4-alleles, 25%) vs late-onset patients (2 e4-alleles, 13%; 1 e4-allele, 54%; 0 e4-alleles, 33%; P < 0.001). At the start of ChEI therapy, the mean age was 62.7 years (95% confidence interval (CI), 61.8–63.6) for the early-onset patients compared with 77.3 years (95% CI, 77.0–77.6) for the late-onset patients (P < 0.001). The duration of illness was longer in the early-onset group than in the late-onset group (4.1 years (95% CI, 3.6–4.7) vs 2.9 years (95% CI, 2.8–3.0); P < 0.001). The early-onset group had more years of education compared with the late-onset group (10.1 years (95% CI, 9.6–10.5) vs 9.3 years (95% CI, 9.2–9.5); P = 0.004). In the entire cohort, 64% were females and the cognitive ability at baseline was assessed as a mean MMSE score of 21.4 points (95% CI, 21.2–21.6) and ADAS-cog score of 20.8 points (95% CI, 20.2–21.3); these values did not differ significantly between groups. Individuals with early-onset AD exhibited less functional impairment compared with those with late-onset AD (IADL score, 13.9 points (95% CI, 13.0–14.8) vs 16.3 points (95% CI, 15.9–16.7); P < 0.001 and PSMS score, 6.7 points (95% CI, 6.5–6.9) vs 7.6 points (95% CI, 7.5–7.8); P < 0.001)) and took fewer concomitant medications (1.8 (95% CI, 1.5–2.0) vs 3.1 (95% CI, 3.0–3.3); P < 0.001). During the study, the mean annual deterioration in ADAS-cog score from baseline for the early- and late-onset groups was 5.0 points (95% CI, 3.7–6.4) vs 2.9 points (95% CI, 2.4–3.5; P = 0.003). The corresponding declines/year for the entire cohort were 1.3 points (95% CI, 0.9–1.8) for MMSE score, 2.7 points (95% CI, 2.4–2.9) for IADL score, and 1.2 points (95% CI, 1.1–1.4) for PSMS score; these did not differ significantly between groups. Twenty-three percent of all patients were admitted to nursing homes during the study, and 38% completed the 3-year SATS; these values did not differ significantly between groups. After 3 years, 6% of the early- and 15% of the late-onset individuals had died (P = 0.002). The ChEI dose received during the study did not differ between groups. Conclusion: This AD study performed in a routine clinical setting shows that more sensitive cognitive measures such as ADAS-cog are required to detect the potential faster decline among early-onset AD patients. Despite better functional performance and fewer concomitant medications at the start of ChEI treatment, early-onset patients had a similar rate of deterioration in ADL and need for institutionalization to the late-onset group. This emphasizes the clinical importance of functional assessments even among younger patients. The possibility of younger individuals living longer after a diagnosis of AD raises questions about the need to provide 24-hour care adapted specifically for this group. (Less)

Response to cholinesterase inhibitors affects lifespan in Alzheimer's disease.

BackgroundA varying response to cholinesterase inhibitor (ChEI) treatment has been reported among patients with Alzheimer’s disease (AD). Whether the individual-specific response, specific ChEI agent or dose affects mortality is unclear. We aimed to examine the relationship between the 6-month response to ChEI and lifespan.MethodsSix hundred and eighty-one deceased patients with a clinical AD diagnosis and a Mini-Mental State Examination (MMSE) score of 10–26 at the start of ChEI therapy (baseline) were included in a prospective, observational, multicentre study in clinical practice. At baseline and after 6 months of treatment, the participants were assessed using the MMSE, the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog), the Clinician’s Interview-Based Impression of Change (CIBIC), the Instrumental Activities of Daily Living (IADL) scale, and the Physical Self-Maintenance Scale (PSMS). The individuals’ socio-demographic characteristics, ChEI dose, and date of death were recorded. Responses to ChEI and the association of possible risk factors with survival were analysed using general linear models.ResultsA longer lifespan (mean of 0.5 years) was observed among the improved/unchanged patients, as measured by MMSE or CIBIC score, but not by ADAS-cog score, after 6 months of ChEI therapy. In the multivariate models, increased survival time was independently related to a better 6-month response in MMSE, CIBIC, IADL, and PSMS scores, female sex, no antihypertensive/cardiac or antidiabetic therapy, younger age, lower education, milder disease stage at baseline, and higher ChEI dose. Apolipoprotein E genotype did not affect mortality significantly. The patients who received a higher ChEI dose during the first 6 months had a mean lifespan after baseline that was 15 months longer than that of those who received a lower dose.ConclusionsA better short-term response to ChEI might prolong survival in naturalistic AD patients. In individuals who received and tolerated higher ChEI doses, a longer lifespan can be expected.

Variables associated to quality of life among nursing home patients with dementia

Objective: To study which variables are associated with quality of life (QOL) in persons with dementia (PWD) living in nursing homes (NHs).Methods: A cross-sectional study included 661 PWD living in NH. To measure QOL the quality of life in late-stage dementia scale (QUALID) was applied. Other scales were: the clinical dementia rating scale (CDR), physical self-maintenance scale (PSMS), and neuropsychiatric inventory questionnaire (NPI-Q).Results: The patients’ mean age was: 86.9 (SD 7.7), 472 (71.4%) were women. Of all, 22.5% had CDR 1, 33.6% had CDR 2, and 43.9% had CDR 3. The mean PSMS score was 18.2 (SD 5.0), 43.1% lived in special care units, 56.9% in regular units.In a linear regression analysis NPI-affective score (β = 0.360, p-value < 0.001), NPI-agitation score (β = 0.268, p-value < 0.001), PSMS total score (β = 0.181, p-value < 0.001), NPI-apathy (β = 0.144, p-value < 0.001), NPI psychosis (β = 0.085, p-value 0.009), CDR sum of boxes score (β = 0.081, p-value 0.026) were significantly associated with QUALID total score (explained variance 44.5%).Conclusion: Neuropsychiatric symptoms, apathy, severity of dementia, and impairment in activities in daily living are associated with reduced QOL in NH patients with dementia.

Japanese versions of the executive interview (J-EXIT25) and the executive clock drawing task (J-CLOX) for older people.

The aim of the study was to develop the Japanese versions of Executive Interview (J-EXIT25) and Executive Clock Drawing Task (J-CLOX) and to evaluate the aspects of executive function that these two tests will be examining. The concurrent validity and reliability of J-EXIT25 and J-CLOX were first examined in all participants (n = 201). Next, the relationship between the two tests was examined using receiver operating characteristic (ROC), correlation, and regression analyses in healthy participants (n = 45) and participants with mild cognitive impairment (n = 36) and dementia (n = 95). Satisfactory concurrent validity and reliability of J-EXIT25 and J-CLOX were shown. ROC analysis indicated that J-EXIT25 and J-CLOX1 were superior to the Frontal Assessment Battery, but inferior to the Mini-Mental State Examination (MMSE), in discriminating between non-dementia and dementia. J-EXIT25, J-CLOX1, and J-CLOX2 scores were significantly correlated with age, scores on the MMSE, Instrumental Activities of Daily Living (IADL) and Physical Self-Maintenance Scale (PSMS), and care level. In stepwise regression analyses of IADL scores, MMSE and J-EXIT25 were significantly independent predictors in men, and MMSE, age, and J-CLOX1 were significantly independent predictors in women. J-EXIT25, MMSE, and J-CLOX1 were significantly independent predictors in stepwise regression analysis of PSMS scores, and J-EXIT25 was the only significantly independent predictor in stepwise regression analysis of care level. J-EXIT25 and J-CLOX are valid and reliable instruments for assessment of executive function in older people. The present results suggest that these tests have common and distinct psychometric properties in the assessment of executive function.

Prevalence of delirium among outpatients with dementia

Delirium and dementia are highly interrelated. However, few comprehensive epidemiological studies have examined this altered state of consciousness superimposed on dementia. We investigated the frequency of delirium in patients with dementia, its prevalence in patients with each dementia type, and its association with cerebrovascular disease (CVD) in patients with neurodegenerative dementias. We studied 261 consecutive outpatients in the memory clinic of a psychiatric hospital between April 2010 and September 2011. All patients underwent routine laboratory tests and computed tomography (CT), and their Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Physical Self-Maintenance Scale (PSMS), and Delirium Rating Scale - Revised 98 scores were recorded. The diagnosis of delirium was based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. CVD was detected by CT. Among the 206 patients with dementia, delirium was present in 40 (19.4%). The proportion of patients who experienced episodes of delirium was 14.7% in the Alzheimer's disease, 34.4% in the vascular dementia, 31.8% in the dementia with Lewy bodies, and none in frontotemporal lobar degeneration. Delirium was frequently observed in patients with dementia and CVD. The NPI total and agitation subscale scores were significantly higher in dementia patients with delirium than in those without delirium. PSMS scores were significantly lower for patients with delirium than for patients without delirium. The frequency of delirium varies with each dementia type. In addition, delirium decreases activities of daily living, exaggerates behavioral and psychological symptoms dementia, and is associated with CVD in patients with neurodegenerative dementias.

Treatment in a ward for elderly patients with dementia in Japan

BackgroundJapan has become the world’s most aged country. The percentage of elderly people in Japan is estimated to reach 25.2% in 2013, and the number of patients with dementia is estimated to reach 2.5 million in 2015. In addition to its deterioration of physical function and activities of daily living (ADL), behavioral and psychological symptoms of dementia (BPSD) often become major clinical problems, greatly annoying patients and their caregivers. In Japan, we utilize wards for elderly patients with dementia (WEDs) for BPSD treatment. However, there are few studies investigating the effectiveness of treatment in a WED. In such treatment, physical complications are a challenge physicians must overcome while treating BPSD and safely returning patients home or to the institutions in which they live. Therefore, we investigated the effectiveness of treatment in a WED, focusing on physical complications.MethodsThe subjects were 88 patients who were admitted to and discharged from a WED. Severity of dementia, basic ADL, and BPSD were investigated using the Clinical Dementia Rating, Physical Self-Maintenance Scale (PSMS), and Neuropsychiatric Inventory. Differences in characteristics between patients discharged from the WED because of physical complications and all other patients were also examined.Results:We found significant improvements in the PSMS score and decreases in delusions and sleep disturbances in all patients. Patients discharged from the WED because of physical complications had significantly greater severity of dementia at discharge compared to all other patients.Conclusion:Treatment in a WED seems to be effective for BPSD and ADL, but care should be taken regarding physical complications, especially in patients with advanced dementia.

Functional response to cholinesterase inhibitor therapy in a naturalistic Alzheimer’s disease cohort

BackgroundActivities of daily living (ADL) are an essential part of the diagnostic criteria for Alzheimer’s disease (AD). A decline in ADL affects independent living and has a strong negative impact on caregiver burden. Functional response to cholinesterase inhibitor (ChEI) treatment and factors that might influence this response in naturalistic AD patients need investigating. The aim of this study was to identify the socio-demographic and clinical factors that affect the functional response after 6 months of ChEI therapy.MethodsThis prospective, non-randomised, multicentre study in a routine clinical setting included 784 AD patients treated with donepezil, rivastigmine or galantamine. At baseline and after 6 months of treatment, patients were assessed using several rating scales, including the Instrumental Activities of Daily Living (IADL) scale, Physical Self-Maintenance Scale (PSMS) and Mini-Mental State Examination (MMSE). Demographic and clinical characteristics were investigated at baseline. The functional response and the relationships of potential predictors were analysed using general linear models.ResultsAfter 6 months of ChEI treatment, 49% and 74% of patients showed improvement/no change in IADL and in PSMS score, respectively. The improved/unchanged patients exhibited better cognitive status at baseline; regarding improved/unchanged PSMS, patients were younger and used fewer anti-depressants. A more positive functional response to ChEI was observed in younger individuals or among those having the interaction effect of better preserved cognition and lower ADL ability. Patients with fewer concomitant medications or those using NSAIDs/acetylsalicylic acid showed a better PSMS response.ConclusionsCritical characteristics that may influence the functional response to ChEI in AD were identified. Some predictors differed from those previously shown to affect cognitive response, e.g., lower cognitive ability and older age predicted better cognitive but worse functional response.

Evaluating functional decline in patients with Multiple Sclerosis

Multiple Sclerosis (MS) is a disease with a wide-ranging impact on functional status. The aim of the study was to examine the added value of simultaneously evaluating fatigue, personal ADL and handwriting performance as indicators for functional decline among patients with MS. Participants were 50 outpatients with MS and 26 matched healthy controls. Data collection instruments included a disability status scale, the Fatigue Severity Scale (FSS), and the Physical Self-Maintenance Scale (PSMS). Handwriting performance was evaluated by objective computerized measures of the handwriting process (ComPET). Significant differences were found between patients with MS and control subjects in their fatigue level, their PSMS score and In-air time per stroke while writing. The FSS together with specific PSMS items and handwriting measures achieved correct classification of 87.7% of the participants. These results are the first step towards demonstrating the added value of evaluating body function outcomes (fatigue) together with activity performance (handwriting and ADL) to document functional decline among patients with MS. These results may contribute to the development of practical intervention strategies targeted at improving performance abilities among patients with MS.

Multidisciplinary Congestive Heart Failure Clinic for Older Women: A Randomized Controlled Trial

Objectives: To determine whether a multidisciplinary clinical pathway, a blueprint of the patient care processes for female patients over age 65, will improve patients' quality of life and functional capacities in comparison to usual care for CHF. Design: A randomized controlled trial. The intervention consisted of a series of 12 visits over 6 weeks to optimize medical care, and to engage in an exercise program with strong educational, counseling and dietary management, involving physician, nursing, dietary, physiotherapy, pharmacy, occupational therapy and social work. Setting: Patients were referred from the Ottawa Hospital and the community with a diagnosis of CHF and were screened to ensure they met the eligibility criteria. Participants: Ninety-one community dwelling women aged 63 to 89 with the diagnosis of CHF were enrolled in this study. Measurements: The primary outcome measure was the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The secondary outcome measures included the MOS 36-Item Short-Form Health Survey (SF-36), the Folstein Mini-mental State Examination (MMSE), the 15 item Geriatric Depression Scale (GDS), the Physical Self-Maintenance Scale (PSMS), and survival and health service utilization over 6 months. Results: There was no difference between the two groups in MMSE or GDS scores by the end of six weeks cycle. Comparison of change from baseline MLHFQ score, including physical and emotional components, did not show a difference (P < 0.470). There was also no difference between the two groups in functional outcome as measured by change from baseline PSMS score (P < 0.321). The treatment group had a tendency to more ER visits (for all reasons and for CHF) and hospitalizations. The treatment group had significantly more cardiologist visits during the study period (P < 0.0001). Conclusion: It is feasible to conduct a randomized study in a frail community-based older female population and to test a complex multidisciplinary pathway. Future studies should provide further insight into the optimal intensity and duration of heart failure management programs, and which patients derive the greatest benefit.

Intellectual faculties in patients with Alzheimer's disease regress to the level of a 4–5‐year‐old child

Background: The present study investigated when children acquire the cognitive abilities and daily living skills that are lost in Alzheimer's disease.Methods: Among a total of 1046 students in kindergarten and elementary schools affiliated with Gunma University, Japan, five female and five male students in each grade were selected at random and examined by the mini‐mental state examination (MMSE) and physical self‐maintenance scale (PSMS). For comparison, a total of 135 outpatients with Alzheimer's disease were examined. The results of MMSE and PSMS from the first visit to Gunma University Hospital after the onset of Alzheimer's disease were used.Results: The MMSE score gradually increased from 10 points in the 1st year of kindergarten (age 3 in Japan) to 29 points in the 6th grade of elementary school (age 11 in Japan). The PSMS score increased similarly from 3 points in the 1st year of kindergarten to 6 points in the 6th grade of elementary school. The mean scores of MMSE and PSMS were 17.3 and 3.7 in the Alzheimer patients’ group. These findings suggested that cognitive and daily performance abilities examined by MMSE and PSMS are acquired in childhood during kindergarten and the early grades of elementary school.Conclusion: These cognitive and daily performance abilities of Alzheimer's disease outpatients regress to a level of a child between 4 and 5 years old. This simple understanding of Alzheimer's disease patients may contribute to further appropriate care by non‐specialists and caregivers.