Attachment representations in people with dementia and their carers: implications for well-being within the dyad

Objectives: The process of developing and living with dementia may activate attachment feelings and behaviours in people with dementia (PwD) and their carers. By obtaining information from both PwD and carer, we aimed to provide information on the nature and concordance of attachment patterns within the dyad and to examine the relative contribution of attachment representations in PwD and carers to the well-being of both parties.

Method: Ninety-seven PwD and their carers completed categorical and dimensional ratings of attachment. PwD also rated their self-concept, mood and quality of life. Carers rated the functional ability of PwD and neuropsychiatric symptoms and measures of subjective well-being.

Results: People with dementia reported more insecure than secure attachment, with the most frequently reported style being dismissive attachment. Attachment security for PwD was related to more positive self-concept and less symptoms of anxiety. Attachment was not related to quality of life in PwD, but mood and self-concept were strong predictors of quality of life. Carer attachment security was related to their psychological health. Distress at symptoms and MMSE score of the PwD were the strongest predictors of stress. There was no association between PwD and carer attachment styles; PwD working models of attachment did not predict carer well-being and vice versa.

Conclusion: Attachment representations may be important for the psychological well-being of PwD and carers, but there was no evidence of the reciprocal nature of attachment within these dyads.     

A survey of memory clinics in the british isles

This survey describes the characteristics and activities of 20 memory clinics currently operating in the United Kingdom and Eire. There was broad agreement with regard to aims, objectives and general operating characteristics, but the clinics varied considerably in the number of patients assessed over a given period and in the proportion of cases diagnosed with dementia (15–98%) and Alzheimer's disease (9–80%) in the year prior to the survey.     

Memory complaint in attenders at a self-referral memory clinic: The role of cognitive factors,affective symptoms and personality

Memory complaint has been shown to be poorly correlated with objective memory performance in non-demented elderly people. A previous study indicated the possible importance of depression and personality in the presentation of memory complaint in people with mild memory impairment. The present study overcomes some previous methodological limitations and describes memory complaint, cognitive, affective and personality variables in subjects with mild cognitive impairment self-referring to a memory clinic, with non-presenting age- and sex-matched community controls. Self-referrers had a higher original IQ, but no evidence of greater decline in memory despite having more memory complaint. Personality factors were demonstrated to be important alongside affective symptoms in the presentation of memory complaint in these subjects.     

Prevalence and correlates of anxiety in Alzheimer's disease

We assessed a consecutive series of 398 patients with probable Alzheimer's disease (AD) for the presence of Generalized Anxiety Disorder (GAD) using a standardized neuropsychiatric evaluation. Five percent of patients showed GAD during the 4 weeks preceding the psychiatric evaluation. AD patients with GAD showed significantly higher scores of depression, irritability, overt aggression, mania, and pathological crying than AD patients without GAD. The most severe symptoms of anxiety were those of tension, fears, insomnia, and physical complaints. Depression and Anxiety 7:166–170, 1998. © 1998 Wiley-Liss, Inc.     

The second Leicester survey of memory clinics in the British Isles.

BACKGROUND: The number of memory clinics in the British Isles has increased since our first survey in 1993. OBJECTIVES: The aim of this survey was to determine the memory clinics' characteristics and functions, and to compare these with the findings of our previous survey. METHODS: An expanded version of the 1993 questionnaire was sent to 102 possible memory clinics, identified by various means. There were 72 replies, 58 of which were from currently active clinics. RESULTS: There has been a substantial growth in the number of clinics since our previous survey in 1993, apparently stimulated by the licensing of cholinesterase inhibitor drugs for Alzheimer's disease (AD) and the development of services for early-onset dementia. Most of the new memory clinics have been set up within NHS old age psychiatry services, and they tend to be smaller and have less of an academic focus than the older clinics. However, they are similar in many aspects of their functioning, and have a similar range of practice with regard to patient assessment. CONCLUSIONS: As memory clinics move out from academic centres into mainstream clinical services, there is potential for greater co-ordination of their activities, and the development of an agreed core data set for assessment that would be valuable in the national monitoring of new anti-dementia treatments in clinical practice.     

The impact of anxiety on the progression of mild cognitive impairment to dementia in Chinese and English data bases: a systematic review and meta‐analysis

Objective

It remains unclear whether or not anxiety increases the risk of dementia in people with mild cognitive impairment (MCI). The aim of this systematic review and meta‐analysis was to investigate the risk of dementia among people with MCI and anxiety compared with those with MCI and no anxiety.

Methods

The hazard ratio of conversion to dementia in people with anxiety and MCI was compared with those without anxiety and was calculated using a generic inverse variance method with fixed effect models.

Results

Eleven studies from the English and Chinese databases were included, seven of which were included in the meta‐analysis. The pooled hazard ratio of conversion to dementia was 1.18 95% CI [1.07, 1.31] (p = 0.002) in the group of MCI plus anxiety compared with those without anxiety.

Conclusion

The results suggest that anxiety increases the risk of progression to dementia in people with MCI. Future interventions targeting anxiety management in vulnerable people with MCI may reduce the risk of dementia. Copyright © 2017 John Wiley & Sons, Ltd.     

Psychosocial risk factors and Alzheimer's disease: the associative effect of depression,sleep disturbance,and anxiety

ABSTRACT

Objectives: Alzheimer's disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions.

Methods: Data from the National Alzheimer's Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models.

Results: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations.

Conclusion: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.     

Prevalence of depression among memory clinic patients as measured by the Cornell Scale of Depression in Dementia

Objectives: Depression in dementia is common, but the prevalence rates differ according to the populations studied and which diagnostic tools are being used. The aim of this study is to explore the prevalence of depression among patients referred to a memory clinic or an outpatient clinic as measured by the Cornell Scale of Depression in dementia (CSDD) and to investigate which factors are associated with depression.

Method: The CSDD was completed for 1470 patients on their first visit to a memory clinic or an outpatient clinic. The prevalence of depression using three different cut-off points was calculated. Logistic regression and correlation analyses were performed.

Results: Half of the patients had dementia. The mean CSDD was 6.7 (SD: 5.3) for the whole group, and 50.2% had a score above 5, whereas 37.5% had depression defined as a CSDD score above 7, and 14.1% had a score above 12. The mean scores were higher among those with dementia other than Alzheimer's disease, those with previous depression, and those with greater impairment in the activities of daily living (ADL). In the logistic regression analyses, younger age, ADL dysfunction, and previous depression were significantly associated with higher CSDD scores.

Conclusion: We found that depressive symptoms are common among patients referred for a dementia assessment in specialist health care. The strongest factors associated with depressive symptoms were younger age, ADL impairment, and previous depression.     

Self-, collateral- and clinician assessment of depression in persons with cognitive impairment

Objectives: This investigation examined the associations between self-reports, collateral-source reports and a clinician's diagnosis of depression in persons with cognitive impairment.

Method: Responses on the Geriatric Depression Scale – 15 (GDS-15) from 162 participants with a diagnosis of Mild Cognitive Impairment (n = 78) or Alzheimer's Dementia and a Mini-Mental State score ≥15 (n = 84) were compared with both their collateral sources’ report on either the Neuropsychiatric Inventory Questionnaire (n = 93) and/or the collateral-source GDS-15 (n = 67), or a clinician's diagnosis of Major Depression (MD).

Results: Significant differences were seen between self- versus collateral-source reports of depression in these participants. Participants’ reports of loss of interest (anhedonia) significantly increased the odds of disagreement with their collateral sources (OR = 3.78, 95% CI: 1.3–11.2) while reports of negative cognitions significantly decreased the odds of such a disagreement (OR = 0.31, 95% CI: 0.1–0.9). The symptom of anhedonia also showed the strongest association with the clinician's diagnosis of MD.

Conclusion: A motivational symptom like loss of interest was seen to play an important role in depression experienced by those with cognitive impairment.     

认知障碍患者个体化智能康复训练技术规范

阿尔茨海默病(AD)是以进行性认知障碍为主要表现的神经变性疾病,伴有日常活动能力损害和人格变化,给家庭和社会带来了严重的负担。轻度认知障碍(MCI)是一组介于健康老化和AD之间的过渡状态。目前的抗认知障碍药物治疗效果不佳,在有效的药物干预上市之前,应积极探索有效的非药物干预方法。越来越多的证据表明,认知干预能够有效改善AD病变引起的认知功能损伤,亦能够用于健康老年人预防AD的发生。在该文中,总结了认知干预的相关研究及可能机制,对未来认知干预的应用提出了建议,并形成了认知障碍患者个体化智能康复治疗的技术规范。     

Topographical recognition memory sensitive to amnestic mild cognitive impairment but not to depression

OBJECTIVE: Amnestic mild cognitive impairment (aMCI) involves episodic memory. The person who presents aMCI has a high risk of developing Alzheimer's disease (AD). However, prediction of deterioration to dementia in cases of aMCI can be confounded with depression due to lack of specificity on selective memory tests. Finding a test sensitive to aMCI but not to depression would be potentially most useful to subsequent longitudinal studies researching the neuropsychological markers of preclinical AD. We hypothesized that the performance on a topographical memory task would be sensitive to the aMCI condition, while depression would not influence such a performance. PARTICIPANTS AND METHODS: A group of 137 community-dwelling French-speaking subjects between 55 and 70 years old was administered a topographical recognition memory task. Based on aMCI and depression criteria, 45 subjects were selected and divided into four groups: 11 patients with aMCI without depression, nine depressive patients with aMCI, ten depressive patients without cognitive impairment and 15 control subjects. The remaining non-selected participants did not belong to any of the previous interest groups. RESULTS: The 'aMCI' factor had a significant effect on the topographical recognition memory task scores, while the 'depression' factor did not. The aMCI patients performed worse than the non-aMCI. CONCLUSION: Although these results were found with relatively small groups, deficits in topographical recognition memory were observed in aMCI patients and did not seem to be sensitive to depression. Further longitudinal studies are needed to examine whether deficits in topographical recognition memory are a neuropsychological marker of preclinical AD.     

Subjective memory complaints in Chinese subjects with mild cognitive impairment and early Alzheimer's disease

BACKGROUND: Mild cognitive impairment (MCI) represents a transitional state between normal aging and dementia. However, there is inconsistent opinion as to the validity of subjective memory complaints as a criterion for diagnosis. OBJECTIVE: This study aimed to examine the potential significance of applying a short memory questionnaire in the assessment of Chinese subjects with MCI and early dementia. METHODS: Three hundred and six ambulatory Chinese subjects were recruited. Each participant completed a short memory questionnaire. They were also assessed with the Chinese versions of the mini-mental state examination (CMMSE), Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog), category verbal fluency test (CVFT) and span tests. Severity of cognitive impairment was evaluated using the Clinical Dementia Rating (CDR); subjects with CDR 0.5 were further classified into MCI not demented (MCIND) and MCI possible incipient dementia (MCIID) depending on the subscale scores of CDR. RESULTS: An increasing frequency of memory complaints with increasing CDR was observed (Kruskal Wallis test, chi square = 21.29, df 3, p < 0.001). With a cutoff of 3 or more memory complaints, the memory questionnaire demonstrated a sensitivity of 65.3% and 70.4% in identifying subjects with incipient and early dementia respectively. Significant associations between memory complaints and most cognitive test performance were found (Spearman's correlations, p < 0.01). Logistic regression analysis revealed that educational level, the memory questionnaire, ADAS-Cog total and delayed recall scores were significant predictors of MCIID status. CONCLUSIONS: The findings suggested that a short memory questionnaire is useful in the screening of MCI, particularly in subjects who already present with subtle functioning disturbances. Subjective memory complaints were significant correlated with objective performance of memory functions, reflecting the usefulness of memory complaints in the assessment of MCI.     

Demographic and clinical features of patients attending a memory clinic

Basic demographic and clinical features of the first 418 patients assessed at the Maudsley Memory Clinic are reported. Alzheimer's disease was the most frequent diagnosis (57%), followed by a group of patients complaining of memory problems but with no obvious neuropsychiatric diagnosis (24%). The latter were more likely to be younger unmarried self-referred women living alone and with a frequent family history of dementia. The routine use of extensive laboratory investigations in memory clinics is not recommended, considering the meagre number of subjects suffering from reversible conditions identified in our clinic. The Maudsley Memory Clinic has proved to be a popular centre for the assessment and diagnosis of patients with memory complaints and has provided a useful source of subjects for research into memory-associated disorders. The role of memory clinics in the new financial climate in the National Health Service remains to be determined.