Francisco Ramos

Prediction of burden in family caregivers of patients with dementia: A perspective of optimism based on generalized expectancies of control

The aim of this study was to investigate the predictors of burden for informal caregivers of patients with dementia. Based on a multidimensional approach of the optimism model proposed by Palenzuela, we assessed the moderating role of generalized expectancies of control (GEC) between caregiver stress and burden. A total of 130 patients with dementia and their main family caregivers were assessed from different rural areas of the province of Salamanca (Spain). Patients with dementia underwent a protocol to assess dementia stage, cognitive–functional impairment and behavioural symptoms. Meanwhile, the 20-item Battery of Generalized Expectancies of Control Scales of Palenzuela was completed by the family caregivers. Clinical variables of patients with dementia (progression and behavioural disorders) and GEC (success, self-efficacy, contingency, helplessness and luck) were considered as potential predictors of burden in the hierarchical regression analysis. The Zarit Burden Interview (ZBI) Scale was used as an outcome measure. The results indicated that the clinical variables could not predict burden in caregivers significantly; however, beliefs in personal abilities (self-efficacy) and internal locus of control (contingency) explained up to 32% of the variance in the ZBI scores. Family caregivers with high expectancies of self-efficacy and contingency are less vulnerable to stress. This research supports a base for interventions with informal caregivers and further study.

Effect of unawareness on rehabilitation outcome in a randomised controlled trial of multicomponent intervention for patients with mild Alzheimer's disease

Unawareness of deficit has been shown to affect the outcome of targeted cognitive intervention programmes applied to patients with Alzheimer’ disease (AD), but the effects on multimodal therapeutic approaches have not yet been explored. This research investigated the efficacy of the Multi-Intervention Programme (MIP) approach on improving cognitive, functional, affective, and behavioural symptoms in people with mild AD. In addition, we examined whether the presence of unawareness influences the MIP outcomes. Sixty-one mild stage AD patients were randomly assigned to either an experimental group which carried out an MIP individually (48 sessions, 16 weeks duration), combining diverse cognitive tasks, training in daily life and recreational activities, or a waiting list group which did not receive any treatment for the same time period. The efficacy of MIP (vs. waiting list) was tested using various standardised neuropsychological, functional, and behavioural outcome measures. Planned analyses were carried out to determine the effect of unawareness versus awareness on such outcomes. The results showed that patients overall benefited from the MIP in terms of both cognitive and non-cognitive symptoms. AD patients with awareness of deficits showed positive effects on all outcome measures in comparison with the waiting list group, while AD patients with unawareness showed improvements in non-cognitive symptoms only. In conclusion, the presence of unawareness reduces the cognitive and functional effects of MIP in patients with mild AD.

Accuracy of a Brief Neuropsychological Battery for the Diagnosis of Dementia and Mild Cognitive Impairment: An Analysis of the NEDICES Cohort

Early separation of mild cognitive impairment (MCI) from normal aging and mild cases of dementia remains a challenge, especially in the general population. We aimed to analyze the diagnostic accuracy of a brief neuropsychological battery (BNB) in dementia and MCI cases from the Neurological Disorders in Central Spain (NEDICES) population-based cohort study. We screened 3,891 participants into dementia and non-dementia groups using a two-phase procedure: screening (MMSE-37 and Pfeffer-11) and clinical diagnosis by specialists (DSM-IV criteria). We selected subsequently a subsample of dementia (n = 98), MCI (n = 71), and cognitively healthy (n = 123) participants matched in socio-demographic characteristics. The clinical validity of each test of the BNB was determined by the area under the ROC curve. We determined the best combination of tests to classify individuals into the diagnostic groups by logistic regression analyses. The results indicated that dementia and MCI groups could be best discriminated from the healthy control group on the basis of their scores on the semantic verbal fluency and delayed recall subtests of the BNB. As for discriminating the MCI group from the dementia group, immediate recall tasks (stories and pictures) yielded the highest level of accuracy. Probably the most interesting finding is that the verbal fluency task consistently allowed discrimination among the diagnostic groups. Overall, subtests of the BNB are more accurate in differentiating dementia patients than MCI patients from healthy controls. In this population-based sample, a more fine-grained discrimination that includes MCI patients should follow a systematic subtest-wise analysis and decision.

Detection of maltreatment of people with dementia in Spain: usefulness of the Caregiver Abuse Screen (CASE)

The objective of our study is to validate the Caregiver Abuse Screen (CASE) as an instrument for detecting the maltreatment of people with dementia in Spain. In total, 326 informal caregivers of people with different types of dementia were interviewed in several cities in northwest Spain. The caregivers were selected from outpatient neurology clinics and associations of relatives of people with Alzheimer’s disease and other dementias. A comprehensive sociodemographic questionnaire was administered to all participants, and several standardized scales were used to assess burden, anxiety, depression, social support and resilience. The “Psychological Aggression” and “Physical Assault” dimensions of the Revised Conflicts Tactics Scale were used as risk factors of caregivers’ maltreatment for the construct validation. To establish the probability of maltreatment, a latent class analysis was carried out according to the item responses obtained from the CASE. The internal consistency (Cronbach’s alpha) of the CASE was 0.71. The construct validity was explored through factorial analysis, and we found that two dimensions of CASE—i.e., interpersonal abuse and neglect/dependency—explained 62.5% of the variability. According to the latent class probabilities, 20.4% of participants were categorized as possible abusers and 21.4% as non-abusers. The optimal maltreatment cutoff point was six points on the CASE. The validation of the CASE provides us a brief and easy instrument for detecting possible cases of maltreatment of Spanish people with dementia.

Influence of Educational Attainment on Cognition-Based Intervention Programs for Persons with Mild Alzheimer’s Disease

OBJECTIVES This research retrospectively analyzed the effect of education on cognitive interventions carried out in patients with mild Alzheimers disease (AD). METHODS The total sample consisted of 75 patients with mild AD receiving treatment with cholinesterase inhibitors. The participants were divided into two groups: cognitive intervention (IG; n=45) and waiting list (WLG; n=30). Patients in the IG received either the Big Brain Academy (n=15) or the Integrated Psychostimulation Program (n=30) during 12 weeks. The influence of education on intervention effect was analyzed comparing mean change scores of the two study groups in the cognitive subscale of the Alzheimers Disease Assessment Scale (ADAS-cog), stratified by educational level. The potential effect of age, sex, cognitive status, and type of intervention was examined using post hoc stratification analyses. RESULTS Higher education was associated with faster cognitive decline in the WLG (effect size=0.51; p<.01). However, cognitive evolution was not influenced by education in the IG (effect size=0.12; p=.42). CONCLUSIONS Our results suggest that cognitive intervention might delay accelerated cognitive decline in higher educated individuals with mild AD.

Resilience and social support as protective factors against abuse of patients with dementia: A study on family caregivers

Scientific literature has identified different vulnerability factors associated to abuse in people with dementia (PWD), but little is known about the psychosocial protective variables against abuse. The main objective of this study is to investigate a set of caregiver and patient factors linked to abuse‐related behavior of PWD.