Mary F. Wyman

Frontal behavioral syndromes and functional status in probable Alzheimer disease.

OBJECTIVE / METHOD The authors used the Frontal Systems Behavior Scale (FrSBe) to determine the frequency of frontal behavioral syndromes in 49 subjects with mild-to-moderate dementia and 23 subjects with severe dementia of Alzheimer disease (AD) and 23 healthy control (HC) participants. RESULTS / CONCLUSIONS Frontal behavior syndromes occurred with higher frequency in AD. Apathy and executive dysfunction were elevated both in mild-to-moderate and severe AD. Disinhibition was elevated only in severe AD. In AD, apathy was associated with difficulty in basic activities of daily living (ADL), whereas executive dysfunction was related to impairment in instrumental ADLs.

Ageism in the Health Care System: Providers, Patients, and Systems

Older adults are major consumers of health care. Within the context of an ageing society, their presence in the health care system will continue to grow. Ageist stereotypes and discrimination against older adults have an impact on the health and well-being of older citizens and are potential barriers to health equality. This chapter addresses ageism at different levels of the health care setting with a review of empirical research and health care policy. At the micro (personal) level, manifestations of ageism include attitudes toward older adults among physicians, nurses, and other health care professionals. Ageist communication styles used with older patients, age-biased clinical decision-making regarding diagnostics and treatments, and self-directed ageism in older patients are also discussed. Macro-level (institutional or structural) aspects of ageism are then examined, as reflected in health care reimbursement structures, participation of older adults in clinical trials, institutional policies governing care, and the lack of emphasis on geriatric-specific training for health care professionals. The chapter closes with an integration of the findings and a discussion of the challenges in identifying and reducing ageism in this setting. Conclusions are drawn and recommendations for future research and practice are made.

Sources of Stressor-Specific Negative Transactions and Depressive Symptoms Among White and African American Older Women

The effects of negative social relationships on mental health are receiving increased attention in the gerontological literature. This study examines a new stressor-specific approach to assessing negative transactions. In-person interviews with an urban, community-based sample of 221 older White and African American women and their significant others were used to develop a measure of interpersonal transactions related to 4 stress domains: personal health problems, others health problems, interpersonal difficulties, and losses. A total of 5 scales were derived: Optimistic/Caring, Self-reliance, Criticism/Conflict, Hindrance, and Letdowns. Optimistic/Caring and Hindrance transactions were commonly reported for personal health problems, whereas interpersonal difficulties were associated with Criticism/Conflict and Letdowns. Family members were most commonly a source of negative transactions. Compared to Whites, African Americans reported more providers and were found to receive fewer transactions from immediate family members. Stressor-specific transaction measures did not add to the prediction of depressive symptoms beyond that provided by global positive and negative perceived relationship measures, but they did provide useful insights into the reactions of network members to the lives of older adults.

Ageism in Mental Health Assessment and Treatment of Older Adults

Though it is generally acknowledged that older adults are underserved in the area of mental health services, the impact of ageist stereotypes on mental health diagnosis and access to care, and on the provision of psychotherapy to older adults, has not been extensively studied. This chapter reviews the sparse literature on ageism and mental health services with the goals of examining current practice related to the assessment of mental health problems and barriers to optimal therapy of older adults from the social perspective of ageism. The chapter begins with a review of literature pertaining to attitudes of mental health clinicians towards psychotherapy of older adults, and focuses on possible contributing factors to the development of ageist attitudes among clinicians. Subsequently, we discuss older adults’ negative attitudes toward ageing, psychiatric diagnosis and psychotherapy, which may affect patients’ interpersonal encounters with a psychotherapist. We also address challenges and problems in the assessment and diagnosis of older mental health patients, and raise the possibility that ageist attitudes may be responsible for some of these issues. Finally, we discuss common difficulties in providing therapy to older adults with mental health problems and review different therapy approaches with older adults. Here again, we discuss the possibility that ageist attitudes might play a role in difficulties with the adaptation of these therapeutic methods for older adults. The chapter concludes with a discussion of possible prevention strategies to address ageist attitudes in mental health settings and makes recommendations regarding future research in this understudied area.

Treatment decision making involving patients with dementia in acute care: A scoping review

OBJECTIVE To summarize the evidence regarding the factors and processes of treatment decision making involving a person with dementia (PWD) in the acute care setting. METHODS We conducted a scoping review, searching 4 databases (PubMed, CINAHL, Web of Science, & PsychINfo) for articles that contained primary data from a quantitative or qualitative study involving treatment decision making in the acute care setting for PWD and were published in English. We categorized the factors and processes of decision making identified in each article using inductive content analysis. We also consulted with healthcare practitioners to receive stakeholder input on our findings. RESULTS Our search initially revealed 12,478 articles, of which 28 were included in the review. We identified 5 categories of factors that influence the decision-making process: knowing the patient, culture and systems, role clarity, appropriateness of palliative care in dementia, and caregiver need for support. CONCLUSION Our findings highlight the complexities of the decision-making process and the importance of attending to the needs of the caregiver, healthcare practitioners, and the patient. PRACTICE IMPLICATIONS It is important to address beliefs of involving palliative care for a PWD and the role of each healthcare discipline.

Apathy in Preclinical Alzheimer’s Disease: Psychometric Validation of the Apathy Evaluation Scale

Objectives: The purpose of the present study was to validate the Apathy Evaluation Scale, self-rated version (AES-S), and assess the severity of apathy in a cognitively healthy middle-aged cohort at risk for Alzheimer’s disease (AD). Method: Three hundred and sixteen middle-aged adults were selected to represent a subset of the Wisconsin Alzheimer’s Disease Research Center Clinical Core: the Investigating Memory in People At-risk, Causes and Treatments cohort. Results: An exploratory factor analysis (EFA) with varimax rotation identified 3 subscales: apathy, disinterest, and social withdrawal factors. Confirmatory factor analysis confirmed the EFA findings. Results indicated acceptable convergent and discriminant validity. The AES-S is a reliable instrument to quantify apathy in cognitively healthy middle-aged individuals at risk for AD. Discussion: This study demonstrates the AES-S is a psychometrically sound measurement tool for assessing levels of apathy in a cognitively healthy middle-aged cohort at risk for AD.

A WHOLE-FACILITY APPROACH: IMPLEMENTING AN INNOVATIVE MODEL OF A ‘DEMENTIA FRIENDLY HOSPITAL’ AT THE MADISON, WI, VA MEDICAL CENTER

ensuring access to resources earlier in the disease process for persons with dementia (PWD) and their caregivers. DCC is modeled on a published, peer-reviewed study (Bass et al. Alzheimer’s Research & Therapy 2014, 6:9). The program goal is to have an impact on health outcomes and utilization; it is expected that, over time, DCC will result in: decreased readmission rate for the PWD; fewer emergency department admissions for the PWD and the caregiver; delayed nursing home admission; increased understanding of the disease; increased satisfaction with care. AMemory Specialist is assigned to the partnering organization once a partnership is established. Referrals can be made for many reasons, including: Symptoms of cognitive impairment; diagnosis of Alzheimer’s disease or a related dementia; and record of prescription of an Alzheimer’s medication. Once a referral is made, the Memory Specialist proactively calls the caregiver to provide a Care Consultation. The Care Consultation reviews a wide range of topics, including: Understanding the dementia diagnosis; planning how to best support the PWD; reviewing resources for both the PWD and the caregiver; and developing strategies for best possible symptom management and communication. After the Care Consultation is complete, a feedback form is sent to the referral source for inclusion in the medical record. Additional follow up is made as needed. Methodology: The Zarit Burden Interview (ZBI; Zarit, Orr, & Zarit, 1985) and the Alzheimer’s Association’s Core Services Quality Evaluation Initiative are used to collect data. 1,993 families served since fiscal year 2017, with a 50% increase in established partnerships. Current baseline data: Prior to intervention, 33% of caregivers reported being a little burdened by caring for the PWD, 32.52% reported being moderately burdened, 17.89% reported being quite a bit burdened, and 3.25% reported being extremely burdened. 83.74% of caregivers also reported feeling uncertain about what to do about their loved one. Subsequent data is currently in progress.

INCIDENT DEMENTIA IN NON-HISPANIC AFRICAN AMERICANS AND WHITES WITH MILD COGNITIVE IMPAIRMENT: CAN WE MAKE RACIAL COMPARISONS USING ALZHEIMER’S DISEASE CENTER DATA?

Model 1 .125 31.13** MFE-Total informants -.359 -5.58** -.53, -.25 Model 2 .134 17.31** MFE-Total informants -.341 -5.26** -.51, -.23 GDS -.115 -1.78 -.98, .05 Model 3 .399 47.63** MFE-Total informants -.227 -4.10** -.36, -.13 GDS -.10 -1.89 -.84, .02 Age -.528 -9.65** -.63, -.42 Model 4 .582 74.58** MFE-Total informants -.186 -4.02** -.3, -.10 GDS -.033 -.73 -.50, .23 Age -.324 -6.43** -.42, -.22 Years of schooling .487 9.62** .64, .98

PSYCHOSOCIAL PREDICTORS OF HIPPOCAMPAL VOLUME AND COGNITION AMONG AFRICAN AMERICAN AND WHITE OLDER ADULTS AT RISK FOR ALZHEIMER’S DISEASE

Frontal 6.87 1.37 (.16) 1.28 (.07) .01 .10 4.92 1.36 (.14) 1.28 (.11) .03 .07 Lateral temporal 5.54 1.32 (.14) 1.24 (.08) .02 .08 7.05 1.33 (.13) 1.24 (.10) .01 .11 Hippocampal 2.65 0.96 (.08) .93 (.05) .11 .03 5.66 .97 (.07) .92 (.06) .02 .09 Posterior cingulate 3.50 1.63 (.17) 1.56 (.09) .07 .05 9.62 1.65 (.15) 1.54 (.11) .003 .15 Precuneus 7.18 1.50 (.15) 1.41 (-08) .01 .11 8.30 1.51 (.12) 1.41 (.11) .006 .13 Supramarginal gyrus 6.83 1.31 (-15) 1.22(-09) .01 .10 4.90 1.31 (.15) 1.23 (11) .03 .07 Angular gyrus 10.01 1.42 (.15) 1.31 (.08) .003 .15 4.42 1.41 (.14) 1.33 (.12) .04 .06

TOBACCO EXPOSURE AND CESSATION IS ASSOCIATED WITH INCIDENT DEMENTIA AND NURSING HOME PLACEMENT

Background:It has been suggested that illiteracy and low level of education are risk factors for developing dementia, but also that bilingualism could function as a protective factor. In Peru, both conditions are very frequent. We observed a dementia prevalence of 6.85% in schooled subjects and 15.2% for illiterates; but there is still no data on how bilingualism modulates cognitive response in healthy illiterates, especially in executive function. Therefore, our objectivewas to compare performance of bilingual andmonolingual healthy elder illiterates in executive control tasks, controlling the influence of age and the type of work. Methods:We evaluated 56 healthy illiterate elderlies, 40 bilinguals (M 1⁄4 71.20, SD 1⁄4 5.94) and 16monolinguals (M1⁄4 75.25, SD1⁄4 10.28) with inhibitory control tasks (modified Stroop, see figure 1), response suppression (Go / No Go), cognitive flexibility (Hanoi tower) and working memory (forward and backward digits, WAIS III). Non-parametric contrast statistics (U Mann Whitney) and covariance analysis were used, where the fixed factors were bilingualism and type of work (elementary or instrumental) and age as a covariate. Results: We observed significant differences between number and symbol (Z 1⁄4 -3.38, p <.001) and interference (Z1⁄4 -2.61, p <.009) of the Stroop tasks; in both cases bilinguals score better than monolinguals (see figure 2). The analysis of covariance also showed a greater effect of bilingualism on the measures of inhibitory control (Numbers and symbols, F 1⁄4 8.085, p <.006 and interference, F 1⁄4 9.604, p <.003) than age and type of work. No significant differences were observed in the other components of executive control. Conclusions: a bilingual advantage is observed in inhibitory control tasks in healthy illiterate older adults, which is not associated with age or type of work. This advantage seems to be associated with the activation of executive control mechanisms formore complex tasks. These data show that bilingualism modulates the cognitive response and functions as a cognitive reserve factor; hence the importance of its promotion and empowerment. We recommend conducting epidemiological and follow-up studies in this population.