Yi-Chen Chiu

Getting Lost: Directed Attention and Executive Functions in Early Alzheimer’s Disease Patients

This study explores the link between directed attention (DA) and getting lost behavior (GLB) in early Alzheimer’s disease (AD) using a cross-sectional design with 3 groups. Based on their dementia levels, 116 community-dwelling participants were recruited from a teaching hospital in Taiwan and classified as the non-demented control, questionably demented, and mild AD groups. Statistical analyses include Pearson correlations, one-way ANOVA, and multiple regressions. Attentional impairments, consisting of distractibility, impulsivity, and executive function problems, significantly predict GLB in familiar and unfamiliar environments. Irritability and executive function problems are associated with mental difficulties in choosing a turn, whereas the use of way-finding strategies reduces GLB. Future interventions may include: (a) mental hygiene of aging; (b) programs targeted at improving attentional function and effective way-finding, and (c) inclusion of DA tests in a routine clinical neuropsychological examination for early detection and accurate diagnosis of dementia.

Family caregivers’ sleep disturbance and its associations with multilevel stressors when caring for patients with dementia

Objective: We tested a stress process model of multilevel stressors on sleep disturbance for family caregivers (FCG) of persons with dementia (PWD).Methods: For this cross-sectional study, trained research assistants collected data from a purposive sample of 180 PWD–FCG dyads at two teaching hospitals, two local hospitals, and two community long-term care service programs in northern Taiwan. PWDs’ neuropsychiatric symptoms were assessed using the Chinese Neuropsychiatric Inventory (CNPI), FCGs’ distress by CNPI Caregiver Distress Scale, physical fatigue by Visual Analogue for Fatigue Scale, mental fatigue by Attentional Function Index, depressive symptoms by the Center for Epidemiological Studies Depression Scale – Short Form, and sleep disturbance by the General Sleep Disturbance Scale.Results: FCGs’ most prevalent sleep disturbance problems were sleep quality problems (99.4%). Hierarchical regression models revealed that FCGs’ sleep disturbance was predicted by their physical fatigue, their depressive symptoms, and the synergistic effect of physical fatigue and depressive symptoms in the final model, explaining 57.8% of the variance.Conclusions: This study supports the model that development of caregivers’ sleep problems may depend on their depression, fatigue, and the synergistic effects of these two variables. These findings suggest that clinicians should educate FCGs about self-care and offer strategies for dealing with a cluster of symptoms when maintaining sleep hygiene.

Association of geriatric conditions and cardiovascular diseases with disability in older adults with diabetes: findings from a nationally representative survey.

Aim:  To examine how diabetes in combination with cardiovascular diseases (hypertension, heart disease and stroke) and geriatric conditions (cognitive impairment and depressive symptoms) affects the odds of disability in older adults.

Validation of the Chinese Revised Algase Wandering Scale-Community Version for persons with dementia in northern Taiwan

Objective: Wandering in persons with dementia is perceived as significant due to its prevalence and negative outcomes. However, lack of a validated wandering measure in Taiwan has limited scientific investigation and clinical practice. Therefore, the purpose of this study was to validate the Chinese Revised Algase Wandering Scale-Community Version (CRAWS-CV) in northern Taiwan. Method: For this cross-sectional study, the sample comprised 180 elders with dementia and their family caregivers (FCs). FCs responded to the CRAWS-CV in interviews with trained research assistants. Results: The structure of CRAWS-CV was examined by exploratory principal component analysis with varimax rotation. This analysis derived nine factors, explaining 71.48% of variance: eloping behavior (EB), mealtime impulsivity/temporal aspects, getting lost inside the house (GLI), pacing, impulsivity, negative outcomes, random pattern (RANDOM), and getting lost outside. The total scale and subscales showed excellent internal consistency. Good construct validity was shown by significant inter-scale correlation coefficients, and significant correlations between scores on the total CRAWS-CV and its subscales with scores on the Mini-Mental State Examination and Chinese Neuropsychiatric Inventory. The receiver operating characteristic curve showed a cutoff score of 67, with sensitivity and specificity of 83.6% and 76.9%, respectively. CRAWS-CV scores were significantly different for wanderers and non-wanderers. The one-week test-retest reliability using intra-class correlation coefficients (ICCs) showed significant correlations except for the EB and RANDOM subscales. Inter-rater reliability using an ICC was significant and acceptable except for GLI. Conclusion: This study supports the CRAWS-CV as a valid measure of wandering in community-dwelling elders with dementia in northern Taiwan.

Developing a Chinese quality of life in dementia instrument for patients with early-to-moderate dementia: an exploratory test of validity.

AIMS The purpose of this study was to examine the psychometric properties of the Chinese Dementia Quality of Life instrument, which included testing the different pathways through theoretical quality of life domains (self-esteem, feelings of belonging and sense of aesthetics) to reach outcomes of positive and negative affect. BACKGROUND Perceived quality of life in dementia has been conceptualised based on dementia stages. However, the relationships among quality of life domains are unclear in patients with dementia with a Mini-Mental State Examination >10. DESIGN Cross-sectional study. METHODS Older people (n = 110) were consecutively recruited from memory disorder clinics and community wellness centres (controls). Of these participants, 27 were controls, 39 were diagnosed with questionable dementia and 44 with mild-to-moderate Alzheimers disease. The instrument was back translated and validated. RESULTS The instrument has good overall internal consistency (Cronbachs alpha = 0.84-0.94). Item-total correlation coefficients, indicating construct validity, were all significant, except for one item. anova showed that controls, patients with questionable dementia and those with mild-to-moderate Alzheimers disease differed significantly in scores on Sense of Aesthetics subscale. Instrument total score and scores on three of five subscales (not Feelings of Belonging) differed significantly between control and dementia groups, but not between patients with questionable dementia and those with mild-to-moderate Alzheimers disease. Factor analyses showed two inconsistencies with the instruments prior conceptualisation, namely the Self-Esteem and Negative Affect subscales. The Positive Affect path model was supported but not the Negative Affect path model. CONCLUSIONS This patient-reported Dementia Quality of Life instrument has acceptable psychometric properties in Taiwanese patients with dementia with a Mini-Mental State Examination score >10. Relevance to clinical practice. The Chinese Dementia Quality of Life instrument can be used to assess subjective quality of life in Taiwanese patients with dementia with a Mini-Mental State Examination score >10.

Caregiving demands, job demands, and health outcomes for employed family caregivers of older adults with dementia: Structural equation modeling

&NA; Many family caregivers are also employed full‐ or part‐time and are known to be affected by job demands. This study explored the mediating effect of job demands on the relationship between caregiving demands and caregiver health outcomes in primary family caregivers of older persons with dementia in Taiwan (N = 214). A cross‐sectional design using a self‐completed structured questionnaire was implemented. Structural equation modeling analyses showed that job demands partially mediated the relationship between caregiving demands and caregiver health outcomes. The indirect effect of caregiving demands on caregiver health outcomes through job demands was 0.208 (95% confidence interval: 0.053 ‐ 0.335). Nurses should evaluate job demands when screening for high‐risk caregiver groups vulnerable to high caregiving demand. Interventions aimed at lessening both caregiving demands and job demands may improve caregiver health outcomes for family caregivers of older adults with dementia.