Predictors of Awareness of Functional Ability in People with Dementia: The Contribution of Personality, Cognition, and Neuropsychiatric Symptoms – Findings from the IDEAL Program

Martyr, Anthony; Gamble, Laura D.; Nelis, Sharon M.; Collins, Rachel; Alexander, Catherine M.; Morris, Robin G.; Quinn, Catherine; Pentecost, Claire; Rusted, Jennifer; Chapot, Victor; Thom, Jeanette M.; Matthews, Fiona; Clare, Linda

doi:10.1159/000524607

Cited by 9 publications

(31 citation statements)

References 65 publications

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“…Findings are also consistent with earlier studies where generally people with dementia recognize that they have difficulties with iADL 12,14,15,17,18,36,37 . Findings, however, are also consistent with self‐rated iADL reflecting fewer difficulties than informant‐rated iADL 12–15,18,37 .…”

Section: Discussionsupporting

confidence: 88%

“…12,14,15,17,18,36,37 Findings, however, are also consistent with self-rated iADL reflecting fewer difficulties than informant-rated iADL. [12][13][14][15]18,37 One possible explanation for this discrepancy could be that people with dementia may be unable to update their mental store or 'personal database' of information about the self and hence adhere to an outdated estimation of their performance. 38 There is convincing evidence for this impaired updating in the memory domain; 39 however, iADL ratings by people with dementia generally indicate increasing difficulties over time, 12,13 suggesting that they are able to update their personal database for iADL tasks at least to some extent.…”

Section: Discussionsupporting

confidence: 60%

“…[12][13][14][15] This discrepancy is also associated with mood, caregiver stress, and the age of the person with dementia. 3,10,[16][17][18][19] Few studies have compared trajectories of cognition and iADL in people with dementia to determine whether cognition and iADL decline at the same rate. The individual cognitive domains most frequently associated with iADL decline are executive function 7,8 and memory.…”

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confidence: 99%

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Trajectories of cognitive and perceived functional decline in people with dementia: Findings from the IDEAL programme

Martyr,

Ravi,

Gamble

et al. 2023

Alzheimer's & Dementia

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INTRODUCTIONImpaired cognition and instrumental activities of daily living (iADL) are key diagnostic features of dementia; however, few studies have compared trajectories of cognition and iADL.METHODSParticipants from the IDEAL study comprised 1537, 1183, and 851 people with dementia, and 1277, 977, and 749 caregivers at baseline, 12 and 24 months, respectively. Addenbrooke's Cognitive Examination‐III and Functional Activities Questionnaire were used to measure cognition and iADL, respectively. Scores were converted to deciles.RESULTSSelf‐rated iADL declined on average by ‐0.08 (‐0.25, 0.08) decile points per timepoint more than cognition. Informant‐rated iADL declined on average by ‐0.31 (‐0.43, ‐0.18) decile points per timepoint more than cognition.DISCUSSIONCognition and self‐rated iADL declined at a similar rate. Informant‐rated iADL declined at a significantly greater rate than cognition. Therefore, either cognition and perceived iADL decline at different rates or informants overestimate increasing iADL difficulties compared to both cognition and self‐ratings.Highlights Self‐ratings of the degree of functional difficulties were consistent with cognition Decline in self‐rated everyday activities was consistent with cognitive decline Informant‐ratings of everyday activities declined more than cognition

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 60%

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confidence: 99%

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Trajectories of cognitive and perceived functional decline in people with dementia: Findings from the IDEAL programme

Martyr,

Ravi,

Gamble

et al. 2023

Alzheimer's & Dementia

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“…Concordance between functional ability based on self-report, proxy report, and objective measures is complex. While some studies show that persons with dementia may underestimate their functional impairment, this can vary based on individual-level factors . Finally, the models were developed among older US adults, which may not be applicable to international contexts.…”

Section: Discussionmentioning

confidence: 99%

Development and External Validation of Models to Predict Need for Nursing Home Level of Care in Community-Dwelling Older Adults With Dementia

Deardorff,

Jeon,

Barnes

et al. 2024

JAMA Intern Med

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ImportanceMost older adults living with dementia ultimately need nursing home level of care (NHLOC).ObjectiveTo develop models to predict need for NHLOC among older adults with probable dementia using self-report and proxy reports to aid patients and family with planning and care management.Design, Setting, and ParticipantsThis prognostic study included data from 1998 to 2016 from the Health and Retirement Study (development cohort) and from 2011 to 2019 from the National Health and Aging Trends Study (validation cohort). Participants were community-dwelling adults 65 years and older with probable dementia. Data analysis was conducted between January 2022 and October 2023.ExposuresCandidate predictors included demographics, behavioral/health factors, functional measures, and chronic conditions.Main Outcomes and MeasuresThe primary outcome was need for NHLOC defined as (1) 3 or more activities of daily living (ADL) dependencies, (2) 2 or more ADL dependencies and presence of wandering/need for supervision, or (3) needing help with eating. A Weibull survival model incorporating interval censoring and competing risk of death was used. Imputation-stable variable selection was used to develop 2 models: one using proxy responses and another using self-responses. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (calibration plots).ResultsOf 3327 participants with probable dementia in the Health and Retirement Study, the mean (SD) age was 82.4 (7.4) years and 2301 (survey-weighted 70%) were female. At the end of follow-up, 2107 participants (63.3%) were classified as needing NHLOC. Predictors for both final models included age, baseline ADL and instrumental ADL dependencies, and driving status. The proxy model added body mass index and falls history. The self-respondent model added female sex, incontinence, and date recall. Optimism-corrected iAUC after bootstrap internal validation was 0.72 (95% CI, 0.70-0.75) in the proxy model and 0.64 (95% CI, 0.62-0.66) in the self-respondent model. On external validation in the National Health and Aging Trends Study (n = 1712), iAUC in the proxy and self-respondent models was 0.66 (95% CI, 0.61-0.70) and 0.64 (95% CI, 0.62-0.67), respectively. There was excellent calibration across the range of predicted risk.Conclusions and RelevanceThis prognostic study showed that relatively simple models using self-report or proxy responses can predict need for NHLOC in community-dwelling older adults with probable dementia with moderate discrimination and excellent calibration. These estimates may help guide discussions with patients and families in future care planning.

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“…The Functional Activities Questionnaire (FAQ) includes questions about basic daily functional activities, such as shopping, cooking, and taking buses, and is more sensitive to predicting cognitive scores than the IADL Scale (0.85 vs. 0.57) ( 9 ). Extensive research has explored the factors associated with functional impairment in dementia ( 10 , 11 ). However, few studies have been conducted on the various functional determinants of older patients with schizophrenia.…”

Section: Introductionmentioning

confidence: 99%

Predictors of everyday functional impairment in older patients with schizophrenia: A cross-sectional study

Ye²,

Li³

et al. 2023

Front. Psychiatry

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ObjectiveThis study investigates the prevalence of everyday functional impairment among older adults with schizophrenia and builds a predictive model of functional decline.MethodsA total of 113 hospitalized older patients enrolled in this study. Functional impairment is defined according to the Functional Activities Questionnaire (FAQ). Patients who scored <9 could function independently daily, while those who scored ≥9 had problems in everyday functional activities. Data collected include sociodemographic characteristics, depressive symptoms, social support, and physical comorbidities, which were classified according to the eight anatomical systems of the human body.ResultsThe sample comprised 75% female participants with a mean age of 63.74 ± 7.42 years old. A total of 33.6% had a functional impairment, while cognitive impairment was present in 63.7%. Independent participants had better urinary system and respiratory system health (P < 0.05). After adjusting for the potential confounders of age, disease course, physical comorbidities, psychiatric symptoms, the ability to independently carry out daily activities, and cognitive function, we found that impaired everyday function is associated with poor cognition, depressive symptoms, first admission, psychiatric symptoms (especially positive symptoms), ADL, and respiratory and urinary system diseases.ConclusionEveryday functional capacity is predicted by disease course, admission time, cognition, depressive symptoms, severity of psychosis, ability to carry out daily activities, and respiratory and urinary system health status. Urinary system diseases contribute significantly to the prediction of impaired function. Future studies should focus on health status, drug use, and everyday functional recovery in older patients with schizophrenia.

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Predictors of Awareness of Functional Ability in People with Dementia: The Contribution of Personality, Cognition, and Neuropsychiatric Symptoms – Findings from the IDEAL Program

Cited by 9 publications

References 65 publications

Trajectories of cognitive and perceived functional decline in people with dementia: Findings from the IDEAL programme

Trajectories of cognitive and perceived functional decline in people with dementia: Findings from the IDEAL programme

Development and External Validation of Models to Predict Need for Nursing Home Level of Care in Community-Dwelling Older Adults With Dementia

Predictors of everyday functional impairment in older patients with schizophrenia: A cross-sectional study

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