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Segernäs Kvitting, A., Johansson, M. M. & Marcusson, J. (2019). Accuracy of the Cognitive Assessment Battery in a Primary Care Population. Dementia and geriatric cognitive disorders extra, 9(2), 294-301
Open this publication in new window or tab >>Accuracy of the Cognitive Assessment Battery in a Primary Care Population
2019 (English)In: Dementia and geriatric cognitive disorders extra, E-ISSN 1664-5464, Vol. 9, no 2, p. 294-301Article in journal (Refereed) Published
Abstract [en]

Background: There are several cognitive assessment tools used in primary care, e.g., the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment. The Cognitive Assessment Battery (CAB) was introduced as a sensitive tool to detect cognitive decline in primary care. However, primary care validation is lacking. Therefore, we investigated the accuracy of the CAB in a primary care population. 

Objective: To investigate the accuracy of the CAB in a primary care population. 

Methods: Data from 46 individuals with cognitive impairment and 33 individuals who visited the primary care with somatic noncognitive symptoms were analyzed. They were investigated with the MMSE, the CAB, and a battery of neuropsychological tests; they also underwent consultation with a geriatric specialist. The accuracy of the CAB was assessed using c-statistics and the area under the receiver operating characteristic curve (AUC) was used to quantify the binary outcomes (“no cognitive impairment” or “cognitive impairment”).

Results: The “cognitive impairment” group was significantly different from the unimpaired group for all the subtests of the CAB. When accuracy was based on binary significant reduction or not in one or several domains of the CAB, the AUC varied between 0.685 and 0.772. However, when a summation or logistic regression of several subcategories was performed, using the numerical values for each subcategory, the AUC was >0.9. For comparison, the AUC for the MMSE was 0.849.

Conclusions: The accuracy of the CAB in a primary care population is poor to good when using binary cutoffs. Accuracy can be improved to high when using a summation or logistic regression of the numerical data of the subcategories. Considering CAB time, lack of adequate age norms, and a good accuracy for the MMSE, implementation of the CAB in primary care is not recommended at present based on the results of this study.

Place, publisher, year, edition, pages
S. Karger, 2019
Keywords
Primary care cognitive tests, Cognitive Assessment Battery, Cognitive assessment tools
National Category
Neurology Geriatrics
Identifiers
urn:nbn:se:liu:diva-160370 (URN)10.1159/000501365 (DOI)2-s2.0-85071030454 (Scopus ID)
Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2019-09-30Bibliographically approved
Segernäs Kvitting, A., Fällman, K., Wressle, E. & Marcusson, J. (2019). Age-Normative MMSE Data for Older Persons Aged 85 to 93 in a Longitudinal Swedish Cohort. Journal of The American Geriatrics Society, 67(3), 534-538
Open this publication in new window or tab >>Age-Normative MMSE Data for Older Persons Aged 85 to 93 in a Longitudinal Swedish Cohort
2019 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 67, no 3, p. 534-538Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/OBJECTIVES: Normative Mini-mental state examination (MMSE) reference values in elderly are scarce. Therefore, the aim is to present normative MMSE values for 85-93 year olds.

DESIGN: A longitudinal age cohort study.

SETTING: A population study of the residents in the municipality of Linköping, Sweden.

PARTICIPANTS: Residents (n = 650) born in 1922 during the course of 2007. In total, 374 individuals participated and were tested with MMSE at age 85, 280 of these were willing and able to also participate at age 86, 107 at age 90 and 51 at age 93.

MEASUREMENTS: MMSE, from 0-30, with lower scores denoting more impaired cognition.

RESULTS: Median MMSE values for the total population over the ages 85, 86, 90 and 93 years was 28 for all ages investigated. The 25th percentile values were 26, 26, 26 and 27, respectively. For a "brain healthy" sub-group median values were 28, 29, 28, and 28. The 25th percentile values were 27, 28, 26 and 27, respectively. Comparisons for age-effects showed no differences when all individuals for each age group were compared. When only the individuals reaching 93 years of age (n = 50) were analyzed, there was a significant lowering of MMSE in that age group.

CONCLUSION: The literature is variable and in clinical practice a low (24) MMSE cut off is often used for possible cognitive impairment in old age. The present data indicate that MMSE 26 is a reasonable cut off for possible cognitive decline in older persons up to the age of 93. J Am Geriatr Soc 67:534-538, 2019.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
Keywords
aged 80 and over, dementia test, mental status
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-160367 (URN)10.1111/jgs.15694 (DOI)000461567700019 ()30536796 (PubMedID)2-s2.0-85058337422 (Scopus ID)
Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2019-09-30Bibliographically approved
Westerlind, B., Östgren, C. J., Midlöv, P. & Marcusson, J. (2019). Diagnostic Failure of Cognitive Impairment in Nursing Home Residents May Lead to Impaired Medical Care. Dementia and Geriatric Cognitive Disorders
Open this publication in new window or tab >>Diagnostic Failure of Cognitive Impairment in Nursing Home Residents May Lead to Impaired Medical Care
2019 (English)In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background/Objectives: Dementia and cognitive impairment are common in nursing homes. Few studies have studied the impact of unnoted cognitive impairment on medical care. This study aimed to estimate the prevalence of diagnostic failure of cognitive impairment in a sample of Swedish nursing home residents and to analyze whether diagnostic failure was associated with impaired medical care. 

Method: A total of 428 nursing home residents were investigated during 2008–2011. Subjects without dementia diagnosis were grouped by result of the Mini Mental State Examination (MMSE), where subjects with <24 points formed a possible dementia group and the remaining subjects a control group. A third group consisted of subjects with diagnosed dementia. These three groups were compared according to baseline data, laboratory findings, drug use, and mortality. 

Results: Dementia was previously diagnosed in 181 subjects (42%). Among subjects without a dementia diagnosis, 72% were cognitively impaired with possible dementia (MMSE <24). These subjects were significantly older, did not get anti-dementia treatment, and had higher levels of brain natriuretic peptide compared to the diagnosed dementia group, but the risks of malnutrition and pressure ulcers were similar to the dementia group. 

Conclusions: Unnoted cognitive impairment is common in nursing home residents and may conceal other potentially treatable conditions such as heart failure. The results highlight a need to pay increased attention to cognitive impairment among nursing home residents.

Place, publisher, year, edition, pages
S. Karger, 2019
Keywords
Cognitive impairment, Nursing homes, Morbidity, Dementia, Heart failure
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-159107 (URN)10.1159/000499671 (DOI)31269489 (PubMedID)2-s2.0-85068515589 (Scopus ID)
Available from: 2019-07-25 Created: 2019-07-25 Last updated: 2019-09-04Bibliographically approved
Johansson, M. M., Marcusson, J. & Wressle, E. (2019). Maintaining health-related quality of life from 85 to 93 years of age despite decreased functional ability. British Journal of Occupational Therapy, 82(6), 348-356
Open this publication in new window or tab >>Maintaining health-related quality of life from 85 to 93 years of age despite decreased functional ability
2019 (English)In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 82, no 6, p. 348-356Article in journal (Refereed) Published
Abstract [en]

Introduction

The ‘oldest-old’ is the most rapidly growing age group in Sweden and in the western world. This group is known to be at great risk of increased functional dependency and the need for help in their daily lives. The aim of this research was to examine how the oldest-old change over time regarding health-related quality of life, cognition, depression and ability to perform activities of daily living and investigate what factors explain health-related quality of life at age 85 and 93 years.

Methods

In this study, 60 individuals from the Swedish Elderly in Linköping Screening Assessment study were followed from age 85 to 93 years. Measurements used were EQ-5D, Geriatric Depression Scale, Mini Mental State Examination and ability to perform activities of daily living. Nonparametric statistics and regression analyses were used.

Results

Although the individuals had increased mobility problems, decreased ability to manage activities of daily living, and thus had increased need of assistance, they scored their health-related quality of life at age 93 years at almost the same level as at age 85 years. No depression and low dependence in activities of daily living speaks in favour of higher health-related quality of life.

Conclusions

Health-related quality of life can be maintained during ageing despite decreased functional ability and increased need of assistance in daily life.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Health-related quality of life; daily living; elderly; occupational therapy
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-158562 (URN)10.1177/0308022619830261 (DOI)000469876400004 ()2-s2.0-85062771149 (Scopus ID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden [FORSS-8888, FORSS-11636, FORSS-31811]; County Council of Ostergotland [LIO-11877, LIO-31321, LIO-79951]; Janne Elgqvist Family Foundation

Available from: 2019-07-03 Created: 2019-07-03 Last updated: 2019-08-12Bibliographically approved
Johansson, M., Marcusson, J. & Wressle, E. (2016). Development of an instrument for measuring activities of daily living in persons with suspected cognitive impairment. Scandinavian Journal of Occupational Therapy, 23(3), 230-239
Open this publication in new window or tab >>Development of an instrument for measuring activities of daily living in persons with suspected cognitive impairment
2016 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 23, no 3, p. 230-239Article in journal (Refereed) Published
Abstract [en]

Background: According to the Swedish National Board of Health and Welfare, structured assessment of function and activity has high priority when investigating for dementia.

Aim/objectives: The aim was to develop and psychometrically test an instrument to measure self-reported and/or informant-reported ability to perform activities of daily living in persons with suspected cognitive impairment.

Material and methods: The Cognitive Impairment in Daily Life (CID) instrument has been developed in several phases. Content validity was achieved through five expert panels using a Content Validity Index (CVI). The content was tested further in a pilot study of 51 patients and 49 relatives from primary care or a specialist memory clinic.

Results: Content validity was good with a CVI index of 0.83. All patients considered that relevant activities were included. Most relatives considered that the activities included in the instrument were adequate and captured the patients’ difficulties in daily life. Some adjustments to the items and scale were suggested and these were done after each phase. In general, relatives indicated more difficulties than patients.

Conclusion: The CID instrument seems promising in terms of content validity. Further testing of reliability and construct validity is ongoing.

Keywords
Cognition, dementia investigation, instrument development
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-115306 (URN)10.3109/11038128.2016.1139621 (DOI)000374634100006 ()
Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2017-12-04Bibliographically approved
Törnvall, E., Marcusson, J. & Wressle, E. (2016). Health-related quality in life in relation to mobility and fall risk in 85-year-old people: a population study in Sweden. Ageing & Society, 36(9), 1982-1997
Open this publication in new window or tab >>Health-related quality in life in relation to mobility and fall risk in 85-year-old people: a population study in Sweden
2016 (English)In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 36, no 9, p. 1982-1997Article in journal (Refereed) Published
Abstract [en]

Optimal mobility is fundamental for healthy ageing and quality of life. This study is part of a cross-sectional population-based study of 85-year-old people residing in Linköping municipality, Sweden. The purpose was to describe 85-year-old peoples' health-related quality of life (HRQoL) in relation to mobility and fall risk while adjusting for gender and body mass index. Data collection included a postal questionnaire, a home visit and a reception visit. HRQoL was assessed with EQ-5D-3L, mobility with the Timed Up and Go test (TUG) and fall risk with the Downton Fall Risk Index (DFRI). All those who completed the DFRI, TUG and EQ-5D-3L were included in the present study (N = 327). Lower HRQoL was associated with longer time taken to complete TUG and higher fall risk in both genders but not with body mass index. Women had higher risk of falling, took a longer time to complete TUG and reported less physical activity compared with men. Health-care professionals should address mobility capacity and fall risk in order to maintain quality of life in elderly people. This is of utmost importance, especially for elderly women because impaired mobility, high risk of falling and occurrence of pain are common among women, and related to lower HRQoL.

Place, publisher, year, edition, pages
Cambridge University Press, 2016
Keywords
Downton Fall Risk Index;Timed Up and Go;EQ-5D;elderly;gender;body mass index
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-126586 (URN)10.1017/S0144686X15000896 (DOI)000384713200010 ()
Note

Funding agencies: Health Research Council of the South-East of Sweden [FORSS-8888, 11636, 31811]; County of Ostergotland [LIO-11877, 31321, 79951]; Janne Elgqvist Family Foundation

Available from: 2016-03-30 Created: 2016-03-30 Last updated: 2017-11-30
Ludvigsson, M., Marcusson, J., Wressle, E. & Milberg, A. (2016). Markers of subsyndromal depression in very old persons.. International Journal of Geriatric Psychiatry, 31(6), 619-628
Open this publication in new window or tab >>Markers of subsyndromal depression in very old persons.
2016 (English)In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 31, no 6, p. 619-628Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate factors associated with subsyndromal depression (SSD) in very old persons, and to develop a model for prediction of SSD among very old persons.

METHODS: A cross-sectional, population-based study was undertaken on 85-year-old persons in Sweden. Data were collected from a postal questionnaire, assessments in the participants' homes and at reception visits. Depressiveness was screened with GDS-15 (Geriatric Depression Scale), and the results were classified into three outcome categories: non-depression (ND), SSD and syndromal depression. Data were analysed with binary logistic, ordinal logistic and linear regression.

RESULTS: With univariate logistic regression 20 factors associated with SSD were identified in very old persons, and the four hypothesized domains-sociodemographic factors, declining physical functioning, neuropsychiatric factors and existential factors-significantly related to SSD. The multivariate logistic model included seven independent factors that increase the likelihood of SSD instead of ND (lower self-perceived health, life not meaningful, problems with self-care, use of tranquilizing medication, no contact with neighbours, history of affective disorder and history of stroke). The ordinal logistic and the linear regression models resulted in seven partly different factors for predicting SSD and depressiveness, in the very old.

CONCLUSIONS: The identified markers may help clinicians with the detection, prevention and treatment of SSD in very old persons. The findings indicate the importance of a comprehensive functional approach to diagnosing and treating depressiveness in this population, and the findings might be interpreted as offering support for the coexistence of a dimensional and a categorical view on depressive disorders.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-127480 (URN)10.1002/gps.4369 (DOI)000374700000009 ()26489528 (PubMedID)
Note

Funding agencies: County Council of Ostergotland, Sweden

Available from: 2016-04-27 Created: 2016-04-27 Last updated: 2018-07-26
Johansson, M., Marcusson, J. & Wressle, E. (2015). Cognitive impairment and its consequences in everyday life: experiences of people with mild cognitive impairment or mild dementia and their relatives. International psychogeriatrics, 27(6), 949-958
Open this publication in new window or tab >>Cognitive impairment and its consequences in everyday life: experiences of people with mild cognitive impairment or mild dementia and their relatives
2015 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 27, no 6, p. 949-958Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to explore experiences of cognitive impairment, its consequences in everyday life and need for support in people with mild cognitive impairment (MCI) or mild dementia and their relatives.

Methods: A qualitative approach with an explorative design with interviews was chosen. The participants included five people with MCI and eight people with mild dementia and their relatives. All participants were recruited at a geriatric memory clinic in Sweden. The Grounded Theory method was used.

Results: The following categories emerged: noticing cognitive changes; changed activity patterns; coping strategies; uncertainty about own ability and environmental reactions; support in everyday life; support from the healthcare system; consequences in everyday life for relatives; and support for relatives. The main findings were that people with MCI and dementia experienced cognitive changes that could be burdensome and changed activity patterns. Most of them, however, considered themselves capable of coping on their own. The relatives noticed cognitive changes and activity disruptions to a greater extent and tried to be supportive in everyday life. Degree of awareness varied and lack of awareness could lead to many problems in everyday life.

Conclusions: Perceived cognitive impairment and its consequences in everyday life were individual and differed among people with MCI or dementia and their relatives. Thus, healthcare professionals must listen to both people with cognitive impairment and their relatives for optimal individual care planning. Support such as education groups and day care could be more tailored towards the early stages of dementia.

Place, publisher, year, edition, pages
Cambridge University Press, 2015
Keywords
Alzheimer’s disease; activities of daily living; qualitative research
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-115307 (URN)10.1017/S1041610215000058 (DOI)000354093800009 ()25644289 (PubMedID)
Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2017-12-04Bibliographically approved
Nägga, K., Mayer, S., Marcusson, J. & Wressle, E. (2015). Evaluation of short cognitive screening tests in 85-year-old men and women. European Geriatric Medicine, 6(6), 545-550
Open this publication in new window or tab >>Evaluation of short cognitive screening tests in 85-year-old men and women
2015 (English)In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 6, no 6, p. 545-550Article in journal (Refereed) Published
Abstract [en]

Introduction: The study aimed to investigate different aspects of cognition using the Cognitive Assessment Battery (CAB) in community-dwelling older adults aged 85 years. We also investigated the eventual influence of sex on the results and aimed to identify predictors for further cognitive decline after 1 year. Methods: CAB consists of 10 subtests covering the cognitive domains of speed and attention, learning and episodic memory, visuospatial abilities, language, and executive functions. Cognitive tests were performed at baseline (n = 335) and follow-up after 1 year (n = 270). Results: Univariate statistics revealed that men performed better than women on episodic memory (P < 0.05) and on the naming test (P < 0.001). However, floor effects in the paragraph memory test were revealed. There was a high rate of abnormal results on Token Test (67%), PaSMO (50%), Clox (48%), and the cube copying (40%) tests in participants with normal cognition. Logistic regression showed that impaired results on the Stroop III test (odds ratio, 2.38; P < 0.05) was independently associated with an increased risk of cognitive decline. Conclusion: Men performed better than women on the memory and on the naming test. However, due to floor effects in the paragraph memory test in 85 year olds, these results can be disputed. The high rate of abnormal results on the Token Test, PaSMO, Clox, and the cube copying tests in cases with normal cognition indicate that these tests are less suitable for screening in the age group. Impaired result on the Stroop test increased the risk more than two-fold for cognitive decline after 1 year.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
populations study, oldest old, MMSE
National Category
Geriatrics Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-123648 (URN)10.1016/j.eurger.2015.10.002 (DOI)000368322100006 ()
Note

Funding agencies: Skane County Council; Lund University; Health Research Council in south east Sweden [FORSS-8888, FORSS-11636, FORSS-31811]; County of Ostergotland [LIO-11877, LIO-31321, LIO-79951]; Family Janne Elgqvist Foundation

Available from: 2016-01-04 Created: 2016-01-04 Last updated: 2019-06-27
Ludvigsson, M., Milberg, A., Marcusson, J. & Wressle, E. (2015). Normal Aging or Depression? A Qualitative Study on the Differences Between Subsyndromal Depression and Depression in Very Old People.. The Gerontologist, 55(5), 760-769
Open this publication in new window or tab >>Normal Aging or Depression? A Qualitative Study on the Differences Between Subsyndromal Depression and Depression in Very Old People.
2015 (English)In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 55, no 5, p. 760-769Article in journal (Refereed) Published
Abstract [en]

Purpose of the Study: The aim of this study was to make a qualitative comparison of experiences of being in very old people with subsyndromal depression (SSD), in relation to the experiences of very old people with syndromal depression or nondepression. Through investigation and deeper understanding of the interface between depressive disease and normal aging, clinicians might give more accurate prevention or treatment to those very old persons who need such help.

DESIGN AND METHODS: Semistructured qualitative interviews were conducted for 27 individuals of 87-88 years of age, who were categorized in the 3 strata of nondepressive, SSD, and syndromal depression. Transcripts were analyzed using qualitative content analysis within each stratum and later with a comparison between the strata.

RESULTS: The content analysis resulted in 4 themes in people with SSD, as defined by a self-report depression screening instrument, giving a comprehensive picture of SSD in very old people, and also showed qualitative differences between the SSD, syndromal depression, and nondepressive groups. A main finding was that SSD differs qualitatively from syndromal depression but not clearly from nondepression.

IMPLICATIONS: The results might indicate that SSD in very old people is not related to pathology but to normal aging, even though the condition correlates with negative health parameters. Overlooking certain psychosocial aspects of living in the very old may pose a risk of both underdiagnosis and overdiagnosis in the spectrum of depressive disorders.

Keywords
Coping, Frailty, Healthy aging, Subthreshold depression, Successful aging
National Category
Psychiatry Geriatrics
Identifiers
urn:nbn:se:liu:diva-120848 (URN)10.1093/geront/gnt162 (DOI)000362984500006 ()24398652 (PubMedID)
Funder
Östergötland County Council
Available from: 2015-08-27 Created: 2015-08-27 Last updated: 2018-07-26Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6452-3930

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