Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-22T19:38:11.207Z Has data issue: false hasContentIssue false

Service use, advance planning and lifestyle changes following cognitive screening in primary healthcare in Singapore

Published online by Cambridge University Press:  20 September 2017

Jamie Jia Yan Lee
Affiliation:
School of Psychology, James Cook University, Singapore
Claire L. Thompson
Affiliation:
School of Psychology, The Cairnmillar Institute, Melbourne, Australia College of Healthcare Sciences, James Cook University, Townsville, Australia
Muhammad Amin Shaik
Affiliation:
Department of Pharmacology, Memory Aging and Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Esther Wan
Affiliation:
Department of Pharmacology, National University of Singapore, Singapore
Christopher Li-Hsian Chen
Affiliation:
Department of Pharmacology, Memory Aging and Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Yan Hong Dong*
Affiliation:
Department of Pharmacology, National University of Singapore, Singapore Centre for Healthy Brain Ageing (CHeBA) and Dementia Collaborative Research Centre – Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia
*
Correspondence should be addressed to: Dr Yan Hong Dong, Department of Pharmacology, National University of Singapore, BLK MD3 Level 4 #04-01, 16 Medical Drive, 117600, Singapore. Phone: +65 6601 3288. Email: [email protected].

Abstract

Background:

Despite recent interest in community-based screening programs to detect undiagnosed cognitive disorder, little is known about whether screening leads to further diagnostic evaluation, or the effects of such programs in terms of actual changes in patient or caregiver behavior. This study followed up informants of older adults (i.e. caregivers of patients who completed informant-based screening regarding the patient) following participation in a study screening for undiagnosed memory problems, to explore uptake of further diagnostic evaluation or treatment, advance planning or preparations, lifestyle changes, medication adherence, and use of support services.

Methods:

A total of 140 informants of older adult patients were surveyed four to fifteen months following participation in a cognitive screening study. The informants were interviewed with a study-specific survey about cognitive assessment, advance planning, lifestyle changes, and use of support services and general medication adherence.

Results:

A minority of patients and informants had engaged in advance planning or made relevant lifestyle changes following cognitive screening. Those assessed as being at higher risk of memory problems were more likely to have attended a full diagnostic evaluation, engaged in support services and experienced medication adherence difficulties.

Conclusion:

Only a small proportion of patients participating in cognitive screening subsequently engaged in diagnostic evaluation, advance planning, or lifestyle changes. However, those with higher risk of cognitive impairment were generally more likely to take some action following cognitive screening. Those at higher risk were also more vulnerable due to greater difficulties with medication adherence.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn, Arlington, VA: American Psychiatric Publishing.Google Scholar
Ashford, J. W. et al. (2007). Should older adults be screened for dementia? It is important to screen for evidence of dementia! Alzheimer's & Dementia, 3, 7580. doi:10.1016/j.jalz.2007.03.005.CrossRefGoogle ScholarPubMed
Borson, S. et al. (2013). Improving dementia care: the role of screening and detection of cognitive impairment. Alzheimers Dement, 9, 151159. doi:10.1016/j.jalz.2012.08.008.CrossRefGoogle ScholarPubMed
Boustani, M. et al. (2006). Who refuses the diagnostic assessment for dementia in primary care? International Journal of Geriatric Psychiatry, 21, 556563. doi:10.1002/gps.1524.CrossRefGoogle ScholarPubMed
Brodaty, H., Thomson, C., Thompson, C. and Fine, M. (2005). Why caregivers of people with dementia and memory loss don't use services. International Journal of Geriatric Psychiatry, 20, 537546. doi:10.1002/gps.1322.CrossRefGoogle ScholarPubMed
Campbell, N. L., Boustani, M. A., Skopelja, E. N., Gao, S., Unverzagt, F. W. and Murray, M. D. (2012). Medication adherence in older adults with cognitive impairment: a systematic evidence-based review. American Journal of Geriatric Pharmacotherapy, 10, 165177. doi:10.1016/j.amjopharm.2012.04.004.Google Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.Google Scholar
Diniz, B. S., Butters, M. A., Albert, S. M., Dew, M. A. and Reynolds, C. F. (2013). Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies. The British Journal of Psychiatry, 202, 329335. doi:10.1192/bjp.bp.112.118307.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Fratiglioni, L., Paillard-Borg, S. and Winblad, B. (2004). An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurology, 3, 343353. doi:10.1016/s1474-4422(04)00767-7.CrossRefGoogle ScholarPubMed
Galvin, J. E. (2011). Dementia screening, biomarkers and protein misfolding: implications for public health and diagnosis. Prion, 5, 1621. doi:10.4161/pri.5.1.14439.Google Scholar
Galvin, J. E. et al. (2005). The AD8: a brief informant interview to detect dementia. Neurology, 65, 559564. doi:10.1212/01.wnl.0000172958.95282.2a.CrossRefGoogle ScholarPubMed
Hawkins, L. A., Kilian, S., Firek, A., Kashner, T. M., Firek, C. J. and Silvet, H. (2012). Cognitive impairment and medication adherence in outpatients with heart failure. Heart & Lung: The Journal of Acute and Critical Care, 41, 572582. doi:10.1016/j.sapharm.2015.11.011.Google Scholar
Lim, J., Goh, J., Chionh, H. L. and Yap, P. (2012). Why do patients and their families not use services for dementia? Perspectives from a developed Asian country. International Psychogeriatrics, 24, 15711580.Google Scholar
Middleton, L. E. and Yaffe, K. (2009). Promising strategies for the prevention of dementia. Archives of Neurology, 66, 12101215. doi:10.1001/archneurol.2009.201.Google Scholar
Morisky, D. E., Green, L. W. and Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24, 6774.CrossRefGoogle ScholarPubMed
Nasreddine, Z. S. et al. (2005). The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695699. doi:10.1111/j.1532-5415.2005.53221.x.Google Scholar
Okuno, J., Yanagi, H. and Tomura, S. (2001). Is cognitive impairment a risk factor for poor compliance among Japanese elderly in the community? European Journal of Clinical Pharmacology, 57, 589594.Google Scholar
Peters, M. E. et al. (2015). Neuropsychiatric symptoms as predictors of progression to severe Alzheimer's dementia and death: the cache county dementia progression study. American Journal of Psychiatry, 172, 460465. doi: 10.1176/appi.ajp.2014.14040480.CrossRefGoogle ScholarPubMed
Prince, M., Wimo, A., Guerchet, M., Ali, G. C., Wu, Y. T. and Prina, M. (2015). World Alzheimer report. Available at: http://www.worldalzreport2015.org/; last accessed 7 September 2017.Google Scholar
Reding, M., Haycox, J. and Blass, J. (1985). Depression in patients referred to a dementia clinic: a three-year prospective study. Archives of Neurology, 42, 894896. doi:10.1001/archneur.1985.04060080080019.CrossRefGoogle Scholar
Shaik, M. A. et al. (2016). The reliability and validity of the informant AD8 by comparison with a series of cognitive assessment tools in primary healthcare. International Psychogeriatrics, 28, 443452. doi:10.1017/S1041610215001702.Google Scholar
Wilson, R. S. et al. (2014). Clinical-pathologic study of depressive symptoms and cognitive decline in old age. Neurology, 83, 702709. doi:10.1212/WNL.0000000000000715.Google Scholar
Yesavage, J. A. et al. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 3749. doi:10.1016/0022-3956(82)90033-4.CrossRefGoogle Scholar
Zubenko, G. S. et al. (2003). A collaborative study of the emergence and clinical features of the major depressive syndrome of Alzheimer's disease. American Journal of Psychiatry, 160, 857866. doi:10.1176/appi.ajp.160.5. 857.Google Scholar