Publications by authors named "Sarah K Lageman"

23 Publications

  • Page 1 of 1

Anticholinergic Medication Burden in Parkinson's Disease Outpatients.

J Parkinsons Dis 2022 ;12(2):599-606

Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA.

Background: Individuals with Parkinson's disease (PD) may be especially vulnerable to future cognitive decline from anticholinergic medications.

Objective: To characterize anticholinergic medication burden, determine the co-occurrence of anticholinergic and cholinesterase inhibitors, and to assess the correlations among anticholinergic burden scales in PD outpatients.

Methods: We studied 670 PD outpatients enrolled in a clinic registry between 2012 and 2020. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Drug Burden Index-Anticholinergic component (DBI-Ach). Correlations between scales were assessed with weighted kappa coefficients.

Results: Between 31.5 to 46.3% of PD patients were taking medications with anticholinergic properties. Among the scales applied, the ACB produced the highest prevalence of medications with anticholinergic properties (46.3%). Considering only medications with definite anticholinergic activity (scores of 2 or 3 on ACB, ADS, or ARS), the most common anticholinergic drug classes were antiparkinsonian (8.2%), antipsychotic (6.4%), and urological (3.3%) medications. Cholinesterase inhibitors and medications with anticholinergic properties were co-prescribed to 5.4% of the total cohort. The most highly correlated scales were ACB and ADS (κ= 0.71), ACB and ARS (κ= 0.67), and ADS and ARS (κ= 0.55).

Conclusion: A high proportion of PD patients (20%) were either taking antiparkinsonian, urological, or antipsychotic anticholinergic medications or were co-prescribed anticholinergic medications and cholinesterase inhibitors. By virtue of its detection of a high prevalence of anticholinergic medication usage and its high correlation with other scales, our data support use of the ACB scale to assess anticholinergic burden in PD patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/JPD-212769DOI Listing
April 2022

Exploration of Parkinson's Disease Symptomatology Subtypes From the Caregiver Perspective: Implications for Caregiver Burden, Depression, and Anxiety.

J Geriatr Psychiatry Neurol 2021 Sep 29:8919887211049146. Epub 2021 Sep 29.

Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.

Background: While research has demonstrated associations between Parkinson's disease (PD) severity and caregiver burden and emotional functioning, less is known about the associations between specific PD symptom patterns and caregiver functioning.

Objective: The purpose of the current study was to explore symptomatology subtypes in PD from the caregiver perspective in the U.S. and Mexico and to determine whether caregiver burden, depression, or anxiety differed by PD symptomatology subtype.

Methods: Two hundred fifty-three caregivers ( age = 59.9) completed Parts I and II of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Zarit Burden Interview, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scales.

Results: Cluster analysis using domains from the MDS-UPDRS revealed 5 symptomatology subtypes: pain/motor predominant, low symptoms, severe diffuse symptoms, moderate restricted symptoms with speech/oral predominant, and mood predominant. Caregiver burden was greatest for caregivers of individuals in the severe diffuse symptom and moderate restricted symptoms with speech/oral predominant clusters. High caregiver depression and caregiver anxiety were observed in all clusters other than the low symptoms cluster. There were no site by cluster interactions, suggesting that symptom patterns contribute to caregiver functioning in similar ways in the U.S. and Mexico.

Conclusions: This data-driven analysis revealed 5 symptomatology subtypes of PD from caregivers' perspectives and highlighted the need for treatments and interventions based on predominant PD symptom expression. Importance of caregiver support across various symptomatology expressions, and particularly on specialist treatment for predominant speech/oral difficulties was recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/08919887211049146DOI Listing
September 2021

Psychometric investigation of the affiliate stigma scale in Mexican Parkinson's disease caregivers: Development of a short form.

NeuroRehabilitation 2021 Aug 13. Epub 2021 Aug 13.

Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.

Background: Parkinson's disease (PD) caregivers, particularly in Latin America, may experience high levels of affiliate stigma due to their association with a person having a disability. The most common measure used of this construct in the literature, the Affiliate Stigma Scale, was validated using non-standard and questionable methods.

Objective: The purpose of this study was to investigate the factor structure and psychometric properties of the Spanish version of the Affiliate Stigma Scale with PD caregivers in Mexico using more widely accepted psychometric approaches including confirmatory and exploratory factor analyses (confirmatory factor analyses (CFAs) and exploratory factor analyses (EFAs)).

Methods: A sample of 148 PD caregivers from Mexico completed this measure, as well as indices of caregiver burden and anxiety.

Results: Initial CFAs revealed that the data did not fit either the originally proposed one-factor or three-factor structures. An EFA was then conducted which was unable to discern any factor structure. Upon instituting a stepwise removal alpha-if-item-deleted process, a 5-item Affiliate Stigma Scale Spanish Short Form was retained with an adequate Cronbach's alpha, good convergent validity, and a Short Form CFA generally indicating adequate fit.

Conclusions: The new Spanish Affiliate Stigma Scale Short Form holds promise for more appropriately measuring affiliate stigma likely in general but particularly in Spanish and among PD caregivers. The Short Form can assist not only in assessing levels of caregiver affiliate stigma, but in creating novel interventions to help support caregivers and decrease stigma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/NRE-210105DOI Listing
August 2021

Parkinson's Symptoms and Caregiver Affiliate Stigma: A Multinational Study.

Curr Alzheimer Res 2021 ;18(3):222-231

Hospital Civil Fray Antonio Alcalde, University of Guadalajara, Americana, 44160 Guadalajara, Jal., Mexico.

Background And Objective: Research has documented the stigma that individuals with degenerative neurological diseases experience, but caregivers also experience stigma by association (i.e., affiliate stigma). In order to shed light on the stigma of caregivers of people with degenerative neurological diseases, the current study aimed to explore cross-cultural differences in the prevalence of Parkinson's disease (PD) caregiver affiliate stigma, as well as the relationship between PD symptoms and caregiver affiliate stigma. Applications for Alzheimer's disease are discussed.

Methods: Survey data were collected in PD clinics at public, academic medical centers. Informal caregivers of an individual with PD from the US (n = 105) and from Mexico (n = 148) participated in the study. Caregivers completed a questionnaire that included the MDS Unified PD Rating Scale to describe the symptoms of the individual with PD, as well as the Affiliate Stigma Scale and demographic information.

Results: A series of multiple regressions was run to examine whether PD symptoms were associated with affiliate stigma and if these differed by country. These regressions suggested that different patterns of PD symptoms predicted affiliate stigma in each country. Stigma was higher in the US compared to Mexico, and the relationship between bowel/bladder symptoms and affiliate stigma was significantly stronger in the US.

Conclusion: Symptoms of individuals with neurodegenerative diseases are related to affiliate stigma experienced by caregivers, and these relationships may differ cross-culturally. Negative public attitudes concerning bowl and bladder issues and the physical symptoms that accompany PD remain a source of stigma for caregivers and families, particularly in the US. Interventions for caregivers of individuals with neurodegenerative diseases should include strategies for coping with stigma concerning bladder and bowel problems, as well as other physical and mental health issues.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1567205018666210608100917DOI Listing
December 2021

Parkinson's family dynamics and caregiver sense of coherence: A family-systems approach to coping in Mexico and the United States.

Aging Med (Milton) 2020 Dec 26;3(4):252-259. Epub 2020 Oct 26.

Department of Neurology Parkinson's & Movement Disorders Center Virginia Commonwealth University Richmond Virginia United States.

Objective: The population of individuals with Parkinson's disease (PD) is growing in Mexico and the United States, and there is an increasing need for family members to provide caregiving. This study examined the connections between family dynamics and coping, or sense of coherence, among PD caregivers in Mexico (n = 148) and the United States (n = 105).

Methods: Caregivers completed measures of family dynamics and sense of coherence across indices of comprehensibility, manageability, and meaningfulness.

Results: Although caregivers in Mexico and the United States had similar levels of sense of coherence and family dynamics reflecting strengths/adaptability and being overwhelmed with difficulties, caregivers in Mexico had worse disrupted communication. Family dynamics explained: 24.2% of the variance in caregiver comprehensibility in the United States and 17.5% in Mexico; 34.1% in manageability in the United States and 23.5% in Mexico; and 22.6% in meaningfulness in the United States and 22.7% in Mexico (all s < 0.001). In both Mexico and the United States, family strengths/adaptability uniquely predicted caregiver comprehensibility, manageability, and meaningfulness. Being overwhelmed with difficulties uniquely predicted comprehensibility in Mexico and manageability and meaningfulness in the United States.

Conclusion: The development of family-systems interventions for PD caregivers to improve family strengths/adaptability and help families deal with difficulties may increase caregiver coping.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/agm2.12130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771559PMC
December 2020

The Translational Approaches to Personalized Health Collaborative: Pharmacogenomics for African American Older Adults.

Clin Transl Sci 2021 03 7;14(2):437-444. Epub 2020 Oct 7.

Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA.

Older adults (i.e., 60 years and older), are the leading consumers of medications, and consequently are suffering the most from medication-related adverse events. Not only are older adults the largest consumers of medications, they are more likely to experience an adverse drug event contributing to increased hospitalization, utilization of emergency medical services, and mortality. Translational Approaches to Personalized Health (TAPH) is a transdisciplinary team of researchers conducting community-engaged participatory research focused on the discovery and translation of pharmacogenomic (PGx) data to improve health outcomes. Underserved and ethnically diverse older adults living in urban settings are significantly under-represented in PGx studies. To address the issue of under-representation, our study enrolls older African American adults into a community-based PGx study. Therefore, we will characterize the frequency of actionable PGx genotypes and identify novel PGx response genes in our cohort of older community dwelling African Americans. The translational component of our work is to use the PGx findings to improve therapeutic outcomes for medication management in older adults. Such findings will serve as a foundation for translational PGx studies aimed at improving medication efficacy and safety for older adults. In this article, we describe the process for launching the TAPH collaborative group, which includes the transdisciplinary team, community-engaged participatory research model, study measures, and the evaluation of PGx genes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cts.12885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993264PMC
March 2021

Sleep, caregiver burden, and life satisfaction in Parkinson's disease caregivers: a multinational investigation.

Disabil Rehabil 2020 Sep 11:1-7. Epub 2020 Sep 11.

Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.

Purpose: The primary aim of this study was to examine the pattern of associations among PD patient and caregiver sleep problems, caregiver burden, and caregiver life satisfaction. A secondary aim was to assess whether the pattern of associations differed between Mexican and U.S. caregivers.

Materials And Methods: Analyses were performed on data obtained from 253 caregivers ( age = 59.92). A composite score was produced for caregiver and patient sleep problems. The Zarit Burden Interview and Satisfaction with Life Scale measured caregiver burden and life satisfaction, respectively. A structural equation model with an invariance design was developed to examine and compare the pattern of associations.

Results: The model was generally invariant across U.S. and Mexican caregivers. Three significant indirect effects were found: caregiver sleep problems were negatively associated with life satisfaction via caregiver burden ( = 0.003); PD patient sleep problems were positively related to caregiver burden via caregiver sleep problems ( = 0.005) and life satisfaction caregiver burden and caregiver sleep problems ( = 0.002).

Conclusions: PD patient sleep problems were associated with caregiver sleep problems, leading to increased burden in caregivers and poorer life satisfaction. The findings highlight a potential opportunity for empirically supported sleep interventions.Implications for rehabilitationParkinson's disease is a progressive neurological condition that impacts patient and caregiver quality of life.Patient sleep problems contribute to greater caregiver burden, sleep problems, and reduced life satisfaction.The findings suggest patient and caregiver sleep may be a worthwhile target for intervention in order to reduce risk of caregiver burden and improve life satisfaction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09638288.2020.1814878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947017PMC
September 2020

Shared mechanisms for cognitive impairment and physical frailty: A model for complex systems.

Alzheimers Dement (N Y) 2020 15;6(1):e12027. Epub 2020 Jul 15.

Laboratory of Neurogenetics National Institute on Aging National Institutes of Health Bethesda Maryland USA.

Introduction: We describe findings from a large study that provide empirical support for the emerging construct of cognitive frailty and put forth a theoretical framework that may advance the future study of complex aging conditions. While cognitive impairment and physical frailty have long been studied as separate constructs, recent studies suggest they share common etiologies. We aimed to create a population predictive model to gain an understanding of the underlying biological mechanisms for the relationship between physical frailty and cognitive impairment.

Methods: Data were obtained from the longitudinal " (Aging in Chianti, InCHIANTI Study) with a representative sample (n = 1453) of older adults from two small towns in Tuscany, Italy. Our previous work informed the candidate 132 single nucleotide polymorphisms (SNPs) and 155 protein biomarkers we tested in association with clinical outcomes using a tree boosting, machine learning (ML) technique for supervised learning analysis.

Results: We developed two highly accurate predictive models, with a Model I area under the curve (AUC) of 0.88 (95% confidence interval [CI] 0.83-0.90) and a Model II AUC of 0.86 (95% CI 0.80-0.90). These models indicate cognitive frailty is driven by dysregulation across multiple cellular processes including genetic alterations, nutrient and lipid metabolism, and elevated levels of circulating pro-inflammatory proteins.

Discussion: While our results establish a foundation for understanding the underlying biological mechanisms for the relationship between cognitive decline and physical frailty, further examination of the molecular pathways associated with our predictive biomarkers is warranted. Our framework is in alignment with other proposed biological underpinnings of Alzheimer's disease such as genetic alterations, immune system dysfunction, and neuroinflammation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/trc2.12027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362211PMC
July 2020

Cross-cultural differences in Parkinson's disease caregiving and burden between the United States and Mexico.

Brain Behav 2020 09 18;10(9):e01753. Epub 2020 Jul 18.

Master of Neuropsychology, Neurosciences Department, University of Guadalajara, Guadalajara, Mexico.

Introduction: Given the rapidly aging population in both the United States and Mexico, rates of Parkinson's disease (PD) are likely to rise in both countries, suggesting that the number of individuals providing informal care will also increase, and the healthcare system will have to consider the burden this places upon caregivers. Therefore, the purpose of the current study was to examine differences in PD caregiving and burden between the United States and Mexico.

Methods: Data were collected from PD caregivers in the Parkinson's Clinic at the Hospital Civil Fray Antonio Alcalde in Guadalajara, Mexico (N = 148) and the Parkinson's and Movement Disorders Center at Virginia Commonwealth University in Richmond, Virginia (N = 105) regarding caregiver demographics and self-reported burden.

Results: Despite considerably more time spent in caregiving duties, higher rates in unemployment or underemployment, and lower education levels, Mexican PD caregivers reported significantly less personal strain and role strain than did their United States counterparts. Even after controlling for these and other demographic differences between the two sites, the differences in caregiver burden remained.

Conclusions: Latino cultural values in Mexico encouraging the importance of caring for family members with PD and respecting elders may promote caregiving and even make it a point of cultural pride, helping to overcome potential negative effects on caregivers seen in the United States. The scientific and medical communities should view caregiving as a culturally embedded and potentially positive role, rather than predominantly as burdensome as frequently conceptualized in Western or Eurocentric cultures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/brb3.1753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507106PMC
September 2020

Sleep Disturbance Mediates the Association Between Loneliness and Health in Older Americans.

Int J Behav Med 2021 Feb;28(1):64-72

Department of Psychology, Virginia Commonwealth University, 806 West Franklin St, Richmond, VA, 23223, USA.

Background: As the research documenting loneliness as a risk factor for morbidity and mortality continues to grow, it becomes increasingly critical to understand the mechanics of this relationship. This study assessed whether sleep disturbance mediates the relationship between loneliness and health.

Method: Data came from the 2006, 2010, and 2014 waves of the Health and Retirement Study, a longitudinal study of older Americans; participants ≥ 65 who completed the Psychosocial and Lifestyle Questionnaire in 2006 were included (n = 5067). Measures include the Hughes loneliness scales, a modified version of the Jenkins sleep scale, and self-reported health. Cross-lagged mediation models (i.e., path analysis) were used to model the relationships between loneliness, sleep disturbance, and self-reported health over the 8-year span.

Results: Loneliness predicted subsequent sleep disturbance, which in turn predicted subsequent self-reported health. Moreover, there was evidence of both direct and indirect effects (via sleep disturbance) of loneliness on self-reported health. These effects remained after controlling for demographics, isolation, and depression.

Conclusion: Sleep disturbance partially mediates the relationship between loneliness and self-reported health over 8 years. These findings are not attributable to isolation or depression. Further research is necessary to develop and assess a more comprehensive model of how loneliness shapes health. This study indicates that targeting sleep disturbance may mitigate the health risks of loneliness in older Americans.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12529-020-09897-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680384PMC
February 2021

Structural Equation Modeling of Parkinson's Caregiver Social Support, Resilience, and Mental Health: A Strength-Based Perspective.

Neurol Res Int 2020 14;2020:7906547. Epub 2020 Feb 14.

Department of Neurosciences, University of Guadalajara, Guadalajara, Mexico.

Only scant literature has focused on social support in Parkinson's disease (PD) caregivers, and no studies to date have examined resilience in this population, despite both variables having been shown to be important in other caregiving populations. As a result, the purpose of the current study was to construct and validate a theoretical structural equation model whereby social support is associated with higher levels of resilience in PD caregivers and increased resilience is related to decreased mental health symptoms. Two hundred fifty three PD caregivers from two clinics in the United States and Mexico completed self-report measures of these constructs. Results suggested that the hypothesized pattern was robustly supported with the structural equation model showing generally good fit indices. Higher levels of social support were associated with increased resilience, which in turn was associated with reduced mental health symptoms. Resilience partially mediated social support's effect on mitigating mental health symptoms. The model explained 11% of the variance in resilience and 35% in mental health symptoms. These findings have implications for future research on the development and tailoring of interventions to improve social support, resilience, and mental health in PD caregivers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2020/7906547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042552PMC
February 2020

The relationship between Parkinson's disease symptoms and caregiver quality of life.

Rehabil Psychol 2020 May 17;65(2):137-144. Epub 2020 Feb 17.

Department of Psychology, Virginia Commonwealth University.

Objective: Caregivers for individuals with Parkinson's disease (PD) can experience high burden, which underlies the importance of examining the needs of caregivers to be able to support them in the caregiving role. The current study aims to assess the relationships among PD symptoms and four measures of caregiver quality of life (QOL; i.e., personal and social activities, anxiety and depression, self-care, and strain).

Method: Data from 181 caregiver/care recipient dyads ( = 362) were collected at a multidisciplinary PD clinic in a public, academic medical center in the southeastern United States at the time of the care recipient's first neuropsychological evaluation.

Results: All PD symptoms were positively correlated with each other, as were all forms of caregiver QOL, and all PD symptoms were associated with each measure of caregiver QOL. A series of regressions suggested that demographics and PD symptoms predicted all four types of caregiver QOL, explaining 33% of the variance in caregiver personal and social activities, 24% in anxiety and depression, 28% in self-care, and 36% in strain. Female caregivers and those who provided care to male care recipients generally had worse QOL. Greater PD-related symptoms including difficulties with mobility, decreased emotional well-being, and greater nonmotor functioning impairment were unique predictors of reduced caregiver QOL.

Conclusions: PD symptoms are robustly related to caregiver QOL, with mobility and nonmotor symptoms as the primary drivers of this relationship. Interventions for PD caregivers should include strategies for managing mobility and nonmotor symptoms, as well as their QOL effects on caregivers. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/rep0000313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195231PMC
May 2020

Parkinson's Symptoms and Caregiver Burden and Mental Health: A Cross-Cultural Mediational Model.

Behav Neurol 2019 1;2019:1396572. Epub 2019 Dec 1.

Hospital Civil Fray Antonio Alcalde, Mexico.

Informal caregivers are critical in the care of individuals with Parkinson's disease (PD) and spend substantial time providing care, which may be associated with negative caregiver outcomes such as burden and mental health issues. Although research in the United States and Europe has generally supported these relations, there is very limited research on PD caregiving in Latin America. The current study examined the following connections in a sample of PD caregivers from the United States ( = 105) and Mexico ( = 148): (a) PD-related impairments (motor and nonmotor symptoms) and caregiver burden, (b) caregiver burden and caregiver mental health, and (c) PD-related impairments and mental health through caregiver burden. Study results uncovered significant relations among PD-related impairments, caregiver burden, and caregiver mental health. Further, caregiver burden fully mediated the relation between PD-related impairments and caregiver mental health at both study sites. Findings highlight a number of important intervention targets for caregivers and families, including caregiver burden and mental health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2019/1396572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913294PMC
April 2020

Parkinson's family needs and caregiver mental health: A cross-cultural comparison between Mexico and the United States.

NeuroRehabilitation 2019 Dec;45(4):433-442

Master's of Neuropsychology, Neurosciences Department, University of Guadalajara, Guadalajara, Mexico.

Background/objective: Given the growing population of individuals with Parkinson's disease (PD) worldwide and the growing need for family members to take on a caregiving role, it is critical that cross-cultural differences be examined in order to better meet the needs of PD caregivers. The purpose of this study was to examine the connections between the unmet needs and mental health of PD caregivers differentially in Mexico and the United States.

Methods: In Parkinson's clinics at public, academic medical centers, PD caregivers from Mexico (n = 148) and the United States (n = 105) completed measures of unmet family needs and mental health.

Results: Caregivers in the United States had higher unmet needs for emotional support and for a community support network than caregivers in Mexico, although caregivers at the two sites had comparable levels of anxiety and depression. Unmet family needs explained 29.5% of the variance in caregiver anxiety in the United States (p < 0.001) but only 5.7% in Mexico (p = 0.209). Unmet family needs explained 30.4% of the variance in caregiver depression in the United States (p < 0.001) and 14.0% in Mexico (p = 0.001). In the United States, unmet needs for emotional support and for instrumental support uniquely predicted caregiver anxiety and depression, and in Mexico only the unmet need for instrumental support was a unique predictor.

Conclusions: PD caregivers in the United States are at increased risk for poor emotional and community support, and these unmet needs channel directly into caregiver anxiety and depression. In Mexico, where caregivers have stronger emotional and community support, caregivers' unmet need for instrumental support generates anxiety and depression. Important targets for PD caregiver interventions may differ between Mexico and the United States.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/NRE-192894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025758PMC
December 2019

Anticholinergic Drug Induced Cognitive and Physical Impairment: Results from the InCHIANTI Study.

J Gerontol A Biol Sci Med Sci 2020 04;75(5):995-1002

Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland.

Background: The aims of this study were to evaluate the relationship between anticholinergic drug burden (ACB) cognitive impairment, physical frailty, and cognitive frailty, and to determine if ACB is predictive of these phenotypes when modeled with biological and genomic biomarkers.

Methods: In a retrospective cohort study, a total of 1,453 adults aged 20-102 years were used to examine ACB as a predictor for cognitive impairment, physical frailty, and cognitive frailty. Anticholinergic burden is examined as a predictor for all phenotypes in a cross-sectional analysis using logistic, ordinal regression models, and Extreme Gradient Boosting for population predictive modeling.

Results: A significant association was found between ACB and cognitive decline (p = .02), frailty (p < .001), and cognitive frailty (p < .001). The odds of cognitive impairment increased by 1.21 (95% confidence interval [CI] = 1.06-1.37, p < .001), odds of being frail increased by 1.33 (95% CI = 1.18-1.50, p < .001), and odds of having cognitive frailty increased by 1.36 (95% CI = 1.21-1.54, p < .001). Population modeling results indicated ACB score as one of the stronger predictors for cognitive impairment, physical frailty, and cognitive frailty with area under the curves ranging from 0.81 to 0.88.

Conclusions: Anticholinergic medications are a potentially modifiable risk factor for the prevention of cognitive and physical decline. Identification of reversible causes for cognitive and physical impairment is critical for the aging population. These findings encourage new research that may lead to effective interventions for deprescribing programs for the prevention of cognitive and physical decline in older adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/gerona/gly289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357452PMC
April 2020

Training Neurodegenerative Disease Support Group Leaders: A New Support Group Functioning Scale.

Gerontol Geriatr Med 2018 Jan-Dec;4:2333721418811755. Epub 2018 Nov 20.

Virginia Commonwealth University, Richmond, USA.

Support group leaders play pivotal roles in maintaining healthy community support groups; however, these leaders also have personal support needs and typically lack formal training in managing complex behaviors of neurodegenerative disorders. A support group well-being questionnaire, assessing support group functioning, was developed and piloted among participants of an educational training program designed for support group leaders of various neurodegenerative disorder-specific support groups. An exploratory factor analysis evaluated the questionnaire's psychometric properties and identified a reliable single factor five-item solution, which was titled the Support Group Functioning Scale (SGFS). Preliminary interpretation guidelines were proposed. Development of this scale is a first step in identifying support group leaders' needs as they provide frontline assistance to caregivers and individuals with neurodegenerative illnesses. This tool shows promise as an efficient way to identify support groups in need of assistance and to assess the impact of trainings on support group functioning. Further validation of the scale is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2333721418811755DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247480PMC
November 2018

Randomized controlled expressive writing pilot in individuals with Parkinson's disease and their caregivers.

BMC Psychol 2015 Nov 30;3:44. Epub 2015 Nov 30.

Parkinson's and Movement Disorders Center, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA, 23298-0539, USA.

Background: Individuals with Parkinson's disease (PD) and their caregivers are at risk for emotional distress and hypercortisolism. Expressive writing is an effective complementary intervention to ameliorate the psychological and physiological effects of chronic illness. This pilot study aimed to evaluate feasibility and preliminary effectiveness of an expressive writing intervention for individuals with PD and their caregivers.

Methods: Individuals with PD (N = 27) and their caregivers (N = 14) were randomly assigned to expressive (N = 15 patients, eight caregivers) or neutral (N = 12 patients, six caregivers) writing conditions. Cortisol awakening response (CAR), non-motor functioning, quality of life, and performance on tests of cognitive functioning were assessed at baseline, immediate post, 4-month, and 10-month post intervention.

Results: Attrition was a challenge as eight patients (29.62 %) and four caregivers (28.57 %) chose to discontinue before beginning the intervention or were lost to follow up prior to completing the intervention or the first follow up visit. Significant reduction in anxiety, marginally significant improvement in depression and caregiver burden, and significant improvements in performance on tests of learning and memory were observed, but these changes did not differ by writing condition. CAR significantly differed over time between patients and caregivers and writing conditions.

Conclusions: Some evidence for the feasibility and effectiveness of writing to alleviate hypercortisolism was demonstrated in a small sample of PD patients; however, relatively high attrition rates and the lack of difference between expressive and neutral writing conditions on emotional and neurocognitive outcomes suggests expressive writing procedure modifications may be needed to obtain optimal results for this population.

Trial Registration: ClinicalTrials.gov, NCT02217735 , Study Start Date: August 30, 2011.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40359-015-0101-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4666161PMC
November 2015

The roles of resilience and nonmotor symptoms in adjustment to Parkinson's disease.

J Health Psychol 2016 12 6;21(12):3004-3015. Epub 2015 Jul 6.

Virginia Commonwealth University, USA.

Resilience contributes to better chronic disease adjustment but is understudied in Parkinson's disease. Although nonmotor symptoms affect quality of life, their effect on other aspects of Parkinson's disease adjustment is less understood. Hierarchical regression analyses from a cross-sectional survey of 138 community-dwelling adults with Parkinson's disease (mean (standard deviation) age = 64.15(10.09) years) investigated relationships between nonmotor symptoms and resilience on depression, apathy, life satisfaction, and quality of life. After controlling for demographic variables, functional status, and nonmotor symptoms, resilience was associated with all adjustment variables. Nonmotor symptoms were associated with depression and worse quality of life. Nonmotor symptoms and resilience appear to play critical roles in Parkinson's disease adjustment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1359105315590268DOI Listing
December 2016

Caregiver-identified needs and barriers to care in Parkinson's disease.

Geriatr Nurs 2015 May-Jun;36(3):197-201. Epub 2015 Mar 3.

Department of Psychology, Parkinson's and Movement Disorders Center, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA 23298-0539, USA.

Perceptions of service needs and barriers to care among caregivers of individuals with Parkinson's disease have not been well explored. The purpose of this study was to assess caregiver perceptions of their own and patients' medical and supportive service needs. An online and paper survey was disseminated to a sample of caregivers (n = 66) of individuals with Parkinson's disease. Although caregivers reported positive quality of life and adjustment to caregiving, nearly half of the sample endorsed feeling stressed about caregiving. Caregivers reported that services for symptom management, coping with changes in lifestyle, future planning, relationships, and cognition, and wellness strategies were most needed. Reported barriers to patients accessing care included limited service availability and a lack of insurance coverage for services. These findings suggest a need to improve access to services for patients and increased efforts to promote caregiver wellness at movement disorder specialty clinics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gerinurse.2015.01.002DOI Listing
April 2017

Exploring primary brain tumor patient and caregiver needs and preferences in brief educational and support opportunities.

Support Care Cancer 2015 Mar 14;23(3):851-9. Epub 2014 Sep 14.

Department of Neurology, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA, 23298-0539, USA.

Purpose: A primary brain tumor patient and caregiver survey was completed to investigate interest in brief support opportunities, focused on education, memory training, and healthy coping, during a routine clinical visit and at 3-month follow-up.

Methods: Patients with primary brain tumors receiving care in the Radiation Oncology Department at Mayo Clinic Rochester and their caregivers were recruited to complete the survey between June 2008 and September 2009.

Results: Both patients and their caregivers expressed greatest interest in education about brain tumors and cognitive effects of treatment. Interest in support opportunities targeting education, memory training, or healthy coping was low to modest. Bimodal distributions were found for almost all the support opportunities, revealing subgroups of patients and caregivers with high interest in such sessions. Overall, ratings of interest did not differ over time.

Conclusions: Patients with primary brain tumors and their caregivers expressed most interest in education about their disease and potential cognitive effects of treatment. It appears that subgroups of patients and caregivers have very high interest in brief support opportunities. Identifying these subgroups of patients and families will allow targeted interventions focused on their needs and make the best use of limited resources.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00520-014-2413-yDOI Listing
March 2015

Patient-reported Needs, Non-motor Symptoms, and Quality of Life in Essential Tremor and Parkinson's Disease.

Tremor Other Hyperkinet Mov (N Y) 2014 5;4:240. Epub 2014 Jun 5.

Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.

Background: Non-motor symptoms, quality of life, service needs, and barriers to care of individuals with movement disorders are not well explored. This study assessed these domains within a sample of individuals with essential tremor (ET) and Parkinson's disease (PD).

Methods: A survey exploring symptoms, needs, and barriers to care was disseminated to a convenience sample (N = 96) of individuals with a primary diagnosis of ET (N = 19) or PD (N = 77).

Results: Similarities in overall quality of life and impact on daily functioning were found across individuals with ET and PD. Noteworthy differences included endorsement of different types of service needs and utilization patterns and fewer non-motor symptoms reported among those with ET (M = 6.1, SD = 2.4) than those with PD (M = 10.4, SD = 3.4). Non-motor symptoms significantly impacted movement disorder-related quality of life for both diagnostic groups, but this relationship was stronger for individuals with ET, t(12) = 3.69, p = 0.003, β = 0.73 than with PD, t(56) = 4.00, p<0.001, β = 0.47. Individuals with ET also reported higher rates of stigma (31.6% vs. 7.8%) and greater impact of non-motor symptoms on emotional well-being, R (2) = 0.37, F(1, 13) = 7.17, p = 0.020.

Discussion: This is the first study to describe and compare the needs, barriers to care, and impact on quality of life of two distinct movement disorder groups. Our results support the recent efforts of the field to identify interventions to address the non-motor symptoms of movement disorders and indicate need for greater appreciation of the specific differences in symptoms and quality of life experienced across movement disorder diagnoses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7916/D8RF5S4JDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050172PMC
June 2014

Comparing neuropsychological tasks to optimize brief cognitive batteries for brain tumor clinical trials.

J Neurooncol 2010 Jan 19;96(2):271-6. Epub 2009 Jul 19.

Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Suite 150, Atlanta, GA 30322, USA.

Neuropsychological tests are increasingly being used as outcome measures in clinical trials of brain tumor therapies. This study informs development of brief neurocognitive batteries for clinical trials by identifying cognitive tasks that detect effects on a group level in a mixed brain tumor population. This is a retrospective study of brain tumor patients who completed a standardized battery sampling multiple cognitive domains using twelve subtests with widely-used task formats (the Repeatable Battery for the Assessment of Neuropsychological Status). Sixty-eight patients with brain tumors were studied (60% high-grade glioma). Forty patients (58.8%) were impaired (>2 standard deviations below published means) on at least one subtest. A combination of four subtests (Figure Copy, Coding, List Recognition, and Story Recall) captured 90% of the impaired subgroup. These results suggest visuoconstruction, processing speed, and verbal memory measures may be the most important domains to assess when evaluating cognitive change in brain tumor clinical trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11060-009-9960-yDOI Listing
January 2010

Challenges in the neuropsychological assessment of ethnic minorities: summit proceedings.

Clin Neuropsychol 2009 Jul;23(5):761-79

Neuropsychology Department, Duke University Medical Center, Durham, NC 27710, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13854040902881958DOI Listing
July 2009
-->