The need for improved cognitive, hearing and vision assessments for older people with cognitive impairment: a qualitative study.

BACKGROUND: Hearing and vision (sensory) impairments are highly prevalent in people with dementia (PwD) and exacerbate the impact of living with dementia. Assessment of sensory or cognitive function may be difficult if people have concurrent dual or triple impairments. Most standard cognitive assessment tests are heavily dependent on having intact hearing and vision, and impairments in these domains may render the assessments unreliable or even invalid. Likewise, dementia may impede on the accurate reporting of symptoms that is required for most hearing and vision assessments. Thus, there is an urgent need for hearing, vision and cognitive assessment strategies to be adapted to ensure that appropriate management and support can be provided. OBJECTIVE: To explore the perspectives of PwD and the care partners regarding the need for accurate hearing, vision and cognitive assessments. METHODS: We conducted focus groups and semi-structured interviews regarding the clinical assessment for cognitive, hearing and visual impairment. Participants (n = 18) were older adults with mild to moderate dementia and a sensory impairment as well as their care partners (e.g. a family member) (n = 15) at three European sites. The qualitative material was analysed according to Mayring's summative content analysis approach. RESULTS: Participants reported that hearing, vision and cognitive assessments were not appropriate to the complex needs of PwD and sensory comorbidity and that challenges in communication with professionals and conveying unmet needs and concerns by PwD were common in all three types of clinical assessments. They felt that information about and guidance regarding support for the condition was not adequate in the assessments and that information sharing among the professionals regarding the concurrent problems was limited. Professionals were reported as being concerned only with problems related to their own discipline and had limited regard for problems in other domains which might impact on their own assessments. CONCLUSIONS: The optimal assessment and support for PwD with multiple impairments, more comprehensive, yet easy to understand, information regarding these linked to conditions and corrective device use is needed. Communication among health care professionals relevant to hearing, vision and cognition needs to be improved.

Cognitive-Linguistic Performance and Quality of Life in Healthy Aging.

BACKGROUND/AIMS: This study investigated quality of life (QoL) in relation to cognitive-linguistic performance and demographic characteristics (age, education and gender) in a large cohort of cognitively healthy older adults. METHOD: A total of 578 Greek-Cypriots aged 60-91 years were recruited from the Neurocognitive Study on Aging. Of those, 395 healthy participants (171 males and 224 females) who met all study criteria were retained. They completed measures of executive functioning, working memory, receptive vocabulary and confrontational naming in addition to the WHOQOL-BREF (brief version of the WHO QoL questionnaire). RESULTS: There were modest but significant relationships between executive functioning, working memory, vocabulary measures and the WHOQOL-BREF (p < 0.01). MANOVA yielded significant gender and education effects on QoL. Sequential stepwise regression confirmed that gender, depression scores and years of education made significant contributions to predicting the total score on WHOQOL-BREF and accounted for 31% of the variance (R² = 0.310). CONCLUSION: Self-reports of QoL remain stable in older adulthood. Demographic variables such as gender and years of education affected several domains of QoL, and, along with depression symptomatology, accounted for a significant part of the WHOQOL-BREF variance. Cognitive-linguistic measures correlated on the physical and psychological health domains of the WHOQOL-BREF in healthy older adults.

The effects of age and education on executive functioning and oral naming performance in greek cypriot adults: the neurocognitive study for the aging.

BACKGROUND/AIMS: Age, educational experiences, language and culture can affect linguistic-cognitive performance. This is the first systematic study investigating linguistic-cognitive aging in Greek Cypriot adults focusing on executive functioning (EF) and oral naming performance. METHOD: Three hundred and fifty-nine participants were included, a group of young-old, aged 60-75 years (n = 231), and a group of old-old participants, aged 76 years and older (n = 128). Participants in each age group were divided into three education groups: 0-4 years (n = 50), 5-9 years (n = 198), and 10 years of education and higher (n = 111). Participants were administered 5 measures of EF along with measures of receptive vocabulary and confrontational naming. RESULTS: There was a significant relationship between the EF composite score and all language measures. MANOVA (α = 0.05) indicated significant age and education effects on most measures of EF and language. Performance on receptive vocabulary and cognitive shift remained stable across age groups, but was mediated by education. CONCLUSION: Education plays a significant role on all measures requiring semantic organization, speed of information processing, cognitive shift, mental flexibility, receptive vocabulary and confrontational naming. Furthermore, strategic thinking has a role in semantic knowledge, word retrieval and semantic access in healthy aging. We conclude with clinical implications and assessment considerations in aphasia.