Evidence for Grief as the Major Barrier Faced by Alzheimer Caregivers: A Qualitative Analysis1
Evidence for Grief as the Major Barrier Faced by Alzheimer Caregivers: A Qualitative Analysis
Feelings of loss and grief are frequent companions for current Alzheimer’s family caregivers. Increased acknowledgment and understanding of caregiver grief among researchers has led to more comprehensive explorations of the multifaceted nature of caregiver grief and loss. Absent from the literature, however, is an exploration of anticipatory grief as an actual barrier to the task of caregiving. Through an analysis of 353 open-ended survey responses, the present article explores links between anticipatory grief, ambiguous loss, and principal barriers that family members face as dementia caregivers across the state of Indiana. By drawing parallels between caregiver responses and the Marwit-Meuser Caregiver Grief Inventory subscales, this article illustrates that the fundamental barrier experienced by current Alzheimer’s caregivers appears to be a combination of anticipatory grief and ambiguous loss rather than hands-on care issues. The implications of this finding for future caregiver research and interventions are discussed.
Addressing the Looming Alzheimer’s Crisis
A few weeks ago, I posted a blog about the prediction that 10 million U.S. baby boomers will develop Alzheimer’s disease. Because this crisis threatens to bankrupt Medicare and Medicaid…
Role of Insulin Metabolism Disturbances in the Development of Alzheimer Disease: Mini Review
Alzheimer disease (AD) is the most common form of dementia. Different pathogenic processes have been studied that underlie characteristic changes of AD, including Aβ protein aggregation, tau phosphorylation, neurovascular dysfunction, and inflammatory processes. Insulin exerts pleiotropic effects in neurons, such as the regulation of neural proliferation, apoptosis, and synaptic transmission. In this setting, any disturbance in the metabolism of insulin in the central nervous system (CNS) may put unfavorable effects on CNS function. It seems that disturbances in insulin metabolism, especially insulin resistance, play a role in most pathogenic processes that promote the development of AD. In this article, the relationships of disturbances in the metabolism of insulin in CNS with Aβ peptides aggregation, tau protein phosphorylation, inflammatory markers, neuron apoptosis, neurovascular dysfunction, and neurotransmitter modulation are discussed, and future research directions are provided.
There is little information regarding the usefulness of the Mini-Mental State Examination (MMSE) for tracking progression of non-Alzheimer’s disease dementias. This study examined the utility of the MMSE in capturing disease severity in the behavioral variant frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA), 2 nonamnestic clinical dementia syndromes. Retrospective data from 41 bvFTD and 30 PPA patients were analyzed. bvFTD patients’ change in MMSE scores over time was significantly correlated with change over time on a measure of activities of daily living. In contrast, PPA patients’ MMSE scores showed greater decline over time than scores on the activities of daily living scale. Results suggest that the MMSE score, heavily dependent on language skill, overestimates dementia severity in PPA patients. However, the score may be a more accurate measure of functional impairment in bvFTD due to the influence of their executive function and attentional deficits on MMSE performance.
Integrating Patient and Informant Reports on the Cornell-Brown Quality-of-Life Scale
Patients with mild cognitive impairment and mild to moderate Alzheimer’s disease can provide information about their quality of life. This study determined whether aggregating patient and informant quality-of-life reports on the Cornell-Brown Scale for Quality of Life in Dementia can provide a broader perspective on the quality of life relative to patient or informant reports separately. Aggregated Cornell-Brown Scale for Quality of Life in Dementia scores were hypothesized to correlate more strongly with both patient and informant perspectives of patient’s memory, function, and neuropsychiatric symptoms than the unaggregated measures. Results indicated that aggregated Cornell-Brown Scale for Quality of Life in Dementia scores reflected a blend of patient and informant perspectives on patient function. This study contributes to a growing line of research that recommends integrating patient and informant perspectives to achieve the most complete assessment of quality of life.
Another Reason To Watch Your Cholesterol
New research reported at the American Academy of Neurology’s 60th Annual Meeting indicates that people in their early 40s who have high cholesterol are at an increased risk for developing…
Can You Have Dementia With an MMSE Score of 30?
Objective. To investigate the possibility that a patient with a diagnosis oF probable Alzheimer’s disease (AD) can still obtain a score oF 30/30 on the Mini-Mental State Exam (MMSE). Design. Chart review. Setting. The McGill University/Jewish General Hospital Memory Clinic. Participants. Participants were selected From the Memory Clinic’s patient database. All underwent comprehensive evaluations, including relevant blood work and a computed tomographic scan or a magnetic resonance imaging scan oF the brain to rule out other causes oF dementia. Measurements. All patients had one or more neuropsychological evaluation. Data oF all psychometric testing, including the MMSE, were gathered From these visits. Results. Eight patients were Found to meet the criteria oF AD although achieving a score oF 30/30 on the MMSE. Four oF 8 patients achieved this score although they were taking cholinesterase inhibitors. Conclusion. Although rare, it is possible to achieve a score oF 30/30 on the MMSE even iF a subject is suFFering From a dementing illness.