Biomedical subjects

D LoGiudice

Publications and source records attributed to D LoGiudice.

9 recordsLinked to original sources

PubMed2006

Kimberley Indigenous Cognitive Assessment tool (KICA): development of a cognitive assessment tool for older indigenous Australians.

BACKGROUND: Indigenous Australians have a unique cultural heritage dating back many thousands of years. Unfortunately, there is no validated tool to assess cognition in older indigenous Australians. This study was designed to address this deficiency. The Kimberley Indigenous Cognitive Assessment (KICA) was developed with Indigenous health and aged care organizations, and comprises cognitive, informant and functional sections. The psychometric properties of the cognitive assessment section (KICA-Cog) are described in this paper. METHODS: The KICA-Cog was tested in 70 indigenous subjects, of varying cognitive abilities and diagnoses, over 45 years of age. Subjects were interviewed using the KICA-Cog and then independently assessed by expert clinical raters using DSM-IV and ICD-10 criteria. Interrater and internal reliability were determined. RESULTS: The KICA-Cog score showed no systematic interrater difference; the mean was -0.07 (SD = 1.83). Interrater reliability for 16 individual questions from the cognitive section revealed a kappa-value > or = 0.6 and intraclass correlations for 12 questions. Internal consistency, as assessed by Cronbach's alpha, was 0.88. Three items on the cognitive score (pension week, recall and free recall) effectively discriminated 85-7% of dementia cases. Sensitivity and specificity were 90.6% and 92.6%, respectively, using a cut-off score of 31/32. CONCLUSIONS: The KICA-Cog appears to be a reliable assessment tool for cognitive impairment in an Australian older traditionally living indigenous population.

Adolescent↗

PubMed2005

Uncommon dementia and the carer's perspective.

There is much caregiving literature describing factors that affect carer burden, and interventions that may be useful for carers of those with common dementias such as Alzheimer's disease (AD). By contrast, relatively little information and few data are available on potentially diverse issues facing carers of those with uncommon dementias, such as frontotemporal dementia (FTD), Huntington's disease (HD) and human immunodeficiency virus (HIV) dementia. This paper highlights particular characteristics of caregiving for those with uncommon dementias, and the unique needs that may arise for this group of carers who often "fall between the net" of services and supports available. Further research into this area is required.

AIDS Dementia Complex↗

PubMed2002

Dementia: an update to refresh your memory.

The number of people with dementia and cognitive impairment is predicted to rise exponentially in the future. The increasing awareness of dementia in the community has led to a better understanding of the impact of this condition on individuals, their families and their carers. There is burgeoning research in the pathogenesis of dementia, and advances have been made in pharmacological treatments for the management of symptoms, including behavioural and psychological disturbances. However, the mainstay of management rests in comprehensive clinical assessment, education, counselling and provision of support for those affected and their families. The present paper provides a clinical update on recent advances in diagnosis and management of the most common forms of dementia.

Alzheimer Disease↗

PubMed2001

Equity of access to a memory clinic in Melbourne? Non-English speaking background attenders are more severely demented and have increased rates of psychiatric disorders.

OBJECTIVES: The aim of this study was to compare demographic and clinical features of patients from Non-English Speaking Background (NESB) with those from English Speaking Background (ESB) who attended a memory clinic in Melbourne, Australia. METHODS: Data on 556 consecutive patients attending the memory clinic were analysed retrospectively. All patients were assessed by a geriatrician (Italian speaking) or psychogeriatrician with the aid of Cambridge Examination for Mental Disorders in the Elderly (CAMDEX) interview schedule. Patients were classified into the categories of dementia, functional psychiatric disorder (including depression), cognitive impairment other than dementia and normal, using ICD 10 criteria. Severity of dementia was determined using the Clinical Dementia Rating scale. Demographic information and use of community services were also documented. RESULTS: Of those seen, 148 (28.8%) were of NESB, the majority Italian (69, 12.4%). Patients of NESB were younger (p = 0.001), less educated (p = 0.001) and less likely to live alone (p = 0.009) compared to persons of ESB. Those of NESB were more likely present with a functional psychiatric disorder (particularly depression) or normal cognition (p = 0.001). Patients of NESB with dementia presented at a later stage of their disease as determined by CDR (p = 0.003). Those of NESB scored significantly lower (more impaired) on CAMCOG in all patients seen (including normal and psychiatric groups) (p = 0.02). CONCLUSIONS: The clinical and demographic features of people of NESB referred to a memory clinic in Melbourne, Australia, differ from their ESB counterparts, with specific groups being under represented. This has implications for equity of assessment, service provision and utilisation for those of ethnically diverse backgrounds.

Aged↗

PubMed1999

Is it dementia?

BACKGROUND: Dementia is a disorder of memory and thinking, severe enough to interfere with a person's life. In the early stages of the disease, an accurate diagnosis may be difficult to make. OBJECTIVE: To outline the assessment of people who present with cognitive difficulties, and discuss important conditions which may mimic dementia, and diagnostic criteria for dementia. DISCUSSION: The assessment of people with cognitive difficulties includes the exclusion of conditions such as depression, delirium and normal changes of ageing. The accurate diagnosis of dementia allows the institution of early and appropriate management and support of affected people and their families.

Aged↗

PubMed1999

Clinical testing in general practice. What is the evidence?

BACKGROUND: Evidence based medicine (EBM) is a term being used widely in reference to diagnostic tests and treatments. In EBM a test or a treatment is only utilised when there is solid evidence that the likelihood of benefit to the patient outweighs the risk of harm. However, EBM is rarely considered in the clinical aspects of medicine: history taking and examination. In looking for clinical signs doctors need to consider the accuracy of those signs and the implications that false negative or false positive results will have for their patient. OBJECTIVE: The issues of sensitivity and specificity of clinical medicine are explored via the example of dementia testing in general practice. DISCUSSION: The article demonstrates that although two commonly used screening tests for dementia have a high sensitivity (75%) and specificity (70%), there is little benefit in the routine use of these assessments for screening in general practice. Clues from appropriate history taking may be of greater diagnostic use.

Dementia↗

PubMed1998

The psychosocial health status of carers of persons with dementia: a comparison with the chronically ill.

This project aimed to determine overall psychosocial health (measured using the psychosocial dimension of the Functional Limitations Profile) and factors which influence this in a group of carers of those with dementia and to compare their psychosocial health with that of older people attending general practitioners (GPs); arthritis support groups and a pain clinic (out-patients) and a group of community dwellers undergoing renal dialysis. The carer group showed a significant decrease in recreation and pastimes and social interactions compared to older GP attenders. The carers showed similar restrictions in social interactions and recreation to those with chronic arthritis, but the latter were more impaired in the domains of emotional behaviour and sleep and rest. The older people attending a pain clinic did not differ in the areas of alertness and social interactions compared to the carer group. The dialysis group demonstrated the greatest dysfunction overall. These results suggest that the psychosocial health of carers of those with dementia is impaired, the profile of which differs from those suffering with chronic diseases. Social and recreation activities appear most affected in the carers. Commensurate with studies exploring the health status of those suffering from diseases, the measurement of the psychosocial health status of carers should also be considered in the scope of assessment and intervention.

Analysis of Variance↗

PubMed1997

Health care costs of people referred to an aged care assessment team: the effect of cognitive impairment.

The aim of this study was to determine the effect cognitive impairment has on direct and indirect costs to elderly people, their carers and the community over one year, by following prospectively a cohort of elderly people referred to an aged care assessment team. The 78 subjects were drawn from a random sample of people referred to the NorthWest Hospital team, and validated tools were used to assess their cognitive state. Outcome measures included total costs of community services, residential care, hospital bed use, carer burden and psychological morbidity. A comparison of outcome measures was made between those with cognitive impairment and those without. Use of community services and hospital beds was high overall. Those with cognitive impairment were substantially greater users of residential care, accounting for the higher expenditure in this group. Psychological morbidity and burden remain high in carers of those with cognitive impairment despite a high rate of institutionalisation in this group. The total costs for those referred to aged care assessment teams with cognitive impairment are double those seen for those with normal cognition.

Aged↗

PubMed1995

Prevalence of dementia among patients referred to an aged care assessment team and associated stress in their carers.

The objective of this study was to determine the prevalence of dementia among patients referred to an aged care assessment team and to compare levels of burden and psychological morbidity between carers of cognitively normal persons and carers of people with dementia, in this population. Validated cognitive tests were administered to participants drawn from a random sample of all persons referred to the North West Hospital Aged Care Assessment Team, and diagnoses of dementia were made according to ICD-10 criteria. Available carers were assessed for psychological morbidity and burden with the General Health Questionnaire and the Zarit Family Burden Interview. Of 100 patients selected, 78 were assessed, of whom 34 (44 per cent) were cognitively normal and 34 (44 per cent) fulfilled ICD-10 criteria for dementia. A further 8 (10 per cent) had cognitive impairment not meeting the criteria for dementia. There was a high level of psychological morbidity and burden among the carers of both the cognitively normal patients and the dementia sufferers, which was largely accounted for by the patients' physical disability. This has implication for the adequate provision of health care and services to both patients and carers of this population. Adequate education of members of aged care assessment teams in the identification of dementia and their ability to refer to appropriate dementia-specific services and provide counselling for carers requires future planning.

Activities of Daily Living↗