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The efficacy and feasibility of neuropsychological services in a primary care setting.
Title
The efficacy and feasibility of neuropsychological services in a primary care setting.
Creator
Herring, Danielle, Paulson, Daniel, Sherod, Megan, Blaney, Cerissa, Cannarozzi, Maria, University of Central Florida
Abstract / Description
Integrated primary care assimilates psychologists into the primary care setting, thus improving health outcomes and physician satisfaction. Neuropsychology has also begun to assimilate into primary care, as neurocognitive impairment is a correlate of many medical disorders. Subjective cognitive decline (SCD), a common complaint among older adults, is an increasingly recognized warning sign of non-normative cognitive aging. These patients typically present first to their primary care providers...
Show moreIntegrated primary care assimilates psychologists into the primary care setting, thus improving health outcomes and physician satisfaction. Neuropsychology has also begun to assimilate into primary care, as neurocognitive impairment is a correlate of many medical disorders. Subjective cognitive decline (SCD), a common complaint among older adults, is an increasingly recognized warning sign of non-normative cognitive aging. These patients typically present first to their primary care providers who may play a critical role in the early detection of cognitive impairment. Given the growing awareness about cognitive health and disability, the importance of neuropsychological assessment as a standard component of integrated care has been recognized by providers. Thus, the purpose of this study is to examine the efficacy and feasibility of neuropsychological services, for memory concerns, in a community primary care setting. The study also explored the relationship between SCD and performance on neurocognitive measures and satisfaction levels for both patient participants and medical providers. A total of 16 patient participants completed the study. On average, patients were in their late-60's and mostly female and Caucasian. Participants completed a brief interview, neurocognitive evaluation, self-report measures of SCD and mood, and satisfaction survey. Results did not reveal significant correlations between SCD and neurocognitive performance. Significantly more referrals were made to the onsite neurocognitive clinic, than were made for outside services in a nine-month period preceding the described program. Patients referred to the onsite clinic were also significantly more likely to have an accessible report located in their EMR than those referred offsite. Both participants and medical providers were reportedly satisfied with clinic services. Results suggest that a clinic of this nature has promising benefits and is well-liked by both patients and providers, though barriers related to full utilization of services remain a challenge. Further research with a larger, more diverse sample is recommended. ?
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Date Issued
2019
Identifier
CFE0007653, ucf:52508
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0007653
The Longitudinal Relationship between Moderate Alcohol Use and Cognitive Aging among Older Adults.
Title
The Longitudinal Relationship between Moderate Alcohol Use and Cognitive Aging among Older Adults.
Creator
Herring, Danielle, Paulson, Daniel, Renk, Kimberly, Lighthall, Nichole, University of Central Florida
Abstract / Description
Cognitive aging appears inconsistent across cognitive domains, indicating that domains may not all decline at the same rate across individuals. Individual trajectories of cognitive aging can vary widely and are affected by numerous lifestyle and health factors. Alcohol use among older adults is known to confer both health risks, typically related to excessive use, and protective effects, often associated with moderate consumption. Moderate alcohol use has been linked with better cognitive...
Show moreCognitive aging appears inconsistent across cognitive domains, indicating that domains may not all decline at the same rate across individuals. Individual trajectories of cognitive aging can vary widely and are affected by numerous lifestyle and health factors. Alcohol use among older adults is known to confer both health risks, typically related to excessive use, and protective effects, often associated with moderate consumption. Moderate alcohol use has been linked with better cognitive functioning as well as a decrease in cardiovascular mortality and systemic inflammation, as compared to heavy or abstinent users. Given that extant research has identified C-reactive protein (CRP) as a mediator between the relationship of moderate alcohol use and cardiovascular disease mortality, this study examined the potential mediating role of CRP between moderate alcohol use and cognitive performance in later life. Therefore, the primary goals of this thesis were to: (1) examine the relationship between moderate alcohol use and cognitive aging over time in a demographically representative, longitudinal survey of Americans over the age of 65, and (2) examine a potential biological mechanisms by which this putative relationship functions. The sample utilized for this study consisted of the ADAMS sample of the Health and Retirement Study (HRS), a longitudinal, cohort-style study on health, retirement, and aging conducted by the University of Michigan and supported by the National Institute of Aging. In order to assess the effect of moderate alcohol use as related to the rate of change in cognitive performance over time, a series of slope-intercept models were run. Logistic regressions and Kaplan-Meier survival analysis were used to examine predictors of dementia risk and time-to-diagnosis. Results indicated that moderate alcohol use was significantly associated with better baseline functioning across cognitive measures (p ?.05), but had no significant effect on rate of change over time. Next, structural equation models were employed to examine the effect of alcohol use on cognitive performance as mediated by CRP within each domain. Ultimately, results from this study did not support the hypothesized models. Following this, a logistic regression and survival analysis were conducted in order to assess the effect of moderate alcohol use on dementia diagnosis. Results of these analyses indicated that moderate users of alcohol develop dementia at lower rates, and later in life, than do abstinent older adults. Lastly, a structural equation model was run to evaluate the effect of alcohol use on dementia diagnosis as mediated by CRP. Primary findings did not support the hypothesized model. Overall, findings from this study suggest that moderate alcohol use is associated with better cognitive functioning among community-dwelling older adults, and these relative benefits appear to persist throughout later life. Moderate alcohol use may also be related to a slower rate and onset of dementia development. Future research should investigate alternate biological mechanisms relating moderate alcohol use and cognitive functioning in later life.
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Date Issued
2016
Identifier
CFE0006460, ucf:51432
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0006460