Marie-Jeanne Kergoat

Université de Montréal, Montréal, Quebec, Canada

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Publications (60)168.53 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The growing interest in early-onset dementia has attracted attention to the situation and experiences of the caregiver, most often the spouse. Several qualitative studies on caregiving spouses have underlined the importance of the feeling of loss, the change of role reported by the caregiving spouses, and the strategies used to protect the person with dementia, all of which raise the question of the relational dynamics at play in these dyads. The present study on 16 couples examines the experiences of each partner, as well as the kinds of interactions taking place within the dyad and how they have evolved since the disease began.
    Dementia (London, England). 10/2014;
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    ABSTRACT: The objective was to evaluate the eye care services offered to older residents living in long-term care facilities (LTCFs).
    Canadian geriatrics journal : CGJ. 09/2014; 17(3):108-13.
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    ABSTRACT: Background: Booster sessions as a means of maintaining the benefits of psycho-educational programs have received little attention in caregiving research. Caregivers were offered a booster session following participation in a program entitled Learning to Become a Family Caregiver (LBFC) intended to facilitate transition to the caregiver role after diagnostic disclosure of dementia in a relative. The 90-minute booster session served to review program content and afforded the opportunity to discuss and practice learned skills. This study sought to test the efficacy of the booster session in maintaining or recovering program effects at six months post-program. Method: Participants in the program were randomly assigned to a group that received the booster session (n = 31) or a group that did not (n = 29). A third control group was also formed, which continued to receive only the usual care provided in memory clinics. Eligible participants - French-speaking primary caregivers of a relative diagnosed with Alzheimer's in the past nine months - were recruited in memory clinics in Quebec (Canada). Participants were blindly assessed before randomization and six months after the booster session on outcomes associated with a healthy role transition. Results: Prediction analyses revealed one significant positive effect of the booster session: emergence of preparedness to provide care. Moreover, with or without the booster session, the program continued to have a positive effect on psychological distress and contributed to the emergence of self-efficacy in dealing with caregiving situations. The booster session had no significant effect on knowledge of services, planning for future care needs, use of reframing as a coping strategy, perceived informal support, and family conflicts. Conclusion: The limited effect observed is discussed in terms of the booster session's content and intensity. Recommendations are made for designing future research on the effect of booster sessions, including the importance of including a placebo booster group.
    Aging and Mental Health 06/2014; · 1.68 Impact Factor
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    ABSTRACT: The aim of this study was to examine the association between physical functioning and cardiovascular burden on the cognitive performance of community-dwelling older adults. Ninety-three adults aged 60 and older completed a medical evaluation by a geriatrician, performance-based physical tests, and neuropsychological assessments. Cognitive composite scores (memory, speed, and executive) as well as a physical functioning score were created by averaging standardized z-scores of selected tests. A cardiovascular burden index was also computed by totalling the number of cardiovascular risk factors and diseases. Multiple hierarchical regression analyses reveal that higher level of physical functioning was significantly associated with greater processing speed and better executive functions but was not associated with memory performance. These relations were independent of age, sex, and level of education. Cardiovascular burden was not significantly associated with any cognitive domain. These results suggest that cognition is related to simple performance-based physical tests and highlight the importance of intervention studies aimed at enhancing cognitive and physical functioning in older adults.
    The Journals of Gerontology Series B Psychological Sciences and Social Sciences 05/2014; · 3.01 Impact Factor
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    ABSTRACT: The phenomenon of early-onset dementia remains an under-researched subject from the perspective of health care professionals. The aim of this qualitative study was to document the experiences and service needs of patients and their family caregivers for optimal clinical management of early-onset dementia from the perspective of health care professionals. A sample of 13 health care professionals from various disciplines, who worked with individuals who suffered from Alzheimer’s disease or related disorders and their family caregivers, took part in focus groups or semi-structured individual interviews, based on a life course perspective. Three recurrent themes emerged from the data collected from health care professionals and are related to: 1) identification with the difficult experiences of caregivers and powerlessness in view of the lack of services; 2) gaps in the care and services offered, including the lack of clinical tools to ensure that patients under age 65 were diagnosed and received follow-up care, and 3) solutions for care and services that were tailored to the needs of the caregiver-patient dyads and health care professionals, the most important being that the residual abilities of younger patients be taken into account, that flexible forms of respite be offered to family caregivers and that training be provided to health care professionals. The results of this study provided some innovative guidelines for optimal clinical management of early-onset dementia in terms of the caregiver-patient dyad.
    Advances in Alzheimer's Disease. 03/2014; 3:33-43.
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    ABSTRACT: Objective: The primary aim of this study was to identify cognitive tests that differentiate between persons with mild cognitive impairment (MCI) who later develop cognitive decline and those who remain stable. Method: This study used a prospective longitudinal design. One hundred twenty-two older adults with single-domain or multiple-domain amnestic MCI were recruited from memory clinics. They completed tests to measure baseline episodic memory, working memory, executive functions, perception, and language. They were then followed annually to determine with criteria independent from those tests whether they had remained stable or had developed dementia or significant cognitive decline. This was used as the reference standard to measure diagnostic test accuracy value. Results: ANOVAs indicated that participants with progressive MCI showed more impaired performance than those with stable MCI at baseline on episodic memory (word and story recall), the Brown-Peterson working memory test, object naming, object decision, and position of gap test. Logistic regression derived a significant model with 87.8% overall predictive value. The model included delayed text memory, free recall, naming, orientation match, object decision, and alpha span. Its sensitivity was 86.2% and its specificity was 88.9%. Positive predictive value was 83.3%, and negative predictive value was particularly high at 90.9%. Conclusions: Identifying individuals with MCI who will progress to dementia or more severe cognitive impairment is a challenge. This study shows that cognitive measures provide valuable information regarding the predictive diagnosis of persons with MCI. Predictive accuracy of a cognitive battery might be optimized by selecting both memory and nonmemory measures. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Neuropsychology 03/2014; · 3.58 Impact Factor
  • The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 03/2014; 41(2):206-9. · 1.33 Impact Factor
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    ABSTRACT: The interRAI suite of assessment instruments can provide valuable information to support person-specific care planning across the continuum of care. Comprehensive clinical information is collected with these instruments, including disease diagnoses. In Canada, interRAI data holdings represent some of the largest repositories of clinical information in the country for persons with neurological conditions. This study examined the accuracy of the diagnostic information captured by interRAI instruments designed for use in the home care, long-term care and mental health care settings as compared with national administrative databases. The interRAI assessments were matched with an inpatient hospital record and emergency department (ED) visit record in the preceding 90 days. Diagnoses captured on the interRAI instruments were compared to those recorded in either administrative record for each individual. Diagnostic validity was examined through sensitivity, specificity and positive predictive value analysis for the following conditions: multiple sclerosis, epilepsy, Alzheimer's disease and other dementias, Parkinson's disease, traumatic brain injury, stroke, diabetes mellitus, heart failure and reactive airway disease. In the three large study samples (home care: n = 128,448; long-term care: n = 26,644; mental health: n = 13,812), interRAI diagnoses demonstrated high specificity when compared to administrative records, for both neurological conditions (range 0.80 -- 1.00) and comparative chronic diseases (range 0.83 -- 1.00). Sensitivity and positive predictive values (PPV) were more varied by specific diagnosis, with sensitivities and PPV for neurological conditions ranging from 0.23 to 0.94 and 0.14 to 0.77, respectively. The interRAI assessments routinely captured more cases of the diagnoses of interest than the administrative records. The interRAI assessment collected accurate information about disease diagnoses when compared to administrative records record within three months. Such information is likely relevant to day-to-day care in these three environments and can be used to inform care planning and resource allocation decisions.
    BMC Health Services Research 11/2013; 13(1):457. · 1.77 Impact Factor
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    ABSTRACT: Both diet quality and socioeconomic position (SEP) have been linked to age-related cognitive changes, but there is little understanding of how the socioeconomic context of dietary intake may shape its cognitive impact. We examined whether equal adherence to "prudent" and "Western" dietary patterns, identified by principal components analysis, was associated with global cognitive function [Modified Mini-Mental State Examination (3MS)] in independently living older adults with different SEPs (aged 68-84 y; n = 1099). The interaction of dietary pattern adherence with household income, educational attainment, occupational prestige, and a composite indicator of SEP combining all 3 was examined in multiple-adjusted mixed models over 3 y of follow-up in participants of the NuAge study (Quebec Longitudinal Study on Nutrition and Successful Aging). Adherence to the prudent pattern (vegetables, fruits, fish, poultry, and lower-fat dairy) was related to higher 3MS scores at recruitment only in the upper categories of income (B = 0.56; 95% CI: 0.11, 1.01), education (B = 0.44; 95% CI: 0.080, 0.80), or composite SEP (B = 0.37; 95% CI: 0.045, 0.70). High prudent pattern adherence was associated with less cognitive decline only in those with low composite SEP (B = 0.25; 95% CI: 0.0094, 0.50). Conversely, adherence to the Western pattern (meats, potatoes, processed foods, and higher-fat dairy) was associated with more cognitive decline (B = -0.23; 95% CI: -0.43, -0.032) only in those with low educational attainment. In summary, among individuals with equivalent diet quality, the magnitude and characteristics of the diet-cognition relationship depended on their socioeconomic circumstances. These results suggest that interventions promoting retention of cognitive function through improved diet quality would provide maximum benefit to those with relatively low SEP.
    Journal of Nutrition 08/2013; · 4.20 Impact Factor
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    ABSTRACT: Evidence is accumulating that vitamin K could have a role in cognition, especially in aging. Using data from the Québec Longitudinal Study on Nutrition and Successful Aging (NuAge), a cross-sectional analysis was conducted to examine the associations between vitamin K status, measured as serum phylloquinone concentrations, and performance in verbal and non-verbal episodic memory, executive functions, and speed of processing. The sample included 320 men and women aged 70 to 85 years who were free of cognitive impairment. After adjustment for covariates, higher serum phylloquinone concentration (log-transformed) was associated with better verbal episodic memory performances (F = 2.43, p = 0.048); specifically with the scores (Z-transformed) on the second (β = 0.47; 95% confidence interval [CI] = 0.13-0.82), third (β = 0.41; 95% CI = 0.06-0.75), and 20-minute delayed (β = 0.47; 95% CI = 0.12-0.82) free recall trials of the RL/RI-16 Free and Cued Recall Task. No associations were found with non-verbal episodic memory, executive functions, and speed of processing. Our study adds evidence to the possible role of vitamin K in cognition during aging, specifically in the consolidation of the memory trace.
    Neurobiology of aging 07/2013; · 5.94 Impact Factor
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    ABSTRACT: To date, few studies have examined the experience of spouse caregivers living with a person with early-onset dementia. Moreover, few support resources are offered to these family caregivers and fewer are still tailored to their unique trajectory. The aim of this qualitative study was to document the lived experience of spouse caregivers of young patients in order to inform the development of professional support tailored to their reality. A sample of 12 spouses of persons diagnosed with dementia before the age of 65 participated in semistructured interviews. Six themes emerged from their caregiver trajectories, namely, difficulty managing behavioral and psychological symptoms, long quest for diagnosis, nondisclosure to others and denial of diagnosis, grief for loss of spouse and midlife projects, difficulty juggling unexpected role and daily life responsibilities, and difficulty planning for future. Results open up innovative avenues for the development of interventions geared to facilitating role transition for these spouse caregivers.
    American Journal of Alzheimer s Disease and Other Dementias 07/2013; · 1.52 Impact Factor
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    ABSTRACT: Abstract Inpatient geriatric assessment units (GAUs) exist in Quebec, Canada, to deliver comprehensive, integrated care to older vulnerable patients. Most cases should be discussed at interprofessional meetings (IMs), but research has shown this not to be so for 39% of GAU patients. Consequently, a study was undertaken to (1) describe GAU team composition and (2) identify GAU and patient characteristics associated with case discussion at IMs at least once during a patient's stay. To this end, 877 hospitalization records from 44 GAUs were reviewed. Results showed most teams were composed of attending physicians, nurses, physical and occupational therapists, dietitians and social workers; 66% included clinical pharmacists and 43% liaison nurses. Multilevel modeling showed longer length of stay to be the strongest predictor of case discussion at an IM. Case discussion was also more likely for patients admitted via in- or inter-hospital transfer rather than via the emergency department, if the GAU included a liaison nurse, and if the GAU was not located in an urban area. In summary, case discussion at an IM depended more on how and where a patient was admitted than on the patient characteristics per se, suggesting that this is a matter of care organization.
    Journal of Interprofessional Care 06/2013; · 1.48 Impact Factor
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    ABSTRACT: BACKGROUND: Little is known about the needs of older home care clients with dementia or their key quality of care issues, including their use of pharmacotherapy for Alzheimer's disease. OBJECTIVES: The objectives of this study were to (1) describe the sociodemographic, psychosocial, and health characteristics of clients with dementia (relative to two control subgroups) from a population-based home care cohort; and, (2) determine the distribution and associated characteristics of cholinesterase inhibitor (ChEI) and/or memantine use among dementia clients overall and according to medication class, comorbid illness, and year of assessment. METHODS: This cross-sectional study included all home care clients aged 50 years or older assessed with the Resident Assessment Instrument-Home Care (RAI-HC) in Ontario, Canada from January 2003 to December 2010. Multivariable logistic regression models were used to identify factors associated with receiving a dementia medication (a ChEI and/or memantine). RESULTS: There were 104,802 (21.5 %) clients with a diagnosis of dementia, 92,529 (18.9 %) cognitively impaired clients without a dementia diagnosis, and 290,929 (59.6 %) cognitively intact clients. Relative to the comparison groups, dementia clients were more likely to have reported conflicts with others, a distressed caregiver, greater levels of cognitive and functional impairment, and to exhibit wandering, aggressive behaviors, anxiety, hallucinations or delusions, and swallowing problems. Approximately half of dementia clients were taking a dementia medication, most commonly donepezil. Characteristics most strongly associated with use of ChEI monotherapy included age greater than 64 (especially 75-84), absence of economic barriers, availability of a primary caregiver, year of assessment, moderate to severe cognitive impairment, relative independence in function, health stability, no depressive symptoms or hallucinations/delusions, no recent hospitalization, use of at least 9 medications, the absence of chronic health and neurological conditions, and the use of an antipsychotic or antidepressant. For combination therapy, strong positive associations were observed for younger age, year of assessment, increasing cognitive impairment, presence of a primary caregiver, male sex, absence of economic barriers, use of at least 9 medications, and various indicators of positive health status (e.g., stability in health, absence of chronic health and neurological conditions, and no recent hospitalization). The percentage of clients receiving ChEIs increased with cognitive impairment scores but declined slightly at the highest level of impairment, whereas the percentage receiving memantine increased with cognitive impairment level. The number and percentage of dementia clients receiving any pharmacotherapy increased during the study interval. CONCLUSIONS: We observed a relatively high prevalence of dementia-specific pharmacotherapy among Ontario long-stay home care clients as well as significant variation in utilization patterns by select sociodemographic, functional, and clinical characteristics, and over time. While physicians generally followed recommended guidelines regarding appropriate dementia pharmacotherapy, continued efforts to monitor practice patterns are required among vulnerable older adults across care settings.
    Drugs & Aging 04/2013; · 2.50 Impact Factor
  • 01/2013; interRAI., ISBN: 9781936065202
  • 01/2013; interRAI., ISBN: 9781622550050
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    ABSTRACT: OBJECTIVE: The evaluation of visual acuity (VA) in cognitively impaired older individuals may be limited by a reduced ability to cooperate or communicate. The objective of this research was to assess VA in older institutionalized individuals with cognitive impairment, including severe dementia, using various acuity charts. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Three groups of 30 participants each were recruited: (1) young participants; (2) older participants with no history of cognitive or communication disorders; and (3) older participants with cognitive impairment, including severe dementia, residing in long term care facilities. The Mini-Mental State Examination was performed for each institutionalized subject. VA was measured using 6 validated charts [Snellen, Teller cards, Early Treatment Diabetic Retinopathy Study (ETDRS)-letters, -numbers, -Patty Pics, -Tumbling Es] presented in random order. Nonparametric tests were used to compare VA scores between charts, after Bonferroni-Holm corrections for multiple comparisons. RESULTS: Participants in groups 1 and 2 responded to all charts. A large proportion of participants with dementia responded to all charts (n = 19), whereas only one did not respond to any chart. In group 3, VA charts with the lowest scores were the Teller cards (20/65) and Patty Pics (20/62), regardless of the level of dementia, whereas the highest VA scores were obtained with the Snellen (20/35) and ETDRS-letter (20/36) charts. Across all groups, the ETDRS-letter chart was the only one whose scores did not differ from those obtained with the standard Snellen chart. CONCLUSIONS: Visual acuity can be measured, and should at least be attempted, in older cognitively impaired individuals having a reduced ability to communicate.
    Journal of the American Medical Directors Association 12/2012; · 5.30 Impact Factor
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    ABSTRACT: PURPOSE: To examine whether patients with age-related macular degeneration (AMD), glaucoma, or Fuchs corneal dystrophy report limiting their activity due to a fear of falling as compared to a control group of older adults with good vision. METHODS: We recruited 345 patients (93 with AMD, 57 with Fuchs, 98 with glaucoma, and 97 controls) from the ophthalmology clinics of Maisonneuve-Rosemont Hospital (Montreal, Canada) to participate in a cross-sectional study from September, 2009 until July, 2012. Control patients who had normal visual acuity and visual field were recruited from the same clinics. Participants were asked if they limited their activity due to a fear of falling. Visual acuity, contrast sensitivity, and visual field were measured and the medical record was reviewed. RESULTS: Between 40 and 50% of patients with eye disease reported activity limitation due to a fear of falling compared to only 16% of controls with normal vision. After adjustment for age, gender, race, number of comorbidities, cognition, and lens opacity, the Fuchs groups was most likely to report activity limitation due to a fear of falling (OR=3.07, 95% CI 1.33, 7.06) followed by the glaucoma group (OR=2.84, 95% CI 1.36, 5.96) and the AMD group (OR=2.42 95% CI 1.09, 5.35). Contrast sensitivity best explained these associations. CONCLUSIONS: Activity limitation due to a fear of falling is very common in older adults with visually impairing eye disease. Although this compensatory strategy may protect against falls, it may also put people at risk for social isolation and disability.
    Investigative ophthalmology & visual science 11/2012; · 3.43 Impact Factor
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    ABSTRACT: Objectives.Frailty is a state of vulnerability associated with increased risks of fall, hospitalization, cognitive deficits, and psychological distress. Studies with healthy senior suggest that physical exercise can help improve cognition and quality of life. Whether frail older adults can show such benefits remains to be documented.Method.A total of 83 participants aged 61-89 years were assigned to an exercise-training group (3 times a week for 12 weeks) or a control group (waiting list). Frailty was determined by a complete geriatric examination using specific criteria. Pre- and post-test measures assessed physical capacity, cognitive performance, and quality of life. RESULTS: Compared with controls, the intervention group showed significant improvement in physical capacity (functional capacities and physical endurance), cognitive performance (executive functions, processing speed, and working memory), and quality of life (global quality of life, leisure activities, physical capacity, social/family relationships, and physical health). Benefits were overall equivalent between frail and nonfrail participants.Discussion.Physical exercise training leads to improved cognitive functioning and psychological well-being in frail older adults.
    The Journals of Gerontology Series B Psychological Sciences and Social Sciences 08/2012; · 3.01 Impact Factor
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    ABSTRACT: Assessment of long-term phylloquinone exposure is challenging in studies investigating vitamin K in health. Data are equivocal as to whether a single measurement of circulating phylloquinone would be adequate. The primary purpose of the present study was to validate the use of a single measurement of serum phylloquinone as a surrogate for long-term phylloquinone exposure in healthy older adults. Using data from the Québec Longitudinal Study on Nutrition and Successful Aging, the objectives were to: 1) determine the reproducibility of circulating phylloquinone over 2 y (n = 234); 2) calculate how a single measurement would rank or classify individuals and attenuate the regression coefficient between circulating phylloquinone and a health outcome; and 3) investigate the association of a single measurement of serum phylloquinone with long-term phylloquinone intakes assessed over the year prior to the blood draw (n = 228). The variance analysis based on 2 blood samples showed a fair to good reproducibility for serum phylloquinone (intra-class correlation = 0.49). The correlation coefficient between the ranking of individuals based on a single measurement of circulating phylloquinone and the "true" ranking would be 0.70. The multiple regression analysis showed that long-term phylloquinone intake was the strongest predictor of serum phylloquinone (t = 4.94; P < 0.001). The partial correlation coefficient (r = 0.32) was comparable with those reported in studies where blood sampling and diet recording were juxtaposed and/or multiple blood samples were used. The present study provides evidence that the use of a single measurement of circulating phylloquinone is adequate for assessing long-term phylloquinone exposure in healthy older adults.
    Journal of Nutrition 08/2012; 142(10):1910-6. · 4.20 Impact Factor
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    ABSTRACT: To identify the structural and patient characteristics associated with better care processes in older vulnerable hospitalized patients. Retrospective study. Forty-four Geriatric Assessment Units (GAU). Patients aged 65 and older who were admitted to a GAU for a fall with trauma. Three care processes (comprehensiveness, informational continuity, completion of advance health care directives) assessed through chart audit; 14 patient- and 23 GAU-related characteristics obtained from hospitalization records, national databases, and GAU managers. A total of 877 hospitalization records were included. Final models were based on multilevel modeling using stepwise variable selection. Strongest predictors of better comprehensiveness were longer hospital length of stay (LOS), higher clinical complexity (eg, higher mortality risk), and having a geriatrician as attending physician. Comprehensiveness score increased sharply up to 3 weeks LOS and then tended to plateau. Better informational continuity was associated with more comprehensive care, higher risk of mortality, acute rather than rehabilitation care, communication with community health care professionals within 48 hours after admission, and a target LOS of 3 weeks or longer. The completion of advance directives was more likely in the presence of advanced age, higher risk of mortality, cognitive impairment, discharge to another care facility, longer LOS, university-affiliated institution, and nonurban location. In GAUs, quality-of-care processes are related to both structural and patient characteristics. Our results pointed toward an organizational framework that may help to streamline the geriatric units and better use resources, notably by narrowing the admission criteria, targeting a proper LOS, improving communication with community organizations, and making systematic completion of advance directives.
    Journal of the American Medical Directors Association 08/2012; 13(8):739-43. · 5.30 Impact Factor

Publication Stats

385 Citations
168.53 Total Impact Points

Institutions

  • 2003–2014
    • Université de Montréal
      • • Center for Mathematical Research
      • • Institute of Geriatrics of Montreal
      • • School of Optometry
      Montréal, Quebec, Canada
  • 2009–2013
    • Université du Québec à Montréal
      • Department of Psychology
      Montréal, Quebec, Canada
    • Institut National de Santé Publique du Québec (INSPQ)
      Québec, Quebec, Canada
  • 2011–2012
    • Hôpital Maisonneuve-Rosemont
      Montréal, Quebec, Canada
  • 2004–2012
    • Centre jeunesse de Montréal-Institut universitaire
      Montréal, Quebec, Canada
  • 2008
    • McGill University
      • Desautels Faculty of Management
      Montréal, Quebec, Canada