Linda Clare

Bangor University, Bangon, Wales, United Kingdom

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Publications (176)513.55 Total impact

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    ABSTRACT: Assessment of activities of daily living is an important element in the diagnosis of dementia, with research suggesting a link between functional ability and cognition. We investigated the relationship between self- and informant ratings of instrumental activities of daily living (iADL) and verbal executive functioning in early-stage dementia. A total of 96 people with early-stage Alzheimer's disease or vascular or mixed dementia and their carers completed the Functional Activities Questionnaire; people with dementia also completed a test of letter fluency. Letter fluency was associated with self-ratings of iADL, while informant ratings of iADL were associated with the age and Mini-Mental State Examination score of the person with dementia. Self-ratings of perceived functioning suggested significantly less impairment than informant ratings. Those with impaired letter fluency rated themselves as having greater difficulties in iADLs than those who performed better. People with early-stage dementia vary in their subjective level of awareness of their iADL functioning, and difficulties with language production may contribute to better awareness of iADL impairments.
    The Clinical Neuropsychologist 03/2012; 26(3):501-19. DOI:10.1080/13854046.2012.665482 · 1.68 Impact Factor
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    ABSTRACT: Amnestic mild cognitive impairment (aMCI) delineates a population at high risk for subsequently developing Alzheimer's disease (AD)--that is, people with preclinical AD. Associative episodic memory tasks are particularly sensitive to preclinical AD; however, they often lack ecological validity, which is important when evaluating performance in daily activities. We describe the development of two quasi-everyday associative memory tasks--the La Trobe Face-Name test and the La Trobe Numberplate task--and their utility in profiling and separating 70 aMCI participants from 101 healthy older adults (HOA) compared with standard episodic memory tasks. aMCI participants performed significantly worse overall and demonstrated a greater forgetting rate than HOA on both tasks. The everyday tasks separated aMCI from HOA participants as effectively as standard episodic memory tasks and were well tolerated. These tasks provide a valuable addition to neuropsychologists' toolkits with enhanced ecological (verisimilitude) and face validity for assisting in counseling clients, measuring the effect of interventions, and profiling everyday memory performance in HOA and aMCI.
    Journal of Clinical and Experimental Neuropsychology 03/2012; 34(3):269-78. DOI:10.1080/13803395.2011.633498 · 2.16 Impact Factor
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    ABSTRACT: Recent research has established that individuals with amnestic mild cognitive impairment (aMCI) have impaired prospective memory (PM); however, findings regarding differential deficits on time-based versus event-based PM have been less clear. Furthermore, the diagnostic utility of PM measures has received scant attention. Healthy older adults (n = 84) and individuals with aMCI (n = 84) were compared on the Cambridge Prospective Memory Test (CAMPROMPT) and two single-trial event-based PM tasks. The aMCI participants showed global impairment on all PM measures. Measures of retrospective memory and complex attention predicted both time and event PM performance for the aMCI group. Each of the PM measures was useful for discriminating aMCI from healthy older adults and the time- and event-based scales of the CAMPROMPT were equivalent in their discriminative ability. Surprisingly, the brief PM tasks were as good as more comprehensive measures of PM (CAMPROMPT) at predicting aMCI. Results indicate that single-trial PM measures, easily integrated into clinical practice, may be useful screening tools for identifying aMCI. As PM requires retrospective memory skills along with complex attention and executive skills, the interaction between these skills may explain the global PM deficits in aMCI and the good discriminative ability of PM for diagnosing aMCI.
    Journal of the International Neuropsychological Society 03/2012; 18(2):295-304. DOI:10.1017/S135561771100172X · 2.70 Impact Factor
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    ABSTRACT: In early-stage dementia, awareness at the meta-representational level involving a person's appraisal of his/her own condition and its implications has usually been assessed by interview, but contextual factors may influence responding. We examined the utility of an indirect, vignette-based method of eliciting awareness. Three vignettes describing early-stage dementia, established dementia and healthy ageing were used to elicit views of the problem and the kinds of advice that might be helpful for the characters depicted. Responses were obtained from 91 people with early-stage Alzheimer's, vascular or mixed dementia, 87 carers and 80 older controls. For the participants with dementia, awareness was assessed in separate in-depth interviews and rated on a five-point scale for comparison purposes. Participants with dementia were often able to correctly identify the problems described in the vignettes, although scoring lower than carers or controls. Participants with dementia were also able to offer advice for those depicted, although to a lesser extent than carers or controls. Ability to offer advice was greater where MMSE scores were higher. For participants with dementia, vignette scores were moderately correlated with ratings derived from interviews, and those showing limited or no awareness offered fewer items of advice than those showing some or good awareness. In addition, 29% of participants with dementia spontaneously pointed out similarities between their own condition and that of the person depicted. The vignette method may be useful where resources preclude the use of in-depth interviews, and may supplement in-depth interviews as part of a multi-dimensional assessment of awareness.
    Aging and Mental Health 02/2012; 16(5):566-75. DOI:10.1080/13607863.2011.652594 · 1.78 Impact Factor
  • Lisa S Caddell, Linda Clare
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    ABSTRACT: Objectives: The aim of the study was to investigate the relationships between identity and cognitive and functional abilities in people with early-stage dementia. Method: Fifty people in the early stages of dementia completed measures of identity and cognitive and functional abilities, including autobiographical memory. Multiple regression analyzes were used to determine whether it was possible to predict any of the variance in identity from cognitive and functional abilities, or from autobiographical memory alone. Results: It was possible to predict approximately a quarter of the variance in two out of three aspects of identity from cognitive and functional abilities. The relationships between aspects of identity and autobiographical memory functioning were very weak. Discussion: The relationship between identity and cognitive and functional abilities is not straightforward. There is no evidence to suggest a linear relationship between an overall decline in cognitive functioning and a deterioration in identity.
    Aging Neuropsychology and Cognition 02/2012; DOI:10.1080/13825585.2012.656575 · 1.07 Impact Factor
  • Lisa S Caddell, Linda Clare
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    ABSTRACT: There is little empirical research regarding the relationships between identity and well-being in people with dementia. The aim of the study was to explore the relationship of identity with mood and quality of life (QoL) in the people in the early stages of dementia. This was a cross-sectional questionnaire-based study. Fifty people in the early stages of dementia completed measures pertaining to different aspects of identity, mood, and QoL. Multiple regression analyses were carried out to determine whether it was possible to predict any of the variance in mood and QoL from aspects of identity. It was possible to predict 12.8% of the variance in anxiety, 23.4% of the variance in depression, and 25.1% of the variance in QoL from different aspects of identity. Predictors varied for each dependent variable. Aspects of identity predict a modest proportion of the variance in anxiety, depression, and QoL. This suggests that supporting identity in people with dementia who are experiencing difficulties in this regard might have a positive impact on mood and QoL. However, the majority of the variance in mood and QoL must be accounted for by other variables.
    International Psychogeriatrics 02/2012; 24(8):1306-15. DOI:10.1017/S104161021100278X · 1.89 Impact Factor
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    ABSTRACT: Insufficient attention has been paid to the influence of psychological and social factors on discrepancy-based measures of awareness. The present study tested a biopsychosocial model of awareness in early-stage dementia by gathering evidence regarding the relative contributions of neuropsychological, individual psychological and social factors to the level of scoring on measures used to index awareness. Awareness was assessed in relation to memory, activities of daily living and social functioning in 101 individuals with early-stage dementia participating in the Memory Impairment and Dementia Awareness (MIDAS) Study. People with dementia (PwD) and carers also completed measures of individual psychological and social variables, and PwD completed measures of neuropsychological functioning. Scores on discrepancy-based indices of awareness and on the self-ratings and informant ratings contributing to these indices were associated with a range of factors including neuropsychological functioning of PwD, individual traits and dispositions and current affective functioning of PwD, socio-demographic characteristics of PwD and carers, carer well-being and carer perceptions of PwD and of quality of relationship with PwD. Patterns of association varied across domains of functioning. The findings support the relevance of a biopsychosocial approach to understanding the factors that influence unawareness of impairment in dementia.
    International Journal of Geriatric Psychiatry 02/2012; 27(2):167-77. DOI:10.1002/gps.2705 · 3.09 Impact Factor
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    ABSTRACT: Delirium is common in persons with dementia and often accompanies acute medical or surgical conditions. These individuals are at risk for an accelerated decline in their cognitive and physical function. For this reason, interventions that help resolve delirium are critically needed. We have developed a non-pharmacological intervention for delirium in persons with dementia based on our prior interdisciplinary work on delirium, dementia and cognitive stimulation. The intervention uses recreational activities that are alerting, capture attention, and provide cognitive stimulation that encourages cognitive processing in support of cognitive function. In this paper we describe the practical protocol we have developed for implementing these activities, and present a video that will enhance treatment fidelity for studies that replicate the approach.
    01/2012; 2(2):101-110.
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    ABSTRACT: Signs of sensory and perceptual awareness can be observed in people with very severe dementia, and may be influenced by the extent to which the environment offers appropriate stimulation. We developed an observational tool, AwareCare, which care staff can use to identify signs of awareness in residents with very severe dementia, based on the concept of the Wessex Head Injury Matrix (WHIM). Using WHIM items as a guide, and following focus groups with care staff and family members, an expert panel identified 28 environmental stimuli and 35 response categories for the initial version of AwareCare. After baseline assessments of cognition, well-being and quality of life were taken, 40 residents were observed individually for 30 minutes on 5 occasions. Based on the observational data, 10 stimulus categories and 14 response categories were identified for further analysis and formed the final version of AwareCare. All participants showed awareness to varying degrees. Social stimuli elicited the most responses. Greater awareness was associated with better cognitive function, self-care, mobility, and responsiveness, but not with proxy-rated quality of life. Understanding the nature of awareness in this group is an important element in ensuring appropriate levels of interaction and stimulation, and hence enhancing quality of care.
    Neuropsychological Rehabilitation 01/2012; 22(1):113-33. DOI:10.1080/09602011.2011.640467 · 2.07 Impact Factor
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    ABSTRACT: Despite the inclusion of memory strategy training in many interventions for amnestic mild cognitive impairment (aMCI), little research has directly examined knowledge and use of memory strategies in aMCI and their relationship to memory performance in order to guide the development of targeted interventions. The present study aimed to compare strategy knowledge and use between an aMCI and a healthy older adult (HOA) sample, and to determine the contribution of strategy knowledge and use to memory performance in each of these groups. The sample comprised 37 aMCI and 52 HOA participants aged over 60 years. All participants completed questionnaires to assess strategy knowledge and self-reported use of internal and external strategies in everyday life. In addition, strategy use was observed on the measures of retrospective and prospective memory performance (the CVLT-II and the CAMPROMPT). The aMCI group demonstrated decreased strategy knowledge and observed use of internal strategies, although equivalent observed use of external strategies compared with the HOA group. Furthermore, they reported equivalent use of both internal and external strategies. Observed use of strategies was significantly associated with retrospective memory performance for both groups and prospective memory performance for the aMCI group, supporting the inclusion of strategy training in interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
    Psychology and Aging 11/2011; 27(3):768-77. DOI:10.1037/a0026256 · 2.73 Impact Factor
  • Lisa Caddell, Linda Clare
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    ABSTRACT: Introduction: Current research is focusing how self and identity might change in people with dementia. One way to investigate what happens to self and identity in this population is to make a comparison between people with early-stage dementia and healthy older people. Method: 50 people with early-stage dementia and 50 age-matched healthy older people completed several measures of identity, focusing on role-iden- tities, self-concept, functions of identity, and identity distress. Results: There were few significant differences between the groups on these measures. The healthy older group appeared to experience more iden- tity-related distress than people with early-stage dementia. Conclu- sion: People in the early stages of dementia do not appear to differ from healthy older people in their sense of identity. There is no evidence that identity is diminished or lost in the early stages of dementia.
    Gerontological Society of America 2011; 11/2011
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    ABSTRACT: SenseCam review has been shown to promote and sustain subsequent access to memories that might otherwise remain inaccessible. While SenseCam review facilitates recollection for personally experienced events, we know little about the boundary conditions under which this operates and about how underlying processing mechanisms can be optimally recruited to offset memory impairments of the sort that occur in dementia. This paper considers some of these issues with a view to targeting future research that not only clarifies our evolving body of theory about how memory works, but also informs about how memory-assistive technologies for patients might be employed to maximal effect. We begin by outlining key factors that are known to influence recollection. We then examine variability in the decline of memory function both in normal ageing and in dementia. Attention is drawn to similarities in the recollection deficits associated with depression and dementia, and we suggest that this may reflect shared underlying mechanisms. We conclude by discussing how one particular theoretical rationale can be intersected with key SenseCam capabilities to define priorities for ongoing and future SenseCam research.
    Memory 10/2011; 19(7):758-67. DOI:10.1080/09658211.2010.533180 · 2.09 Impact Factor
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    ABSTRACT: Although it is often assumed that awareness decreases as dementia severity increases, there is limited evidence regarding changes in awareness over time. We examined awareness in 101 individuals with early-stage dementia (PwD) and their carers; 66 were reassessed after 12 months and 51 were seen again at 20 months. Awareness was assessed in relation to memory, everyday activities, and socio-emotional functioning using discrepancies between PwD and carer ratings on parallel questionnaires. PwD completed neuropsychological tests and measures of mood and quality of life. Carers completed measures of mood and stress. At initial assessment, discrepancies were greatest for activities of daily living, moderate for memory, and least pronounced for socio-emotional functioning. Discrepancy scores did not change over time. PwD self-ratings indicated perceived poorer functioning in everyday activities over time, but no change for memory and socio-emotional functioning. Carer ratings indicated perceived decline in everyday activities and socio-emotional functioning, but no change for memory. PwD declined in neuropsychological functioning, but self-ratings of depression, anxiety, and quality of life remained stable over time. Carer mood and stress levels also remained stable. At least in the earlier stages of dementia, it should not be assumed that awareness will inevitably decrease as dementia progresses.
    Alzheimer disease and associated disorders 09/2011; 26(2):140-7. DOI:10.1097/WAD.0b013e31822c55c4 · 2.88 Impact Factor
  • Lisa S. Caddell, Linda Clare
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    ABSTRACT: Research suggests that the onset and progression of dementia may pose a threat to a person’s sense of identity. This qualitative study used Interpretative Phenomenological Analysis to explore participants’ perceptions of the impact of dementia on their identity. Participants were ten people with dementia. The four themes emerging from the data represented participants’ views on aspects of their current identities, whether they believed that dementia would alter their identities in the future, perceptions of how dementia had affected their lifestyle, and relationships with friends and family. The analysis suggested that for the most part, participants felt that little had changed with respect to their identities as a whole, but most identified features of themselves that were different than they had been prior to the onset of dementia. Thus it appeared that participants were in a state of flux, experiencing both continuity and change in their sense of identity simultaneously.
    Dementia 07/2011; 10(3):379-398. DOI:10.1177/1471301211408255
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    ABSTRACT: This study explores the extent to which awareness of social and emotional function is reduced in early-stage dementia and whether this relates to the quality of life of the person with dementia (PwD), the quality of the relationship between the PwD and carer and carer stress. Ninety-seven participants with a diagnosis of Alzheimer's, vascular or mixed dementia rated their social functioning using the Socio-Emotional Questionnaire (SEQ). Carers provided parallel ratings, allowing calculation of discrepancy scores used to index awareness. Neuropsychiatric symptoms, PwD quality of life, the perceived quality of the relationship for both partners and carer stress were also measured. Factor analysis of the SEQ indicated three domains of social functioning: emotional recognition and empathy (ERE), social relationships (SR) and prosocial behaviour (PB). For PwD unawareness was related to cognitive dysfunction and psychiatric disturbance, but not to quality of life or quality of relationship. Lower awareness was associated with greater carer stress and poorer perceived quality of relationship. Lack of awareness of social functioning had important implications for relationship quality and levels of carer stress.
    Aging and Mental Health 07/2011; 15(8):961-9. DOI:10.1080/13607863.2011.575350 · 1.78 Impact Factor
  • Alzheimer's and Dementia 07/2011; 7(4). DOI:10.1016/j.jalz.2011.05.1787 · 17.47 Impact Factor
  • Lisa S Caddell, Linda Clare
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    ABSTRACT: Recently, researchers have started to focus on ways to support self and identity in people with dementia. The purpose of this review is to discuss the main features of existing interventions aiming to support self and identity in people with dementia, to draw conclusions regarding the effectiveness of these interventions and to highlight the implications for future research. Systematic review of intervention studies aiming to support self and identity in people with dementia. Ten studies met the inclusion criteria. All reported some benefits to participants. There were significant methodological limitations and study quality was generally low. The interventions varied in terms of participant characteristics, content and outcome measures, making it difficult to draw overall conclusions about effectiveness. Interventions aiming to support self and identity in people with dementia are currently in the early stages of development. Firm recommendations cannot be made at this time. Further well-designed studies are required to provide more robust evidence.
    Aging and Mental Health 06/2011; 15(7):797-810. DOI:10.1080/13607863.2011.575352 · 1.78 Impact Factor
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    ABSTRACT: Awareness can be defined as a reasonable or realistic perception or appraisal of a given aspect of one's situation, functioning or performance, or of the resulting implications, expressed explicitly or implicitly. Disturbances of awareness have significant implications for people with dementia and their caregivers. The construction of awareness has been extensively studied in dementia, but a lack of conceptual and methodological clarity in this area means that few clear findings have emerged. This article presents a framework for conceptualizing awareness in people with Alzheimer's disease and associated dementias that can guide research and influence practice. This article begins by considering the general concept of awareness and the ways in which neurological damage can place constraints on awareness. Within an integrative biopsychosocial model that acknowledges the influence of neurocognitive, psychological, and social variables on awareness, challenges for empirical research on awareness in dementia are addressed, and a 'levels of awareness' framework is presented within which awareness operates at four levels of increasing complexity, providing a means of differentiating among awareness phenomena. Approaches to mapping awareness phenomena are discussed, and directions for future research and clinical practice are outlined. The levels of awareness framework should act as a stimulus to further research in this area, resulting in a more coherent understanding of the nature of awareness deficits, the implications of these for people with dementia and their caregivers, and the possibilities for targeted and effective interventions.
    Aging and Mental Health 06/2011; 15(8):936-44. DOI:10.1080/13607863.2011.583630 · 1.78 Impact Factor
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    ABSTRACT: Spouse caregivers of people with dementia (PwD) report relatively poor marital relationship quality (RQ), but few studies have obtained the perspective of the PwD, examined discrepancies between spouses, or considered changes in RQ over time. This study explored caregiver and PwD perceptions of RQ, identified associated factors, and examined changes over an 18-month period. Participants were 54 couples where one spouse had early-stage dementia and 54 were control couples. RQ was assessed with the Positive Affect Index. Measures of mood, stress, and quality of life (QoL) were also administered. The clinical couples were followed up after 9 and 18 months. Caregivers gave significantly lower RQ ratings than controls. PwD ratings did not differ significantly from those of caregivers or controls. Dyadic discrepancies were significantly greater in the clinical than in the control group. Caregiver ratings were associated with stress, whereas PwD ratings were associated with depression and QoL. Discrepancies were associated with caregiver stress and with PwD mood, QoL, and age. Caregiver ratings declined significantly over time; PwD ratings did not decline significantly, but showed different trends for men and women. It is important to consider RQ when considering how to support couples where one partner has early-stage dementia.
    Alzheimer disease and associated disorders 06/2011; 26(2):148-58. DOI:10.1097/WAD.0b013e318221ba23 · 2.88 Impact Factor
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    ABSTRACT: Delirium is a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Delirium is common and deadly in older adults with dementia, and is often referred to as delirium superimposed on dementia, or DSD. Interventions that treat DSD are not well-developed because the mechanisms involved in its etiology are not completely understood. We have developed a theory-based intervention for DSD that is derived from the literature on cognitive reserve and based on our prior interdisciplinary work on delirium, recreational activities, and cognitive stimulation in people with dementia. Our preliminary work indicate that use of simple, cognitively stimulating activities may help resolve delirium by helping to focus inattention, the primary neuropsychological deficit in delirium. Our primary aim in this trial is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD). This randomized repeated measures clinical trial will involve participants being recruited and enrolled at the time of admission to post acute care. We will randomize 256 subjects to intervention (RESERVE-DSD) or control (usual care). Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. We hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. We will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status). Our secondary aim is to describe the costs associated with RESERVE-DSD. Our theory-based intervention, which uses simple, inexpensive recreational activities for delivering cognitive stimulation, is innovative because, to our knowledge it has not been tested as a treatment for DSD. This novel intervention for DSD builds on our prior delirium, recreational activity and cognitive stimulation research, and draws support from cognitive reserve theory. identifier: NCT01267682
    Trials 05/2011; 12:119. DOI:10.1186/1745-6215-12-119 · 2.12 Impact Factor

Publication Stats

4k Citations
513.55 Total Impact Points


  • 2005–2015
    • Bangor University
      • School of Psychology
      Bangon, Wales, United Kingdom
  • 2014
    • University of Toronto
      • Department of Psychology
      Toronto, Ontario, Canada
  • 2012
    • University of Oxford
      • Nuffield Department of Clinical Medicine
      Oxford, England, United Kingdom
  • 2011
    • MRC Cognition and Brain Sciences Unit
      Cambridge, England, United Kingdom
  • 2009
    • Hinchingbrooke Health Care NHS Trust
      Huntingdon, England, United Kingdom
    • University of Zurich
      Zürich, Zurich, Switzerland
  • 2004–2008
    • University of Wales
      Cardiff, Wales, United Kingdom
  • 2007
    • Humboldt-Universität zu Berlin
      • Department of Psychology
      Berlin, Land Berlin, Germany
  • 1999–2004
    • University College London
      • Department of Clinical, Educational and Health Psychology
      London, ENG, United Kingdom