Mary Catherine Tierney

Sunnybrook Health Sciences Centre | sunnybrook · Department of Family and Community Medicine

We are developing whack-a-mole games for cognitive assessment. In prior research, we have shown that variants of the game assess cognitive speed and executive functioning (response inhibition), and can be used to screen for delirium in emergency departments. We have also found that whack-a-mole game performance is significantly correlated with over...

We are developing whack-a-mole games for cognitive assessment. In prior research, we have shown that variants of the game assess cognitive speed and executive functioning (response inhibition), and can be used to screen for delirium in emergency departments. We have also found that whack-a-mole game performance is significantly correlated with over...

Purpose Evidence suggests endocrine therapy (ET) for breast cancer (BC) has adverse cognitive effects, but its specific effects on older women are unknown. This is despite the fact that older women are at increased risk of both breast cancer (BC) and cognitive decline relative to younger women. This study prospectively examined the cognitive effect...

Background The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort study of the Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative to catalyze research on dementia, set up to support the research agendas of CCNA teams. This cross-country longitudinal cohort of 2310 deeply phenotyped subjects...

Objectives: Recognition of delirium in the emergency department (ED) is poor. Our objectives were to assess: (1) the diagnostic accuracy of the Predicting Emergency department Delirium with an Interactive Computer Tablet (PrEDICT) "serious game" to identify older ED patients with delirium compared to clinical recognition and (2) the feasibility of...

Introduction : BACKGROUND: Recognition rates of delirium in older ED patients were reported between 13 to 25% in studies conducted in the U.S in the 1990's. Recently, there has been increased attention to delirium in Emergency Medicine, with the development of Geriatric curriculums in Canada specifically focused on delirium. However rates of deliri...

Background and Objectives Depression is an important risk factor for Alzheimer’s disease (AD) but little is known about the mechanisms of this association. Given sex differences in both AD and depression, we sought to conduct a systematic review and meta-analysis to examine whether there are sex differences in their association, as this may improve...

Objective There are impressive differences in the incidence, prevalence and experience of women and men with Alzheimer’s Disease (AD). Notably, two-thirds of those with AD, the most common form of dementia, are women. Our objective was to provide a literature-based framework to understand these sex and gender differences in AD. Methods We conducte...

Introduction: Better awareness of the cognitive domains affected in non-demented Parkinson's Disease (PD) should improve understanding of cognitive disease mechanisms. A complete understanding of the cognitive areas impaired in non-demented PD is hindered because most studies use small clinical samples without comparison to healthy controls. This...

Background: Approximately 75% of women with BC have hormone receptor-positive (HR+) disease and are treated with anti-estrogen endocrine therapy (ET) in the adjuvant setting. Consistent with estrogens' well-established roles in neuroprotection and cognitive functioning, accumulating evidence suggests ET has adverse effects on cognition. However, th...

An international committee set up through the IAP for Health met to develop an action plan for dementia. Comprehensive international and national initiatives should move forward with calls for action that include increased public awareness regarding brain health and dementia, support for a broad range of dementia research objectives, and investment...

PurposeEvidence suggests anti-estrogen endocrine therapy (ET) is associated with adverse cognitive effects; however, findings are based on small samples and vary in the cognitive abilities affected. We conducted a meta-analysis to quantitatively synthesize the evidence. Methods Electronic databases were searched in November 2016. Fourteen studies t...

Technology questionnaires can assist in developing profiles that characterize the ability of people to use new technologies. Technology profiles may also be related to physical and cognitive abilities, and may possibly serve as proxies for constructs that may be more difficult to measure. The purpose of the research reported in this paper was to ex...

Computerized cognitive assessment tools may facilitate early identification of dementia in the primary care setting. We investigated primary care physicians' (PCPs') views on advantages and disadvantages of computerized testing based on their experience with the Computer Assessment of Mild Cognitive Impairment (CAMCI). Over a 2-month period, 259 pa...

Introduction Despite important sex differences, there remains a paucity of studies examining sex and gender differences in neurodegeneration. The Canadian Consortium on Neurodegeneration in Aging (CCNA), a national network of researchers, provides an ideal platform to incorporate sex and gender. Methods CCNA's Women, Gender, Sex and Dementia (WGSD...

Objective: To conduct a meta-analysis that investigates sex differences in the prevalence of mutations in the 3 most common genes that cause amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD)-chromosome 9 open reading frame 72 (C9orf72), progranulin (GRN), or microtubule-associated protein tau (MAPT)-in patients clinically diagn...

Background: Delirium is common and potentially lethal. Unfortunately, delirium recognition is poor- 75% of Emergency Department (ED) cases are missed. Objectives: We previously developed a “serious game” using participants’ game performance to evaluate delirium risk. Our goal is to validate this algorithm against the delirium severity index (DSI)....

Frailty predicts adverse health outcomes, and the Clinical Frailty Scale (CFS) has been validated internationally to predict adverse outcomes and mortality. Emergency Departments (ED) are challenged to assess frailty due to a lack of training and limited time. We studied the agreement between ED physicians and patient self-assessments using a table...

Recent population studies suggest an intriguing inverse relationship between several types of cancer and neurodegenerative diseases, including Alzheimer's disease. Understanding the intersection of the underlying biology for these two distinct families of diseases with one another may offer novel approaches to identify iiew therapeutic approaches a...

Background: Developed nations are currently facing a demographic shift towards a higher proportion of elderly people and increasing age-related health concerns. Elderly adults often enter into the health care system through emergency services. As a result, emergency departments (EDs) are an opportune environment for cognitive screening to improve p...

Objectives: The number of drivers with dementia is expected to increase over the coming decades. Because dementia is associated with a higher risk of crashes, driving cessation becomes inevitable as the disease progresses, but many people with dementia resist stopping to drive. This meta-analysis examines whether there are sex differences in the p...

Recent population studies suggest an intriguing inverse relationship between several types of cancer and neurodegenerative diseases, including Alzheimer's disease. Understanding the intersection of the underlying biology for these two distinct families of diseases with one another may offer novel approaches to identify new therapeutic approaches an...

Introduction: Cognitive screening in settings such as emergency departments (ED) is frequently carried out using paper-and-pencil tests that require administration by trained staff. These assessments often compete with other clinical duties and thus may not be routinely administered in these busy settings. Literature has shown that the presence of...

Objective: More women have Alzheimer's disease (AD) than men. Understanding sex differences in mild cognitive impairment (MCI) may further knowledge of AD etiology and prevention. We conducted a meta-analysis to examine sex differences in the prevalence and incidence of MCI, which included amnestic and non-amnestic subtypes. Method: Systematic s...

The rise in aging populations worldwide places a focus on shifting healthcare needs to match changing demographics. Older adults have a higher risk of becoming frail and losing functional abilities (e.g., walking and bathing) as well as the ability to perform daily activities such as shopping and cooking. Providing care and appropriate intervention...

Background: Population-based surveillance of Alzheimer's and related dementias (AD-RD) incidence and prevalence is important for chronic disease management and health system capacity planning. Algorithms based on health administrative data have been successfully developed for many chronic conditions. The increasing use of electronic medical record...

Endocrine-based treatments are the mainstay of therapy for postmenopausal women with breast cancer; yet concern has been raised about potential adverse cognitive effects. We performed a systematic review of the published literature to evaluate whether endocrine-based treatments for breast cancer are associated with changes in cognitive domains and...

Background: We evaluated effects of providing primary care physicians (PCPs) with reports of their patients' results on the Computer Assessment of Mild Cognitive Impairment (CAMCI) by examining their documented care approaches after receipt of the report. Methods: Patients were 65 years and above, without a diagnosis or previous workup for demen...

Background: We propose the use of serious games to screen for abnormal cognitive status in situations where it may be too costly or impractical to use standard cognitive assessments (eg, emergency departments). If validated, serious games in health care could enable broader availability of efficient and engaging cognitive screening. Objective: T...

Current cognitive testing methods in the elderly rely on clinical assessments, which are time consuming, costly, and require highly trained staff (Kueider, Parisi, Gross, & Rebok, 2012). We are developing a serious game with the goal of improving the ergonomics of cognition assessment. Instead of pencil and paper, or a computer, we are using touch-...

Background: Primary care physicians (PCPs) increasingly must identify which of their cognitively impaired patients who live alone are at greatest risk of harm due to self-neglect. Objectives: To determine whether brief patient self-report measures could accurately do this. Methods: Participants were ≥65 years, lived alone, and recruited from PCPs'...

The under-diagnosis of cognitive impairments can lead to increased economic burden, hospitalization, and even death (Inouye, Bogardus, Baker, Leo-Summers, & Cooney, 2000). Many of the current cognitive tests have been developed to diagnose specific conditions. However, there is a lack of cognitive tools to assess transitory conditions that occur be...

Although there are accurate screens for cognitive impairment, there is as yet no evidence that screening improves outcomes including primary care physicians' (PCP) medical decision making. PCPs' recognition of cognitive impairment being suboptimal, we investigated factors associated with improved recognition. Eligible patients were aged 65 years an...

We investigated whether a validated computerized cognitive test, the Computerized Assessment of Mild Cognitive Impairment (CAMCI), could be independently completed by older primary care patients. We also determined the optimal cut-off for the CAMCI global risk score for mild cognitive impairment against an independent neuropsychological reference s...

For individuals providing care for older people the issue of risk is a well-established concern, especially in the context of the older person's declining functional abilities and cognitive skills. Recently in expert discussions of health care, the issue of risk has been subsumed under the discourse of patient safety with the assumption that risk i...

Menopausal changes in endogenous estrogen have been associated with memory decline. However, because earlier findings regarding the effects of lifelong estrogen exposure on memory have been inconsistent, our purpose was to investigate these effects in older postmenopausal women with a comprehensive battery of memory measures. Participants were 126...

The aim of this study was to prospectively examine the influence of cognitive, medical, behavioral, and social risk factors on medication nonadherence in community-dwelling older adults with cognitive impairment. A sample of 339 elderly participants with cognitive impairment, who lived alone and took at least one medication, underwent baseline asse...

To determine whether neuropsychological tests and the Hachinski Ischemic Score (HIS) can differentiate incident vascular dementia (VaD) from Alzheimer's disease (AD) in nondemented older adults within 5 years of initial testing. The Canadian Study of Health and Aging (CSHA) included three waves: CSHA-1 (1991-1992), CSHA-2 (1996-1997), and CSHA-3 (2...

While neuropsychological deficits have been reported in healthy individuals who use street cannabis, data in patients with multiple sclerosis (MS) are lacking. Given that MS is associated with cognitive deterioration, the aim of this study was to determine the neuropsychological effects of cannabis use in this population. Two groups, each of 25 pat...

Menopausal hot flashes have been associated with increased scores on measures of anxiety. Anxiety measures are typically composed of items measuring somatic and affective symptoms. Because hot flash symptoms are similar to symptoms of somatic anxiety, we wanted to examine the differential contribution of somatic anxiety and affective anxiety to hot...

Long-term physical activity may affect risk of cognitive impairment but few studies have examined later life cognition in relation to intensity of life-long physical activity. We examined the associations between the intensity of long-term recreational physical activity and neuropsychological functioning in 90 healthy postmenopausal women on tests...

While neuropsychological tests have been identified for the early prediction of Alzheimer's disease, this has not been established for prediction of all-cause dementia. This would be helpful for clinicians concerned about the risk of progression to dementia in patients who may present with a variety of medical and neurological conditions. We wanted...

Our purpose was to determine whether performance on the Geriatric Depression Scale (GDS) predicted the development of probable Alzheimer's disease (AD) in memory-impaired non-demented participants. Participants were followed for two years, after which they underwent a diagnostic assessment: 27 developed probable AD, 98 remained cognitively impaired...

The incidence and prevalence in those over age 65 of neurodegenerative disorders and chronic diseases, which often have deleterious effects on cognition, are rapidly increasing in western societies. Primary care physicians (PCPs) provide the majority of medical treatment for older people and in order to effectively care for their patients with susp...

We examined whether estradiol and norethindrone hormone therapy (HT) prevented decline in delayed verbal recall in older women with normal to mildly impaired memory functioning. This was a 2-year, randomized, double-blind, placebo-controlled trial of 142 women aged 61–87, randomly assigned to receive 1 mg 17-β estradiol daily and 0.35 mg norethindr...

Objectives: To compare older adults' and occupational therapists' (OTs) awareness of patients' functional abilities at discharge from inpatient rehabilitation using patient performance in the home as the criterion for functional abilities. Design: A prospective cohort study. Setting: Inpatient rehabilitation unit of a large community hospital follo...

To examine the validity of the Menopause Specific Quality of Life Questionnaire (MENQOL) domains when used with elderly women. We also determined whether MENQOL domain scores were related to depression and cognitive complaints. 148 post-menopausal women (60-88 years old), not on hormone replacement therapy, were screened for a randomized control tr...

This chapter contains section titled: Search strategy and study validation Evidence Conclusions Recommendations Acknowledgements Background Search strategy Evidence Recommendations for practice Search strategy and study validation Evidence Conclusions Recommendations Acknowledgements Background Search strategy Evidence Recommendations for practice

Multiple arguments for considering routine dementia screening have been presented. Furthermore, dementia diagnoses are widely unrecognized. As a result, persons with dementia are missing important clinical care and treatment interventions. By distinction, the problems of defining, diagnosing, and treating mild cognitive impairment (MCI) are not yet...

Explanations for the association between educational attainment and the risk of dementia fall into three main categories. It may arise as an artefact of study methods; education may predict broader socioeconomic circumstances and exposures, or education may reflect brain reserve or cognitive capacity that protect against dementia. Data from the Can...

The authors examined the accuracy of certain neuropsychological tests in the prediction of harm resulting from self-neglect in cognitively impaired seniors who lived alone. The study included 130 participants, aged 65 and older, who scored less than 131 on the Dementia Rating Scale. Neuropsychological tests were administered at baseline, resulting...

The question of whether to screen for dementia and Alzheimer's disease (AD) has been discussed in many forums throughout the world. Generally, medical advisory groups and policy-making groups have recognized the importance of early diagnosis but have uniformly avoided making recommendations to screen at-risk populations. This presentation reflects...

Mild cognitive impairment is a syndrome defined as cognitive decline greater than expected for an individual's age and education level but that does not interfere notably with activities of daily life. Prevalence in population-based epidemiological studies ranges from 3% to 19% in adults older than 65 years. Some people with mild cognitive impairme...

To determine whether neuropsychological tests accurately predict incident Alzheimer disease (AD) after 5 and 10 years in participants of the Canadian Study of Health and Aging (CSHA) who were initially nondemented. The CSHA was conducted in three waves: CSHA-1 (1991 to 1992), CSHA-2 (1996 to 1997), and CSHA-3 (2001 to 2002). The 10-year prediction...

Because of discrepant findings regarding the accuracy of mild cognitive impairment (MCI) in predicting Alzheimer's disease (AD), further study of this construct and conversion rates is essential before use in clinical settings. We aimed to develop an operational definition of MCI consistent with criteria proposed by the Mayo Alzheimer's Disease Cen...

To identify risk factors for harm due to self-neglect or behaviors related to disorientation in cognitively impaired seniors who live alone that can be used in primary care. Inception cohort followed prospectively for 18 months. Participants were referred by their primary care physicians and community service agencies or were patients of several me...

Previous research has identified two subgroups of patients with Alzheimer's disease (AD) based on performance discrepancies on semantic and visual-constructional measures: Left AD (LAD) and Right AD (RAD). In this study, verbal fluency performances (Animal Fluency [AF] and Letter Fluency [FAS]) of these two subgroups were examined. It was hypothesi...

The purpose of this investigation was to replicate the statistical approach used in a previous investigation (Toronto study) within a French population to determine the best predictive model for Alzheimer's disease (AD). Data from neuropsychological tests from two prospective studies were entered into a regression model. Replication of the statisti...

Objectives: To determine whether the accuracy of the Mini-Mental State Examination (MMSE) in predicting future Alzheimer's disease (AD) could be improved by the addition of patient and informant ratings of cognitive difficulties. Design: An inception cohort of nondemented patients followed longitudinally for 2 years. Setting: Patients referred...

Two important trends have begun to converge in industrialized nations: there are more older people who live alone and there are more people with Alzheimer's disease and related dementias. Those with cognitive impairment or dementia who live alone are more frequently placed in residential care facilities than those who reside with another person. Ou...

Alzheimer disease (AD) and vascular dementia are among the most frequently occurring causes of dementia in the world, and their accurate differentiation is important because different pharmaceutical strategies may modify the course of each disease. To determine which of 10 neuropsychological test scores can accurately differentiate patients with pr...

Our purpose was to determine whether we could predict, from among seniors with cognitive impairment who lived alone, those at highest risk of experiencing harm or needing emergency services. Specifically, our focus was on the problems that occurred as a result of negligence due to cognitive impairment. We assessed 139 people, 65 years of age and ol...

Fatty acid differences, including docosahexaenoic acid (DHA; 22:6n-3) have been shown in the brains of Alzheimer's patients (AD) as compared with normal age-matched individuals. Furthermore, low serum DHA is a significant risk factor for the development of AD. The relative concentration of DHA and other fatty acids, however, in the plasma of AD pat...

Editorial Beyond 1999: A Research Agenda - Volume 19 Issue 3 - Ingrid Connidis, Norah Keating, Sheila Neysmith, Colin Powell, Kenneth Rockwood, Mary Tierney

We report a case of dementia in an elderly woman with the pathological findings of Alzheimer's disease and numerous intranuclear inclusions in astrocytes and occasionally in neurons. These inclusions were seen in the cerebral cortex, limbic areas, basal ganglia, thalamus, brain stem and cerebellum. They expressed ubiquitin and were ultrastructurall...

The Mini-Mental State Examination (MMSE) is a widely used diagnostic tool for dementia. Its use as a predictive indicator of probable Alzheimer disease (AD) has not been established. To determine the accuracy of the MMSE in predicting emergent AD in a sample of patients who were referred because of symptoms suggestive of memory problems and to dete...

Éditorial La recherche au-delà de 1999 - Volume 19 Issue 3 - Ingrid Connidis, Norah Keating, Sheila Neysmith, Colin Powell, Kenneth Rockwood, Mary Tierney

It has been suggested that the 30-item version of the Boston Naming Test (BNT), in which either the odd or even items from the standard 60-item test are given, is the most psychometrically sound short form. However, no normative data are available for this version. We administered the Odd/Even BNT to 30 community-dwelling elderly individuals (age M...

We undertook a longitudinal crossvalidation of the Ryan and Paolo (1992) equation's ability to postdict Wechsler Adult Intelligence Scale-Revised (WAIS-R) Verbal IQ (VIQ) from National Adult Reading Test (NART) performance measured 5 years after VIQ scores were obtained, for a sample of 49 elderly normal individuals (mean age 71 years). Five-year i...