ArticlePDF AvailableLiterature Review

Keeping People with Dementia or Mild Cognitive Impairment in Employment: A Literature Review on Its Determinants

International Journal of Environmental Research and Public Health (IJERPH)

January 2020
17(3):842

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CC BY 4.0

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Background: Approximately 10–20% of people with early onset dementias (EOD) or mild cognitive impairment (MCI) are aged under 65 and, due to extended working life and increasing prevalence of dementias, they more and more frequently will be present in the active workforce. This review aimed to synthesize the available information about the ability of people with EOD or MCI to retain their participation in the labor workforce. Methods: We searched SCOPUS and EMBASE for peer-reviewed papers that reported studies assessing work ability in employees with EOD or MCI that were published in the period of January 2010 to August 2019. Results: We selected four publications, in which 1012 participants with EOD or MCI were enrolled (41.2% males). Cognitive difficulties rather than motor dysfunction were found to reduce patients’ ability to work. Two main themes emerged: management of dementia in the workplace and the impact of symptoms on working status. Conclusions: EOD and MCI impact on workforce participation by determining problems in executive functions. Although this review was based on a small sample of studies, it can be shown that support in the workplace may act as a facilitator to enhance workforce participation, and occupational health professionals can help patients with EOD or MCI continue working as much as possible.

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Int.J.Environ.Res.PublicHealth2020,17,842;doi:10.3390/ijerph17030842www.mdpi.com/journal/ijerph

Review

KeepingPeoplewithDementiaorMildCognitive

ImpairmentinEmployment:ALiteratureReviewon

ItsDeterminants

FabiolaSilvaggi1,*,MatildeLeonardi1,PietroTiraboschi2,CristinaMuscio2,ClaudiaToppo1

andAlbertoRaggi1

1UOCNeurologia,SalutePubblicaeDisabilità,FondazioneIrccsIstitutoNeurologicoCarloBesta,

20133Milan,Italy;matilde.leonardi@istituto‐besta.it(M.L.);claudia.toppo@istituto‐besta.it(C.T.);

alberto.raggi@istituto‐besta.it(A.R.)

2UOCNeurologia5–Neuropatologia,FondazioneIrccsIstitutoNeurologicoCarloBesta,

20133Milan,Italy;pietro.tiraboschi@istituto‐besta.it(P.T.);cristina.muscio@istituto‐besta.it(C.M.)

*Correspondence:fabiola.silvaggi@istituto‐besta.it;Tel.:+39‐02‐2394‐3105

Received:5December2019;Accepted:27January2020;Published:29January2020

Abstract:Background:Approximately10–20%ofpeoplewithearlyonsetdementias(EOD)ormild

cognitiveimpairment(MCI)areagedunder65and,duetoextendedworkinglifeandincreasing

prevalenceofdementias,theymoreandmorefrequentlywillbepresentintheactiveworkforce.

ThisreviewaimedtosynthesizetheavailableinformationabouttheabilityofpeoplewithEODor

MCItoretaintheirparticipationinthelaborworkforce.Methods:WesearchedSCOPUSand

EMBASEforpeer‐reviewedpapersthatreportedstudiesassessingworkabilityinemployeeswith

EODorMCIthatwerepublishedintheperiodofJanuary2010toAugust2019.Results:Weselected

fourpublications,inwhich1012participantswithEODorMCIwereenrolled(41.2%males).

Cognitivedifficultiesratherthanmotordysfunctionwerefoundtoreducepatients’abilitytowork.

Twomainthemesemerged:managementofdementiaintheworkplaceandtheimpactofsymptoms

onworkingstatus.Conclusions:EODandMCIimpactonworkforceparticipationbydetermining

problemsinexecutivefunctions.Althoughthisreviewwasbasedonasmallsampleofstudies,it

canbeshownthatsupportintheworkplacemayactasafacilitatortoenhanceworkforce

participation,andoccupationalhealthprofessionalscanhelppatientswithEODorMCIcontinue

workingasmuchaspossible.

Keywords:employment;dementia;workperformance;workengagement;publichealth

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1.Introduction

Dementiaisabroadtermreferringtoanumberofneurologicaldisordersthatcausea

progressivedeclineincognitivefunctioning[1]andcanbeassociatedwithseveralneurological

conditions,suchasParkinson’sdisease(PD),Huntington’sdisease(HD),Alzheimer’sdisease(AD)

andAD‐relateddisorder(ADRD),Lewybodiesdementia(LBD),frontotemporaldementia(FTD),or

vascularconditions[2].

Thevastmajorityofdementiacasesarediagnosedamongpeopleaged70orolder,andfeware

diagnosedinadulthood,thatis,beforetheageof65—theseconditionsarereferredtoasearly‐onset

dementia(EOD).EODincidencehasbeenestimatedat13.4/100,000personsperyearinthe30–64year

oldagegroup[3],whileitsprevalenceinthelast15yearswasreportedbetween42.3and81.0per

100,000cases[4–6].

Inadditiontothis,dementiacanbeprecededbymildcognitiveimpairment(MCI),whose

prevalenceis3–22%inpeopleaged65orolderandcanalsobediagnosedbeforeaged65inaportion

ofthepopulationwhereinitprogressesintodementiain5–10%ofcasesperyear[7].

Int.J.Environ.Res.PublicHealth2020,17,8422of11

Thus,thereisaportionofworkingpeoplethatmayexperiencedifficultieswithwork‐related

activities,orhaveareducedworkability,duetoEODorMCI;worldwide,itisinfactestimatedthat

10%ofthe35.6millionpeoplelivingwithdementiaareagedunder65[8].

SomeworkerswithEODorMCIcontinuetowork,thankstotheadjustmentstotheiractivities

madebycompanies,whereasothershavetoquitbecauseofimpairedperformance[9,10].

Symptomsofcognitivedeclineareinfactfrequentlyfirstnoticedbycaregiversorrelevant

others—employedpeople,co‐workers,clients,andemployersmaynoticethepresenceofcognitive

difficultiesbecausetheyinterferewithanindividual’sabilitytowork,expressedasbeingeasily

distractedbybackgroundnoise,poormemory,andinabilitytoperformmulti‐taskingactivities[11].

Ithastobenotedthatthesesymptomsalsoaffectolderadultswithoutdementiaandmaycause

areductionintheirworkperformance.Olderworkersareoftenconsideredlessflexible,withalower

abilitytolearnandwithmoredifficultytotrain,duetoanormaldeclineofcognitiveabilityand

motorfunctioning[12,13].Organizationalpracticesoftendissuadeolderemployeesfrom

participatingintraining[14,15],withimplicationsbeingontheassignmentofjobtasks.Older

workersarenotalwaysdeemedsuitablefortasksthatarecommonlyassociatedwithyounger

workers,andmaycauseareductionofself‐esteemandmotivation,aswellasdifficultyinremaining

inthelabormarket[16].

DementiasandMCIareexpectedtoincreaseinprevalenceduetopopulationageing[17],early

diagnosisduetotheincreasinguseofbiomarkers[18,19],aswellasduetoincreasedriskofhigher

prevalenceofconditionsthatincreasetheriskofdementiasuchastype‐2diabetesmellitus[20,21].

Paralleltothis,workinglifewillbeextendedinthenearfutureduetheageingpopulation,less

replacementfromyoungerworkers,andnationalwelfarepoliciesencouragingolderworkersto

remaininthelaborworkforce,delayingretirement[10,22].Thejointeffectofthesethreephenomena

willlikelydetermineahigherpresenceintheworkplaceofpeoplewithcognitiveimpairments,MCI,

orEOD.

Itisimportantinanyworkplacetoconsideranddecidewhatkindofinterventionscouldlead

tobetterworkperformanceforpeoplewithbraindisordersassociatedwithcognitivedeterioration

[23].Work‐siteinterventionsarefeasibleiftheytakeintoaccountthebalancebetweenthejob

demandsononesideand,ontheotherside,thementalandphysicalresourcesofworkersthat,in

thiscase,areimpairedasaconsequenceofcognitivedifficulties[24].

Therelationshipbetweenjobdemandsandworkers’resourcesisknownas“workability”[22],

andisdeterminedbyprofessionalknowledgeandskills,values,attitudes,motivation,andfeatures

ofworkitself[23].Helpingworkerstomaintaintheirworkabilityisbeneficialtocompanies,asithas

thepotentialtoenhanceworkers’productivityandstrengthentheirmentalandphysicalresources

[25,26].

Tokeeponworkinghasseveraladvantagesforpeoplewithcognitiveimpairments,MCI,or

EOD.Beyondeconomicbenefits,socialandpsychologicalbenefits,includingself‐esteem,personal

identity,qualityoflife,andfullparticipationinsocietyareofimportance[27].

Manystudies,whichhavefocusedontheproblemsassociatedwithanunplannedearlylabor

marketexit,haveevidencedseveralnegativeconsequences,includingincreasedincidenceof

depression[28],lossofpersonalidentity[29],andlossofsocialnetworks[30].

Forthisreason,itisimportantthattheworkerscollaboratewithHumanResourcesstaffin

planninginterventionsaimedatfosteringtheirworkability[31].Inplanningworkplacesupport

activities,theyshouldconsidertheseverityofworkers’cognitiveimpairmentandmanageitsrelated

stigmathroughclearandinclusivepraxesinwhichcolleaguesareinformedonthepotentialbenefits

ofsupportingpeoplewhodevelopcognitiveimpairment[32].

Insum,EODandMCIareconditionswhosetypicalageofonsetisaroundtheperiodof

retirement,andlittleresearchhasaddressedthework‐relatedexperienceofpeoplewiththis

symptomatology[21,33],aswellasthesocialandeconomicconsequencesoftheirexitfromthelabor

force[34–36].

Int.J.Environ.Res.PublicHealth2020,17,8423of11

Forthisreason,understandingthecapacityofpeoplewithEODandMCItokeeponworking,

thatis,understandingtheirworkability,aswellasunderstandingwhatcanbedoneintheworkplace

andhowtodealwithfactorsassociatedwithjobloss,willbeofimportanceforpublichealthpolicies.

Assuchapieceofinformationhasnotyetbeensynthesizedinaliteraturereview,theaimofthe

presentstudywastoprovideupdatedinformationabouttheabilityofpeoplewithEODandMCIto

keeponparticipatinginthelaborworkforce.

2.MaterialsandMethods

2.1.SearchStrategy

WeperformedacomprehensivesearchonSCOPUSandEMBASE,coveringtheperiodof

January2010toAugust2019toidentifyprimaryresearchpapersreportingeitherrandomizedclinical

trials(RCTs)orobservationalstudiesthatassessedworkabilityinworkerswithEODorMCI,orthe

factorsassociatedwithjobloss.

Thefollowingcombinationsofkeywordsweresearchedwithinthetitles,abstracts,orkeywords:

(dementiaOR“mildcognitiveimpairment”ORMCI)AND(“workperformance”OR“workability”

OR“performanceappraisal”ORemployment).

Oursearchwaslimitedtooriginalstudies,publishedinEnglishandwithanabstract,whichhad

tobeindexedbySCOPUSorEMBASE.PleaseseetheSupplementaryMaterialsforthedetailedsearch

strategy.

2.2.Articles’InclusionandExclusionCriteria

Wespecificallysearchedforclinicaltrialsandobservationalstudies,eithercross‐sectionalor

longitudinal,andexcludedreviews,commentaries,letterstotheeditors,editorials,qualitative

studies,andcasereports.

Thecontentofpapershadtoenabletheextractionofinformationonworkability,definedas

workperformanceorperformanceappraisal,inworkerswithEODassociatedwithdifferent

neurologicalconditions(i.e.,PD,HD,AD,ADRD,LBD,FTD,orvascularconditions)orMCI.

StudiesdrawingfrompopulationswhereinthepresenceofEODorcognitivedifficultieswas

chieflyaddressedasasymptominthecontextofothergeneralmedicalconditionswereexcluded.

Finally,studiesthatwerebaseduponcaregivers’reportsonlywereexcludedaswell.

2.3.PaperSelectionandDataExtraction

Abstractsofpaperswerescreenedbyajuniorresearcher(F.S.).Toensurequalityand

consistencyofdataextraction,20%oftheabstractsandoffulltextswererandomlyselectedfora

secondcheckbyaseniorresearcher(A.R.)whowasblindtothedecisionofthefirstcheck.We

determinedtheoverallagreementratebetweenresearchers—ifitwasbelow70%,eachofthedouble‐

checkedabstractormanuscriptwasre‐reviewedagainbythetworesearcherstogettoafinaldecision

byconsensus,andanadditional20%setofabstractsandfulltextswasdouble‐checkedagain.

Extractedinformationincludedhealthconditions—broadlydefinedasunspecifiedEOD;EOD

duetoaspecificunderlyingcondition,i.e.,PD,HD,AD,ADRD,LBD,FTD,vascularconditions;

MCI—andthemaincharacteristicsofpatients,whichincludedsamplesize,genderdistribution,age,

andpercentageofemployedsubjectsforeachstudy.

Aswehadforeseenthatlittleliteraturewasavailableonthistopic,wedidnotorganizethemain

contentsonworkabilityintooverarchingcategories.Rather,availableinformationonworkability

wasdescriptivelyreportedandwereliedonabottom‐upapproachfortheorganizationofreview’s

results,thatis,wedescribedliteraturefindingsconsistentlywiththewayinwhichresultswere

reportedineachpaper.

Whetheranyissueassociatedwithordeterminantofworkabilitywasfound,thecontentofthe

manuscriptwasincludedunderatopic,andthesameprocedurewasfollowedincasethesametopic

wasaddressedinotherstudies.

Int.J.Environ.Res.PublicHealth2020,17,8424of11

3.Results

Theinitialsearchreturned1675records.Followingabstractscreeningandfulltextassessment,

fourpublicationswereselectedforinclusioninthisreview[37–40].Therateofagreementbetween

reviewerswas99.8%attheabstractcheckand100%atfull‐textevaluation.

Figure1showstheflowdiagramofoursearchprocessandTable1presentssummaryfindings

ofthepublicationsincludedinthisreview.

Recordsretrievedin

SCOPUS

Recordsexcludedatabstract

check(n=1655):

Noabstract(n=0);

Notdealingwiththetopic(n

=1130);

Casestudies(n=6);

Editorial/letter(n=0);

Primarydata(n=308);

Psychometricdata(n=211)

RecordsretrievedinEMBASE

withoutMedline

(

n=125

)



Selectedforfull‐textanalysis

(n=20)

Totalresearchresult

(n=1680)

Duplicates

(n=5)

Recordsscreenedafter

duplicatesremove

(n=1675)

Fulltextnonfound(n=0)

Fulltextanalyzed

(

n=20

)



Fulltextsexcluded(n=16):

Datanotadequateforextraction

(n=16).

Fulltextsincludedinthe

qualitativeandquantitative

synthesis

(

n=4

)



Int.J.Environ.Res.PublicHealth2020,17,8425of11

Figure1.Flowchartofpapers’selection.

Table1.Maincharacteristicsandmainoutcomesoftheincludedstudies.

IDDementia

Type

Sample

SizeAge

Male

Gender

(%)

Employed

(%)MainResults

Robertsonetal.,

2013[37]EOD757.5

(50–65)b

4

(57.1%)

7

(100%)

Appropriatesupportprovidedinthe

workplaceisassociatedwithimprovement

oftheworkabilityinpatientswithEOD.

Jacobsetal.,

2018[38]HD22046.6

(19–75)b

96

(43.6%)

114

(52%)

Apathyandcognitiveimpairments

(informationprocessingspeedand

cognitiveflexibility)aredeterminants

ofunemploymentinpatientswithHD.

Sakataetal.,

2017[39]EOD14353

(48–57)a

19

(13%)

143

(100%)

Atotalof14%ofpatientswithEODlefttheirjobs

withinoneyearaftertheirdiagnosis

(7.3%amongthosewithoutEOD).

Watkinsetal.,

2018[40]HD64218–65298

(46%)

305

(44%)

Cognitivesymptomsandmotorsymptoms

haveasignificantinfluenceondeclineof

workabilityandonthedecisiontoleave

workinpatientswithHD

Notes:amedianandinterquartilerange;bagerange.EOD:earlyonsetdementia,HD:Huntington’sdisease.

Acrossthestudies,1012participantswithadiagnosisofneurologicalconditionsassociatedwith

dementiawereenrolled,withmenbeingaminorpart(41.2%oftheentiregroup)—twostudies

involvedsamplesofpatientswithunspecifiedEOD,andtwowithEODduetoHD.

Onestudyaddressedthemanagementofpatientsintheworkplace[37],andthreeprospectively

addressedworkingstatuschange—oneaddressedjoblossafterunspecifiedEODdiagnosis[38],and

thesecondandthirdevaluatedthenegativeimpactofneuropsychiatricsymptomsinpatientswith

EODduetoHD[39,40].

3.1.ManagementofDementiaintheWorkplace

OnestudyaddressedthemanagementofpatientswithunspecifiedEODintheworkplace[37].

ThepaperdescribedademonstrationprogramcalledSidebySidetoevaluatethepossibilityof

engagingpatientswithEODthroughwork‐siteinterventions.TheprogramstartedinAugust2011

andwasstillongoingwhenthepaperwaspublished.

TheprograminvolvedsevenpeoplewithmildEODagedbetween50and65years.Theyworked

onedayperweekinahardwarestorewiththesupportprovidedbywork‐buddiesandprogramstaff.

Theparticipantsthemselveschosetheareaofthestorewheretheywishedtoworkandundertook

theworkdutiesrelatedtothatspecificarea.

TheworkdaystartedwithanappointmentinacottageofLifeCare’scommunity,whereall

participantsweresubjectedtosafetychecksandbriefingandthentravelledtotheirworkplaceina

minibus.

Inahardwarestore,theparticipantsworkedfora4hourshiftwithamid‐shiftmealbreak.

Endofdayactivitiesincludeddebriefingtoidentifyanddiscussanydifficultiesencountered

duringtheworkshift,journalingtoprovideamonitoringoftheworkexperienceforeachparticipant,

andsocializationwiththegroup.

Allparticipantswereabletoworkandenjoyedtheirworkplaceexperience,showinginterest

andanimprovementofself‐esteem,asreportedbyfamilycarers.

3.2.TheimpactofSymptomsonWorkingStatus

Threestudiesaddressedworkingstatuschange.SakataandOkumuraconductedamatched

cohortstudytoshowtheincidenceofjoblossamongpatientswithunspecifiedEOD[38].

Thestudyinvolved220participantswithEODaged40–59,and1100ageandgender‐matched

controlswithoutEOD.Thedatashowedthatby2andahalfmonthsafterEODdiagnosis,therewas

anincreasedlikelihoodinleavingone’sjob.After6months,9.1%ofparticipantswithEODand3%

ofnon‐EODcontrolslefttheirjob.After1year,thesamefigureswere14%and7.3%,respectively.

Int.J.Environ.Res.PublicHealth2020,17,8426of11

ThesecondstudyevaluatedwhichHD‐relatedsignsareassociatedwithunemployment[39]in

patientswithEODduetoHD.Thestudyinvolved220HDmutationcarriersthatwerecategorized

asemployed(n=114)andunemployed(n=106).Inthemultivariateanalysis,thesignsthatwere

significantlyrelatedtounemploymentstatewereapathy,cognitiveflexibility,andexecutive

functioningdomains,withapathybeingthestrongestsignrelatedtounemployment.

Thethirdstudyevaluatedtheassociationofcognitivedecline,comparedwithmotordecline,

withthedecisiontoleavework[40]inpatientswithEODduetoHD.Thestudyinvolved642patients

withHDaged18–64,recruitedfromtheEnroll‐HDobservationalstudyof2015.Resultsshowedthat

everyyearofdelayincognitivesymptomonsetcorrespondedtoapproximately0.8yearsofdelayin

retirementage(approximately0.5aftercorrectingforconfounders).

Paralleltothis,everyyearofdelayinmotorsymptomonsetcorrespondedtoapproximately0.8

yearsofdelayinretirementage(approximately0.4aftercorrectingforconfounders).

Moreover,posthocanalysisrevealedthatpresenceofbothmotorandcognitivesymptomswas

associatedtoahigherlikelihoodofquittingwork.

4.Discussion

Withthisreview,weaimedtoidentifyandsynthesizetheavailableknowledgeregardingthe

abilityofpeoplewithEODandMCItoremaininthelaborworkforce,aswellasthefactorsassociated

withjobloss.TheresultsstrengthentheideathatpatientswithEODhaveanincreasedlikelihoodto

leavetheirjobduetotheimpactofsymptomsontheabilitytowork,aswellasduetotheworkplace’s

inabilitytoadapttotheperson’sneeds.Thesymptomsthathavebeenreportedasreducingpatients’

abilitytoworkaremostlyrelatedtocognitiveandbehavioraldeficits,suchasapathyandcognitive

impairment,ratherthantomotordysfunction.Onestudyreportedtheresultsofaworkparticipation

programdedicatedtopatientswithEODthat,althoughbasedonaverylimitednumberof

participants,showedsomepositiveresults.Finally,ourstudypointsoutthelimitedattentionthatis

giventosuchatopicsofar;infact,ourresultsarebasedonaverysmallamountofmanuscripts,

whichrepresentapproximately0.2%ofalltheretrievedrecords.

Ithastobenotedthattheparticipantsofthestudieshereinincludedweremostlywomenofan

olderage,whichbasicallycorrespondstothetypicalpresentationofdementia.Apreviousreporthas

moreovershownthatwomenwithdementiahaveamorerapiddeclinecognitivecomparedtomen

[41].Thissituationimpactstheirparticipationintheworkforce.Ourreviewhighlightsthefactthat

womenweremorelikelythanmentoleavetheirjobwithin1yearaftertheirdiagnosis.Thisevidence

issimilartotheresultsofpriorstudiesexaminingtheincreasedriskofjoblossassociatedwithhealth

problems[42].

ApathyisacommonlyreportedsymptominpatientswithdementiasandMCI[39],anditcan

haveamajorimpactonhealth‐relatedqualityoflife[41].Itisconnectedtoadeclineingeneral

functioningdefinedaslossofautonomyinperformingactivitiesofdailylivingandexecutive

dysfunction[43],andithasbeenfoundtoberelatedtounemploymentinpeoplewithEODdueto

HD[37].However,apathycanbedifficulttomeasureasaconsequenceoftheabsenceofaclear

definition—wheredifferentconceptssuchaslackofinterest,abulia,affectiveflattening,social

withdrawal,andindifferencecoexist[44]—andthuscanbemisinterpretedinworkplacecontextsand

takenaslaziness.

Conversely,depressionwasnotassociatedtounemploymentstatus[38].Sucharesultsisatleast

unexpectedbecausedifferentstudies,includingclinicalstudiesandpopulationsurveys[45,46]found

theoppositeassociation.ItshouldmoreovertobenotedthatinthesampleofthestudybyRobertson

[37],theoveralllevelofdepressionwasmoderatetosevere,withhalfoftheparticipantsreferring

depressivesymptoms.Cognitivedifficulties,suchasvisualattention,processingspeed,and

cognitiveflexibility,i.e.,executivefunctions,havebeenfoundtobeassociatedwithunemployment

[38].

Executivefunctionsincludeplanning,organization,cognitiveflexibility,andbehavior

regulation.Thus,patientswithexecutivefunctiondeficitsmayfailinunderstandingwhatisneeded

tocompleteataskandmaybeunabletofocustheirattentiononmorethanonethingatatime.

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Theassociationbetweendeficitsinexecutivefunctionsandunemploymentistherefore

expectable,asthesefunctionsconstitutethesoftskills,thatis,theclusterofpersonalitytraitsand

personalhabits,includingworkethic,courtesy,teamwork,self‐discipline,self‐confidence,

conformitytoprevailingnorms,andlanguageproficiency[47],thatareneededtocomplywiththe

vastmajorityofjobtasks.Previousresearcheshavehighlightedtheimportanceofsoftskillsin

workplacecontexts;infact,ithasbeendemonstratedthat75%–85%oflong‐termjobsuccessdepends

onpeople’sabilitytoutilizesoftskills,andonly15%–25%isdeterminedontechnicalknowledge

[48,49].

Softskillsareconsideredextremelyimportantinmanyoccupationsandindustries[50,51],and

impairmentoftheseskillsduetoemergingcognitivedifficultiesmakesitdifficultfordementia

workerstocontinuetowork.ThisisconfirmedbyWorach‐KardasandKostrzewski,whofoundthat

anyimpairmentinmentalhealthcanresultinunemployment[52].

Thedecisionorneedtoleaveworkisinfluencedbytheonsetandpresenceofbothcognitiveor

motorsymptoms,andsuchaconceptwasaddressedinonestudyinwhichpatientswithEODdue

toHDwereenrolled[39].

Apreviousstudyhasrevealedthattheparticipantswithhigherbaselinecognitivescoreshad

slowerdeclineinfunctionalcapacity,demonstratingamarkeddeclineofbothcognitivesymptoms

andmotorsymptoms[53].Itis,however,difficulttodistinguishtheimpactofmotorvs.cognitive

symptomsinpatientswithHD,astheyarecloselyinterlinked—thisisconsistentwiththeideaof

corticalloopssubservingthecoordinationofmotor,cognitive,andemotionalfunction,integratedin

thebasalganglia[54].

Ontheotherhand,somepatients,inthemildstageofdementia,retaintheabilitytowork,

providedtheadjustmentstotheiractivitiesmadebyemployers,asshowninarecentqualitative

report[55].Thisisconsistentwithwork‐siteinterventionsthatprovideanopportunityforpeople

withEODtoundertaketailoredactivities,withtheconstantpresenceofstaffsupervisors[37,56–60].

Takingintoconsiderationthetrendstowardsincreasingworkingage[19,20]coupledwith

increaseintheprevalenceofneurologicalconditionsassociatedwithdementiaandcognitivedecline,

alsoduetoearlydiagnosticability[12–16],itisreasonabletoexpectariseinthepresenceofpeople

withEODorMCIinthelaborforce.Suchaphenomenonhasimplicationsbothforemployeesand

employers,aswellasforthoseworkingindependently.

Bykeepingonworking,peoplemaygaininoverallfunctioningandqualityoflifeandpreserve

positivehealthoutcomesandwellbeing,whereasthelattermaybenefitfromavoidingimmediate

lossofskilledpersonnelandmayenhancethegeneralworkplaceenvironmentandthecompanies’

socialresponsibility,forexample,inhelpingtoreducingstigmaandpromotingsocialinclusion[62].

However,thereareintrinsicdifficultiesthatdealwiththeimpairmentsinbothtechnicalandsoft

skillsduetodementiasorMCI,whichcallforcounsellingandprofessionalsupportintheworkplace

forworkersandformanagers.

ItisouropinionthatsuchservicesshouldberoutinelyprovidedtoworkerswithEODandMCI

toextendtheirprofessionallivesasmuchaspossible.

Occupationalhealthprofessionalscanhelppatientscontinueworking[59].This,besidesthe

aforementionedpositiveeffectsforworkersandemployers,mayinturnimpactontheindirectcosts

ofdementias,thatis,thoseconnectedtoprematureretirement,whichaccountforapproximately36%

to60%oftotaldementiacost[61].

Tomaximizetheoutcomeintermsofpreservedworkability,itisouropinionthatsupport

servicesforemploymentshouldbeintegratedwithinthecarepathway,andthatlegaldisposition

encourageolderworkerstoremaininthelaborworkforcetothemostprolongedperiodpossible.

Onelimitationofthisreviewneedsbeacknowledged.Eventhoughoursearchwasquite

extensive,wecannotbesurethatallrelevantarticleswerefound.Inadditiontothis—althoughthis

isnotaproperlimitation—anoverallcautionisneededwiththeinterpretationofourresultsin

considerationofthefactthatonly0.2%ofretrievedrecordswerefinallyincludedinourreview.



Int.J.Environ.Res.PublicHealth2020,17,8428of11

5.Conclusions

Thisreviewpointsout,asafirstresult,thepaucityofliteratureaddressingtheworkabilityand

factorsassociatedwithjoblossinpeoplewithEOD,alongwiththeabsenceofstudiesaddressingthe

sameissuesinpeoplewithMCI.

Suchafactcallsforaction,asitislikelythatincomingyearsmoreandmorepeoplewithsuch

conditionswillneedinformationonhowthesesymptomsshouldbehandledintheworkplace,as

wellaspatients’associationsneedingevidencetodeveloprecommendationsfortheworkingsector

soastoavoidprematureleavingofjobsofpatientswithmildsymptomsofdementia.

Keepinginmindthesmallamountofstudies,wecancautiouslyconcludethatEOD,associated

withHDorofanunspecifiedorigin,impactsuponworkforceparticipation,mostlydueto

neuropsychiatricsymptomsthatmaydetermineproblemswiththeso‐called“softskills”.

However,oneexperiencethatwasfoundwasthatsupportintheworkplacemayactasa

facilitatorinenablingpatients’abilitytocarryoutdailyworktasks.

Suchwork‐siteinterventionsmaycontributetopreservepatients’overallhealthoutcomesand

wellbeing,reducestigma,promoteparticipationandsocialinclusion,and,inturn,mightimpacton

societalcostsofdementiasthroughacontainmentofindirectcosts.

Futurestudiesshouldtaketheseaspectsintoaccountandinvestigatewhichsignsandsymptoms

aremostlyconnectedtojoblossacrossdifferentkindofEODandMCI,sothatstrategiesaimedat

enhancingworkretentioninthesepatientscanbeplanned.

SupplementaryMaterials:Thefollowingareavailableonlineatwww.mdpi.com/xxx/s1.

AuthorContributions:Conceptionanddesign:F.S.andA.R.;dataacquisition:F.S.;dataanalysis:F.S.;

interpretationofresults:F.S.andA.R.;manuscriptdrafting:F.S.andA.R.;criticalrevisionofthemanuscript:

M.L.,P.T.,C.M.,andC.T.;approvalofthefinalversion:alloftheauthorsrevisedandapprovedthefinalversion

ofthemanuscript.Allauthorshavereadandagreedtothepublishedversionofthemanuscript.

Funding:Thisresearchreceivednoexternalfunding.

ConflictsofInterest:Theauthorsdeclarenoconflictofinterest.

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Cognitive function in long-term testicular cancer survivors: Impact of modifiable factors

Article

Full-text available

Aug 2024

No study has comprehensively examined associated factors (adverse health outcomes, health behaviors, and demographics) impacting cognitive function in long-term testicular cancer survivors (TC-survivors). TC-survivors given cisplatin-based chemotherapy completed comprehensive, validated surveys, including those which assessed cognition. Medical record abstraction provided cancer and treatment history. Multivariable logistic regression examined relationships between potential associated factors and cognitive impairment. Among 678 TC-survivors [median age: 46 (IQR: 38, 54); median time-since-chemotherapy: 10.9 years (IQR = 7.9, 15.9)], 13.7% reported cognitive dysfunction. Hearing loss (OR = 2.02; P = .040), neuropathic-pain (OR = 2.06; P = .028), fatigue (OR = 6.11; P<.001), and anxiety/depression (OR = 1.96; P = .029) were associated with cognitive impairment in multivariable analyses. Being on disability (OR = 9.57; P = .002) or retired (OR = 3.64; P = .029) were also associated with cognitive declines. Factors associated with impaired cognition identify TC-survivors requiring closer monitoring, counseling, and focused interventions. Hearing loss, neuropathic-pain, fatigue, and anxiety/depression constitute potential targets for prevention or reduction of cognitive impairment in long-term TC-survivors.

Association of reported sleep disturbances with objectively assessed mild cognitive impairment among adults in the United States

Article

Full-text available

Feb 2025

Background Sleep is a multifaceted phenomenon influenced by both duration and quality. Various sleep disturbances have been associated with mild cognitive impairment, but the role of specific disturbances in mild cognitive impairment pathophysiology remains unclear. This study investigated the associations between distinct sleep disturbances and mild cognitive impairment in adults aged 50 and older using nationally representative data. Methods Longitudinal data from the Health and Retirement Study were analyzed to explore the association between mild cognitive impairment and three types of sleep disturbances: trouble falling asleep, trouble waking up, and waking up too early. Logistic regression models estimated unadjusted (Model 1) and adjusted associations accounting for sex, race/ethnicity, age, social determinants of health (Model 2), general health (Model 3), depression (Model 4), and pain and physical activity (Model 5). Results The study cohort included 8877 participants aged ⩾50 years in 2018 (baseline) who were followed up in 2020. Overall, 15.4% reported trouble falling asleep, 23.2% reported trouble waking up, and 12.8% reported waking up too early and being unable to fall back asleep most of the time. Among older adults, approximately 13.1% reported experiencing mild cognitive impairment; The prevalence of mild cognitive impairment was even higher in those who experienced sleep disturbances. The unadjusted odds ratio (uOR) for experiencing trouble falling asleep most of the time was 1.69 (95% CI: 1.42–2.03), for trouble waking up most of the time was 1.31 (95% CI: 1.10–1.57), and for waking up early most of the time was 1.88 (95% CI: 1.51–2.35). However, these positive associations attenuated depending on the covariate adjustment. Conclusions Nearly one in seven adults had mild cognitive impairment. The relationship between sleep disturbances and mild cognitive impairment has been challenging to delineate. Our findings demonstrate a positive association between sleep disturbances and mild cognitive impairment, although these associations were sensitive to covariate adjustments. These findings suggest multifaceted pathways for reducing the risk of mild cognitive impairment.

Exploring the impact of early-stage dementia on everyday activities

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Full-text available

Jul 2024

Introduction: This paper explores the impact that early-stage dementia has on everyday activities from the perspective of people living with dementia, their supporters and occupational therapy practitioners. Method: People living with dementia and their supporters (n = 10), and occupational therapy practitioners (n = 21) took part in semi-structured interviews, with transcripts analysed thematically. Findings: Six primary themes were identified across participants, namely: (1) ‘Everybody seems to be different, [but] they are similar’; (2) An awareness of change: ‘Something’s not quite right’; (3) ‘Changes’ and ‘difficulties’ associated with complex and unfamiliar activities; (4) Social withdrawal and exclusion: ‘I’ve felt like I was a leper’; (5) Post-diagnostic mental health: ‘. . .a dark place’; and (6) A process of adaptation: ‘I’m still who I am, I can still do things. . .’ Conclusion: Findings indicate that occupational therapy intervention programmes for people living with early-stage dementia should target difficulties associated with a broad range of activity types, and include components that target mental health and motivational needs. The study adds to existing knowledge about the need to personally tailor interventions to ensure that they meet individual needs, experiences, and circumstances. Findings will inform the development of an occupational therapy intervention programme theory (theory of change) for early-stage dementia.

The impact on employment and education of caregiving for a family member with young onset dementia: A scoping review

Article

Full-text available

Apr 2024
Dementia

Young-onset dementia (YOD) affects individuals under 65 years of age, often leading to loss of employment and independence. Families provide increasing levels of care to family members with YOD, resulting in changes to their daily lives, including their occupational pursuits. This review examines evidence of the occupational implications for family members who provide care to a family with YOD to identify: (i) the influence and impact caregiving tasks and responsibilities have on employment, volunteering, and education, and (ii) caregiver, and caregiving situation factors associated with changes in employment, volunteering, and education. A scoping review was performed using eight electronic databases. Included articles were narratively synthesized using a thematic analysis. Sixteen studies met the inclusion criteria and were included for review. The over-arching (main) theme of ‘decision-making’ was identified, with family members required to make choices about their own occupational goals and roles to be able to provide care to family living with YOD. The outcomes of these decisions are dynamic and changeable across the caregiving trajectory. Three caregiving factors influence decision-making: (1) Implications of Combining Caregiving and Occupations, (2) Altered Identity (3) Strategies to Support Caregivers of Individuals Living with YOD. A fourth theme was also identified ‘Guidance for Researchers To Support Caregivers’. There is a scarce body of literature examining the influence caregiving has on occupational outcomes for the YOD caregiver population. Much of this work is descriptive and lacks focus on the implications, particularly long-term impacts. This review provides a foundational guide for future research and practices to support YOD family caregivers to obtain and sustain occupations.

Do type, timing and duration of life course non-employment differentially predict dementia risk? An application of sequence analysis

Article

Mar 2025

Memory function and early exit from paid employment through different pathways among ageing European workers

Article

Full-text available

Feb 2025
SCAND J WORK ENV HEA

OBJECTIVES: Understanding memory function’s role in early workforce exit is key in supporting sustainable employment among ageing workers. This study examined the impact of memory function on early exit from paid employment, analyzed changes in memory function before, during and after such transitions, and assessed memory function trajectories in relation to the presence or absence of effort-reward imbalance at work. METHODS: This study included 16 339 respondents from the Survey of Health, Ageing, and Retirement in Europe (SHARE) between age 50 and the country-specific retirement age. The effects of objective and subjective memory functioning on early exit were assessed using Cox proportional hazards with Fine-Gray sub distribution models. Changes in memory function before and after a transition to non-employment were assessed using generalized linear mixed-effects models. These changes were described and compared based on exposure to job effort–reward imbalance. RESULTS: Workers with poor subjective memory were 2.3 times more likely to exit employment prematurely due to disability ([sub-distribution hazard ratio (SHR) 2.30, 95% confidence interval (CI) 1.77–3.00] and 1.3 times more likely to exit through unemployment (SHR 1.29, 95% CI 1.06–1.55). Workers with low objective memory were 1.6 times more likely to exit through unemployment (SHR 1.56, 95% CI 1.30–1.87). Subjective memory generally declined prior to, and during early exit from paid employment. While subjective memory generally improved post-exit, objective memory function declined after exiting. An accelerated decline in objective memory functioning was noted among early retirees who had been exposed to effort–reward imbalance at work (β -0.45, standard error 0.16). CONCLUSION: Workers with poor memory function are at higher risk of early involuntary exit from paid employment. Promoting memory function and balancing job efforts and rewards may help mitigate the risk of a premature exit.

Understanding employee experiences of developing younger onset dementia within the workplace: A scoping review

Article

Aug 2024

Background: There is limited information focussing on the perspectives of persons with younger onset dementia (YOD) in employment. This poses challenges for supporting this demographic within the workplace and during their transition to retirement. Objective: The aim of this scoping review is to address the identified need to ascertain what is known about the perspectives of employees with YOD. Methods: Records were included if they: considered working-aged persons who received a diagnosis of YOD whilst employed or soon after ceasing employment; considered the perspective of the person with YOD; and were published in English. Four databases (CINAHL, PubMed, Embase, Cochrane Library) were systematically searched, and grey literature was sought using the Google Scholar search engine. Using PRISMA-ScR guidelines, two reviewers screened the title/abstract then full text of identified documents. Disagreements were resolved with a third reviewer. Research papers were narratively synthesised, thematically analysed, and critically appraised. Results: Fourteen peer-reviewed research papers, and nineteen grey literature items were included in the review, with research papers found to be of reasonably high methodological quality. Five themes were identified, describing the experiences of employees with YOD: (1) Trying to manage difficulties prior to diagnosis; (2) Disclosure at the point of diagnosis; (3) Reasonable adjustments; (4) Employment cessation; and (5) Regaining meaningful roles following retirement. Conclusion: Findings revealed evidence for an emerging understanding of the lived experience of developing YOD within the workplace; however, further research is needed regarding the capabilities and support needs for persons with YOD to influence workplace policies and practices.

Sources and perceptions of hope: A qualitative study involving younger people with dementia

Article

May 2024
Dementia

Hope is an important but overlooked phenomenon in dementia studies. Few studies have examined how people with dementia experience or perceive hope, possibly because it is seen as a diagnosis without hope. In this article, we report on a doctoral study, the aim of which was to examine the phenomenon of hope from the perspective of younger people with dementia to generate new understanding and enable community-based healthcare professionals to support well-being. The study was conducted in the Midlands, England, and used a modified diary-interview method. Six participants were given a camera and asked to take pictures of whatever made them feel hopeful. During a post-diary semi-structured interview, a conversation about hope took place. Interviews were transcribed and interpreted using the ‘Voice-Centred Relational Method’. Findings show that hope is important to younger people with dementia. Sources of hope were the surrounding environment, keeping connected, taking action, and drawing on internal resources. An over-arching theme was ‘defying dementia’ and participants demonstrated resistance to negative stereotypes. Living with dementia did not curtail hope, although it could be weakened when participants felt ‘cast adrift’ by services. The In vivo codes generated were fear of dementia, threats to identity, disconnection from others, and frustrations and restrictions. It is concluded that hope should be a more central part of practice-based conversations with people with dementia.

'Too young to sit at home': a qualitative study conducted among employees with young-onset dementia and their relatives

Article

Apr 2024
AGING MENT HEALTH

Objectives: Young-onset dementia (YOD) symptoms often first present in the workplace, resulting in work performance challenges and eventually loss of employment. This study aims to investigate the experiences, work values, and support needs of employees with YOD and their relatives. Method: Semi-structured interviews were conducted to explore the experiences, work values, and support needs of (former) employees with YOD and their relatives. Subsequently, separate focus group discussions were conducted for employees and relatives to review and prioritize interview findings. Inductive thematic analysis was applied to both datasets. Results: A total of 15 interviews (six employees; nine relatives) and four focus group discussions (ten employees; six relatives) were conducted. Six themes emerged, with five revolving around the central theme: desire to work. The other themes represent essential contributing factors, including importance of receiving a YOD diagnosis; knowledge, awareness, and understanding regarding YOD; open communication, joint decision making, and collaboration; work adjustments, involvement, and support; phasing out work and future perspectives. Conclusion: The findings highlight a strong desire to work post-YOD diagnosis, serving as a foundation for developing workplace support tools and guidance. This has the potential to help individuals with YOD preserve their self-confidence and identity while working within their capabilities.

Dementia and Cognitive Impairment

Chapter

Jan 2023

Huntington’s Disease and Employment: The Relative Contributions of Cognitive and Motor Decline to the Decision to Leave Work

Article

Full-text available

Sep 2018

Background: Huntington's disease (HD) presents with motor, cognitive, and behavioral symptoms that impair functional capacity and the ability to maintain employment. The relative contribution of cognitive decline to work disability remains controversial. Objective: To evaluate the association of cognitive decline, compared with motor decline, with the decision to leave work. Methods: Data from the Enroll-HD observational study were analyzed. The correlation of age of cognitive symptom onset and age of motor symptom onset with age at leaving work was assessed. The association of the Stroop Color Naming Test (SCNT) cognitive assessment and the Total Motor Score (TMS) assessment (reverse scored) with the Total Functional Capacity (TFC) assessment was also assessed. Results: For every year delay in cognitive symptom onset, there was a 0.806 year increase in age at leaving work (SE = 0.030, p < 0.001, adj-R2 = 0.628). For every year delay of motor symptom onset, there was a 0.814 year increase in age at leaving work (SE = 0.031, p < 0.001, adj-R2 = 0.603). For every additional correct SCNT response given and for every unit increase in TMS, there was a 0.105 unit increase (SE = 0.006, p < 0.001, adj-R2 = 0.315) and a 0.104 unit decrease in TFC (SE = 0.003, p < 0.001, adj-R2 = 0.640), respectively. Conclusions: Cognitive symptoms have a significant association, comparable to that of motor symptoms, with occupational functioning and the decision to leave work, suggesting that development of therapies for both cognitive and motor decline would be important for allowing people with HD to remain in the workforce longer.

Validation of prognostic biomarker scores for predicting progression of dementia in patients with amnestic mild cognitive impairment

Article

Full-text available

Feb 2018
NUCL MED COMMUN

Objective: The objective of this study was to develop and validate a practical computerized prognostic model that uses baseline psychometric and imaging data, including results of PET imaging of amyloid deposition, to predict the progression to dementia in patients at risk for Alzheimer's disease (AD). Patients and methods: Data from patients in a phase II trial of [F]flutemetamol for PET imaging of brain amyloid and from the Alzheimer's Disease Neuroimaging Initiative were used to train the prognostic model to yield a disease state index (DSI), a measure of the similarity of an individual patient's data to data from patients in specific diagnostic groups. Inputs to the model included amyloid PET results, MRI measurements of hippocampal volume, and the results of psychometric tests. The model was subsequently validated by using data from a prospective study of an independent cohort of patients with mild cognitive impairment. Results: In total, data from 223 patients of the 233 enroled were suitable for analysis. The DSI predicted by the model and the risk of progression to AD dementia within 3 years were higher for patients with amyloid deposition and neurodegeneration than for patients with amyloid deposition without neurodegeneration. Rates of non-AD dementia among patients with neurodegeneration at baseline were consistent with the results of other studies. The results were consistent with the Jack model of AD progression. Conclusion: The DSI from the model that included psychometric, MRI, and PET amyloid data provides useful prognostic information in cases of mild cognitive impairment.

Job Loss After Diagnosis of Early-Onset Dementia: A Matched Cohort Study

Article

Full-text available

Feb 2025
J ALZHEIMERS DIS

Early-onset dementia (EOD) affects the employment of patients and family members. To demonstrate how likely employees are to leave their jobs after an EOD diagnosis for themselves or a family member, we conducted a matched cohort study of 143 employees and 77 family members diagnosed with EOD using a claims database. We matched these participants to 5 controls each, and followed them for approximately 600 days. In the employee cohort, patients with EOD were more likely to leave their jobs than were controls (hazard ratio: 2.26). This suggests that healthcare providers should offer employment support to patients just after diagnosis.

The economic cost of dementia: A systematic review

Article

Mar 2019

The purpose of this article is to analyse the available literature describing the economic burden of dementia and to compare costs between studies examining cost drivers. To shed light on this field, a systematic review is performed using PubMed, the Cochrane Library and Web of Science. An eight-year retrospective horizon was considered until 25 May 2018. Several papers were obtained from the database search (n = 23), being others (n = 3) identified through other sources (hand-searching) because we did not detect it through the three databases. The cost estimates were compared between three perspectives: state/publicly funded health services, third-party/private sector/not-for-profit organisations and patient and family and/or societal. The estimated total annual cost per person with dementia in Europe is on average €32,506.73 (n = 10), whereas for the United States, it gets €42,898.65 (n = 2). Furthermore, differences are appreciated by type of costs. Besides, differences by severity groups are also considered. Overall, the higher the severity the higher the associated costs. Dementia imposes a huge economic burden. The figures here presented provide a good framework to quantify these costs for both, economic experts and researchers, and policy decision makers.

Association of Retinal Neurodegeneration on Optical Coherence Tomography With Dementia: A Population-Based Study

Article

Jun 2018

Importance Retinal structures may serve as a biomarker for dementia, but longitudinal studies examining this link are lacking. Objective To investigate the association of inner retinal layer thickness with prevalent and incident dementia in a general population of Dutch adults. Design, Setting, and Participants From September 2007 to June 2012, participants from the prospective population-based Rotterdam Study who were 45 years and older and had gradable retinal optical coherence tomography images and at baseline were free from stroke, Parkinson disease, multiple sclerosis, glaucoma, macular degeneration, retinopathy, myopia, hyperopia, and optic disc pathology were included. They were followed up until January 1, 2015, for the onset of dementia. Exposures Inner retinal layer thicknesses (ie, retinal nerve fiber layer [RNFL]) and ganglion cell–inner plexiform layer (GC-IPL) thicknesses measured on optical coherence tomography images. Main Outcomes and Measures Odds ratios and hazard ratios for incident dementia per SD decrease in retinal layer thickness adjusted for age, sex, education, and cardiovascular risk factors. Results Of 5065 individuals eligible for optical coherence tomography scanning, 3289 (64.9%) (mean [SD] age 68.9 [9.9] years, 1879 [57%] women) were included in the analysis. Of these 3289 individuals, 41 (1.2%) already had dementia. Thinner GC-IPL was associated with prevalent dementia (odds ratio per SD decrease in GC-IPL, 1.37 [95% CI, 0.99-1.90]). No association was found of RNFL with prevalent dementia. During 14 674 person-years of follow-up (mean [SD], 4.5 [1.6] years), 86 individuals (2.6%) developed dementia of whom 68 (2.1%) had Alzheimer disease. Thinner RNFL at baseline was associated with an increased risk of developing dementia (hazard ratio per SD decrease in RNFL, 1.44 [95% CI, 1.19-1.75]), which was similar for Alzheimer disease (hazard ratio, 1.43 [95% CI, 1.15-1.78]). No association was found between GC-IPL thickness and incident dementia (hazard ratio, 1.13 [95% CI, 0.90-1.43]). Conclusions and Relevance Thinner RNFL is associated with an increased risk of dementia, including Alzheimer disease, suggesting that retinal neurodegeneration may serve as a preclinical biomarker for dementia.

The association between unemployment and depression – Results from the population-based LIFE-Adult-Study

Article

Apr 2018
J AFFECT DISORDERS

Background: Unemployment is a risk factor for impaired mental health. Based on a large population-based sample, in this study we therefore sought to provide detailed information on the association between unemployment and depression including information on (i) differences between men and women, (ii) differences between different types of unemployment, and (iii) on the impact of material and social resources on the association. Methods: We studied 4,842 participants (18-65 years) of the population-based LIFE-Adult-Study. Depression was assessed using the Center for Epidemiological Studies Depression Scale. Employment status was divided into three groups: being employed, being unemployed receiving entitlement-based benefits, being unemployed receiving means-tested benefits. Multivariate logistic regression models were applied to assess the association between employment status and depression. Results: Statistically significantly increased depression risk was solely found for unemployed persons receiving means-tested benefits. Adjusting for differences in sociodemographic factors, net personal income and risk of social isolation, comparable associations of being unemployed and receiving means-tested benefits with elevated depression risk were found for men (Odds Ratio/OR = 2.17, 95%-CI = 1.03-4.55) and women (OR = 1.98, 95%-CI:1.22-3.20). Limitations: No conclusions regarding causality can be drawn due to the cross-sectional study design. It was not possible to assess length of unemployment spells. Conclusion: Unemployed persons receiving means-tested benefits in Germany constitute a risk group for depression that needs specific attention in the health care and social security system. The negative impact of unemployment on depression risk cannot be explained solely by differences in material and social resources. Contrasting earlier results, women are equally affected as men.

Cognitive Performance and Apathy Predict Unemployment in Huntington’s Disease Mutation Carriers

Article

Jan 2018

Unemployment is common for those with Huntington's disease (HD), a genetic neurodegenerative disorder, and affects patients' quality of life. HD is characterized by motor disturbances, cognitive dysfunction, and psychiatric symptoms. The purpose of this article was to determine which clinical signs of HD are predictive of unemployment. Data for employed (N=114) and unemployed (N=106) HD mutation carriers were used to investigate group differences. Univariate logistic regression analyses, adjusted for age and gender, were performed to determine individual predictors of unemployment. Subsequently, a multivariate logistic regression analysis was performed, entering all significant results from the univariate analyses into one fully adjusted model to determine the strongest predictors. HD mutation carriers with lower cognitive performances and higher apathy scores were more likely to be unemployed than were HD mutation carriers with higher cognitive scores and no signs of apathy. Motor functioning was an independent predictor of unemployment but was not associated with unemployment in the fully adjusted model. Cognitive impairments, especially in the executive domain, and apathy were independent determinants of unemployment in HD mutation carriers. Motor disturbances, the clinical hallmark of HD, did not appear to be the most important predictor for work cessation. These results should be taken into consideration in clinical practice when evaluating HD patients' ability to work.

A new potential biomarker for dementia with Lewy bodies: Skin nerve α-synuclein deposits

Article

Jun 2017
NEUROLOGY

Objective: To investigate whether (1) phosphorylated α-synuclein (p-syn) deposits in skin nerves could be useful in differentiating dementia with Lewy bodies (DLB) from different forms of dementia and (2) small fiber neuropathy (SFN) is associated with DLB. Methods: We studied 18 well-characterized patients with DLB (11 with autonomic dysfunction), 23 patients with nonsynucleinopathy dementia (NSD; 13 with young-onset Alzheimer disease dementia, 6 frontotemporal dementia, and 4 vascular dementia), and 25 healthy controls. All participants underwent skin biopsies from proximal (i.e., cervical) and distal (i.e., thigh and distal leg) sites to study small nerve fibers and deposits of p-syn, considered the pathologic form of α-synuclein. Results: No p-syn was detected in any skin sample in patients with NSD and controls but was found in all patients with DLB. SFN was found in patients with DLB and the autonomic denervation of skin was more severe in patients with autonomic dysfunctions. Conclusions: (1) In autonomic skin nerves, p-syn is a sensitive biomarker for DLB diagnosis, helping to differentiate DLB from other forms of dementia, although this needs to be confirmed in a larger, more representative sample; and (2) skin autonomic neuropathy is part of the DLB pathology and may contribute to autonomic symptoms. Classification of evidence: This study provides Class III evidence that p-syn in skin nerve fibers on skin biopsy accurately distinguishes DLB from other forms of dementia.

Mild Cognitive Impairment

Article

May 2017
CLIN GERIATR MED

Angela M. Sanford

Mild cognitive impairment (MCI) occurs along a continuum from normal cognition to dementia. A roadblock to earlier diagnosis and potential treatment is the lack of consistency with screening for MCI. Universal screening would be ideal, but is limited. Once a diagnosis of MCI is made, it is important for the clinician to evaluate for reversible causes. At present time, there are no pharmacologic treatments proven to slow or cure progression of MCI to dementia; nonetheless, there is evidence that lifestyle modifications including diet, exercise, and cognitive stimulation may be effective.

Prevalence, neurobiology, and treatments for apathy in prodromal dementia

Article

Apr 2017

Background Apathy, characterized by diminished motivation, is a highly prevalent neuropsychiatric symptom in dementia. However, there is a substantial knowledge gap with regard to prevalence rates, neurobiological underpinnings, and effective treatments for apathy in pre-dementia states, including mild cognitive impairment (MCI) and mild behavioral impairment (MBI). Methods We conducted a comprehensive literature search using MEDLINE, Embase, and PsycINFO databases to identify available research on apathy in prodromal dementia. Results Apathy has consistently been detected in individuals with MCI with varying prevalence rates, and only recently has literature discussed the prevalence of apathy in MBI. Few pharmacological treatments have been utilized for apathy, with galantamine and risperidone showing mild reductions in apathetic behaviors. Non-pharmacological interventions in prodromal dementia are beginning to be explored and show promise, but few studies have replicated those results. Discussion More comprehensive guidelines for diagnosing apathy and further research investigating neurobiological mechanisms of apathy in MCI and MBI are required in order to effectively treat apathetic patients in prodromal dementia.

Keeping People with Dementia or Mild Cognitive Impairment in Employment: A Literature Review on Its Determinants

Abstract

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