Mary E. Kelleher’s research while affiliated with NYU Langone Medical Center and other places

This chapter presents a foundational overview of dementia, with a focus on Alzheimer's disease (AD), the most common cause of dementia. The authors start with an overview of mild cognitive impairment, which is often a dementia precursor, looking at symptoms and diagnostic criteria. AD is reviewed in depth, from the perspective of 2011 diagnostic guideline revisions that, for the first time, outline stages of the illness and also incorporate biomarkers to clarify diagnosis and track disease progression. Recent advances from the use of CSF tests, structural and functional imaging, and genetics are discussed. These advancements pose ethical challenges for patients and caregivers. Treatment options, including nonpharmacological strategies and medications, are reviewed.

Objective: Our aim is to determine the clinical correlates of impaired insight in patients with mild cognitive impairment (MCI) by examining its impact on cognition, functional status, neuropsychiatric symptoms, and caregiver burden. Methods: The study involved 75 patients with MCI and their caregivers. Patients and caregivers underwent a comprehensive evaluation including the Clinical Dementia Rating, memory tests, and the Functional Assessment Questionnaire. Behavioral symptoms were assessed by the Neuropsychiatric Inventory, caregiver burden by the Zarit Burden Inventory, and insight by comparing self-report on the AD8 dementia screening tool to informant collateral. Patients were asked about their perceptions of their memory, and answers were compared with informants' responses. Patient mood was assessed with the Hospital Anxiety Depression Scale. Results: There was a significant difference in AD8 scores among patients who retained versus lacked insight. Zarit Burden Inventory scores showed a significant rise as patient insight declined; the burden appeared greater on spouse versus non-spouse caregivers. Patients with poor insight had significantly worse ratings in Clinical Dementia Rating domains of personal care and judgment, while patients who retained insight had significantly higher depression and anxiety. Insight impairment was associated with worse caregiver mood. Conclusions: Decreased patient awareness for cognitive problems was significantly associated with higher caregiver burden, independent of neuropsychiatric symptoms, functional abilities, and cognition. Personal care, judgment, and problem-solving skills could contribute to caregiver burden. Increased awareness seemed a source of patient depression and anxiety. The research highlights the need to focus on the needs of MCI caregivers and to incorporate psychosocial assessments of caregiver-patient dyads into office visits.

Objective: Our aim is to determine the clinical correlates of impaired insight in patients with mild cognitive impairment (MCI) by examining its impact on cognition, functional status, neuropsychiatric symptoms, and caregiver burden. Methods: The study involved 75 patients with MCI and their caregivers. Patients and caregivers underwent a comprehensive evaluation including the Clinical Dementia Rating, memory tests, and the Functional Assessment Questionnaire. Behavioral symptoms were assessed by the Neuropsychiatric Inventory, caregiver burden by the Zarit Burden Inventory, and insight by comparing self-report on the AD8 dementia screening tool to informant collateral. Patients were asked about their perceptions of their memory, and answers were compared with informants' responses. Patient mood was assessed with the Hospital Anxiety Depression Scale. Results: There was a significant difference in AD8 scores among patients who retained versus lacked insight. Zarit Burden Inventory scores showed a significant rise as patient insight declined; the burden appeared greater on spouse versus non-spouse caregivers. Patients with poor insight had significantly worse ratings in Clinical Dementia Rating domains of personal care and judgment, while patients who retained insight had significantly higher depression and anxiety. Insight impairment was associated with worse caregiver mood. Conclusions: Decreased patient awareness for cognitive problems was significantly associated with higher caregiver burden, independent of neuropsychiatric symptoms, functional abilities, and cognition. Personal care, judgment, and problem-solving skills could contribute to caregiver burden. Increased awareness seemed a source of patient depression and anxiety. The research highlights the need to focus on the needs of MCI caregivers and to incorporate psychosocial assessments of caregiver-patient dyads into office visits.

This chapter presents a foundational overview of dementia, with a focus on Alzheimer's disease (AD), the most common cause of dementia. The authors start with an overview of mild cognitive impairment, which is often a dementia precursor, looking at symptoms and diagnostic criteria. AD is reviewed in depth, from the perspective of 2011 diagnostic guideline revisions that, for the first time, outline stages of the illness and also incorporate biomarkers to clarify diagnosis and track disease progression. Recent advances from the use of CSF tests, structural and functional imaging, and genetics are discussed. These advancements pose ethical challenges for patients and caregivers. Treatment options, including nonpharmacological strategies and medications, are reviewed.