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Cognitive disorders in the DSM-IV-TR included delirium, dementia, amnestic disorder, and cognitive disorders not otherwise specified. DSM-V retains the diagnosis of delirium and introduces the term neurocognitive disorder (NCD), dividing NCDs into major NCD or mild NCD and unspecified NCD. The diagnostic category of major NCD encompasses syndromes that were previously categorized as dementia and amnestic disorder. Memory loss is no longer an essential criterion for major NCD in DSM-V as it was for dementia in DSM-IV-TR. Major NCD also includes progressive neurodegenerative dementias, as well as static cognitive disorders that are not expected to worsen over time. The term dementia is retained in DSM-V because of familiarity of the term to the public and medical practitioners.
Among older people with cognitive impairment and mild dementia, relatively little is known about the factors that predict preferences for everyday living activities and experiences and that influence the relative importance of those activities and experiences.
Participants were recruited from the Massachusetts Alzheimer’s Disease Research Center (MADRC) Clinical Core longitudinal cohort.
The sample included 62 community-dwelling older adults with cognitive impairment (Clinical Dementia Rating global score ≥ 0.5).
We used the Preferences for Everyday Living Inventory (PELI) to assess preferences for activities and lifestyle experiences among persons with cognitive impairment. Within-subjects analysis of variance was used to test for significant differences in the mean ratings of importance for four domains of the PELI (“autonomous choice,” “social engagement,” “personal growth,” and “keeping a routine”). Multiple regression models were used to relate predictors, including neuropsychiatric symptoms, to importance ratings for each domain.
Significant differences were noted in the mean importance ratings of the preferences domains: “social engagement” preferences were rated as most important, followed by “autonomous choice,” “personal growth,” and “keeping a routine.” For the “social engagement” preferences domain, female sex was significantly associated with higher importance of “social engagement,” while depressive symptoms (Geriatric Depression Scale-15 scores) were significantly associated with lower importance.
This study adds novel insight into the everyday preferences of community-dwelling older adults with cognitive impairment and highlights the impact of a number of factors, particularly level of depression, on how important various everyday experiences are perceived.
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