Showing papers in "International Psychogeriatrics in 2017"
TL;DR: Poorer cognition and behavioral and psychological symptoms of dementia (BPSD) were consistently associated with an increased risk of nursing home admission and most of the meta-analyses demonstrated impairments in activities of daily living as a significant risk.
Abstract: Background: Up to half of people with dementia in high income countries live in nursing homes and more than two-thirds of care home residents have dementia. Fewer than half of these residents report good quality of life and most older people are anxious about the prospect of moving into a nursing home. Robust evidence is needed as to the causes of admission to nursing homes, particularly where these risk factors are modifiable.
Methods: We conducted a systematic literature search to identify controlled comparison studies in which the primary outcome was admission to nursing home of older adults with dementia. Identified studies were assessed for validity and 26 (17 cohort and 9 case-control) were included. Qualitative and quantitative analyses were conducted, including meta-analysis of 15 studies.
Results: Poorer cognition and behavioral and psychological symptoms of dementia (BPSD) were consistently associated with an increased risk of nursing home admission and most of our meta-analyses demonstrated impairments in activities of daily living as a significant risk. The effects of community support services were unclear, with both high and low levels of service use leading to nursing home placement. There was an association between caregiver burden and risk of institutionalization, but findings with regard to caregiver depression varied, as did physical health associations, with some studies showing an increased risk of nursing home placement following hip fracture, reduced mobility, and multiple comorbidities.
Conclusion: We recommend focusing on cognitive enhancement strategies, assessment and management of BPSD, and carer education and support to delay nursing home placement.
254 citations
TL;DR: Functional analysis-based interventions should be used as first line management of BPSD whenever possible due to the lack of associated adverse events, and low-quality evidence suggests assessment of pain should be conducted and a stepped analgesic approach trialled when appropriate.
Abstract: Background:This systematic overview reports findings from systematic reviews of randomized controlled trials of pharmacological and non-pharmacological interventions for behavioural and psychological symptoms of dementia (BPSD). Methods The Cochrane Database of Systematic Reviews, DARE, Medline, EMBASE, and PsycINFO were searched to September 2015. Results Fifteen systematic reviews of eighteen different interventions were included. A significant improvement in BPSD was seen with: functional analysis-based interventions (GRADE quality of evidence moderate; standardized mean difference (SMD) -0.10, 95%CI -0.20 to 0.00), music therapy (low; SMD -0.49, 95%CI -0.82 to -0.17), analgesics (low; SMD -0.24, 95%CI -0.47 to -0.01), donepezil (high; SMD -0.15 95% CI -0.29 to -0.01), galantamine (high; SMD -0.15, 95%CI -0.28 to -0.03), and antipsychotics (high; SMD -0.13, 95%CI -0.21 to -0.06). The estimate of effect size for most interventions was small. Conclusions Although some pharmacological interventions had a slightly larger effect size, current evidence suggests functional analysis-based interventions should be used as first line management of BPSD whenever possible due to the lack of associated adverse events. Music therapy may also be beneficial, but further research is required as the quality of evidence to support its use is low. Cholinesterase inhibitors donepezil and galantamine should be trialled for the management of BPSD where non-pharmacological treatments have failed. Low-quality evidence suggests that assessment of pain should be conducted and a stepped analgesic approach trialled when appropriate. Antipsychotics have proven effectiveness but should be avoided where possible due to the high risk of serious adverse events and availability of safer alternatives.
196 citations
TL;DR: Affective symptoms are of prognostic utility, but interventions to prevent dementia syndromes are limited, and trials need to assess interventions targeting known dementia pathology, toward novel pathology, as well as using psychiatric medications.
Abstract: Background Affective and emotional symptoms such as depression, anxiety, euphoria, and irritability are common neuropsychiatric symptoms (NPS) in pre-dementia and cognitively normal older adults. They comprise a domain of Mild Behavioral Impairment (MBI), which describes their emergence in later life as an at-risk state for cognitive decline and dementia, and as a potential manifestation of prodromal dementia. This selective scoping review explores the epidemiology and neurobiological links between affective and emotional symptoms, and incident cognitive decline, focusing on recent literature in this expanding field of research. Methods Existing literature in prodromal and dementia states was reviewed, focusing on epidemiology, and neurobiology. Search terms included: "mild cognitive impairment," "dementia," "prodromal dementia," "preclinical dementia," "Alzheimer's," "depression," "dysphoria," "mania," "euphoria," "bipolar disorder," and "irritability." Results Affective and emotional dysregulation are common in preclinical and prodromal dementia syndromes, often being harbingers of neurodegenerative change and progressive cognitive decline. Nosological constraints in distinguishing between pre-existing psychiatric symptomatology and later life acquired NPS limit historical data utility, but emerging research emphasizes the importance of addressing time frames between symptom onset and cognitive decline, and age of symptom onset. Conclusion Affective symptoms are of prognostic utility, but interventions to prevent dementia syndromes are limited. Trials need to assess interventions targeting known dementia pathology, toward novel pathology, as well as using psychiatric medications. Research focusing explicitly on later life onset symptomatology will improve our understanding of the neurobiology of NPS and neurodegeneration, enrich the study sample, and inform observational and clinical trial design for prevention and treatment strategies.
132 citations
TL;DR: Support is provided for the potential influence of some neighborhood attributes on population levels of depression, however, further research is needed to adequately examine physical attributes associated with depression and moderators of both social and physical neighborhood environment attribute – depression outcome associations.
Abstract: Background:While depression is a growing public health issue, the percentage of individuals with depression receiving treatment is low. Physical and social attributes of the neighborhood may influence the level of depressive symptoms and the prevalence of depression in older adults.Methods:This review systematically examined the literature on neighborhood environmental correlates of depression in older adults. Findings were analyzed according to three depression outcomes: depressive symptoms, possible depression, and clinical depression. Based on their description in the article, environmental variables were assigned to one of 25 categories. The strength of evidence was statistically quantified using a meta-analytical approach with articles weighted for sample size and study quality. Findings were summarized by the number of positive, negative, and statistically non-significant associations by each combination of environmental attribute – depression outcome and by combining all depression outcomes.Results:Seventy-three articles met the selection criteria. For all depression outcomes combined, 12 of the 25 environmental attribute categories were considered to be sufficiently studied. Three of these, neighborhood socio-economic status, collective efficacy, and personal/crime-related safety were negatively associated with all depression outcomes combined. Moderating effects on associations were sparsely investigated, with 52 articles not examining any. Attributes of the physical neighborhood environment have been understudied.Conclusion:This review provides support for the potential influence of some neighborhood attributes on population levels of depression. However, further research is needed to adequately examine physical attributes associated with depression and moderators of both social and physical neighborhood environment attribute – depression outcome associations.
127 citations
TL;DR: Well-designed, clearly structured multi-component interventions can help maintain the psychological health of carers of people with dementia and delay institutionalization of the latter.
Abstract: Background Psychosocial interventions for carers of people with dementia are increasingly recognized as playing an important role in dementia care. We aim to systematically review the evidence from existing systematic reviews of psychosocial interventions for informal carers of people with dementia. Methods Thirty-one systematic reviews were identified; following quality appraisal, data from 13 reviews, rated as high or moderate quality, were extracted. Results Well-designed, clearly structured multi-component interventions can help maintain the psychological health of carers of people with dementia and delay institutionalization of the latter. To be most effective, such interventions should include both an educational and a therapeutic component; delivery through a support group format may further enhance their effectiveness. Conclusions Successful translation of evidence into practice in this area remains a challenge. Future research should focus on determining the most cost-effective means of delivering effective multi-component interventions in real-world settings; the cost-effective potential of technology-based interventions is considerable.
123 citations
TL;DR: In this paper, the authors explored perspectives of older adults with Alzheimer's disease and their caregivers on robots that provide stepwise prompting to complete activities in the home, and found that older adults expressed opportunities for robots to help in daily activities, were open to the idea of robotic assistance, but did not want a robot.
Abstract: Background Robots have the potential to both enable older adults with dementia to perform daily activities with greater independence, and provide support to caregivers. This study explored perspectives of older adults with Alzheimer's disease (AD) and their caregivers on robots that provide stepwise prompting to complete activities in the home. Methods Ten dyads participated: Older adults with mild-to-moderate AD and difficulty completing activity steps, and their family caregivers. Older adults were prompted by a tele-operated robot to wash their hands in the bathroom and make a cup of tea in the kitchen. Caregivers observed interactions. Semi-structured interviews were conducted individually. Transcribed interviews were thematically analyzed. Results Three themes summarized responses to robot interactions: contemplating a future with assistive robots, considering opportunities with assistive robots, and reflecting on implications for social relationships. Older adults expressed opportunities for robots to help in daily activities, were open to the idea of robotic assistance, but did not want a robot. Caregivers identified numerous opportunities and were more open to robots. Several wanted a robot, if available. Positive consequences of robots in caregiving scenarios could include decreased frustration, stress, and relationship strain, and increased social interaction via the robot. A negative consequence could be decreased interaction with caregivers. Conclusions Few studies have investigated in-depth perspectives of older adults with dementia and their caregivers following direct interaction with an assistive prompting robot. To fulfill the potential of robots, continued dialogue between users and developers, and consideration of robot design and caregiving relationship factors are necessary.
112 citations
TL;DR: Although the relationship between total number of ACEs and MSUDs was cumulative for both men and women, the associations of physical abuse, sexual abuse, emotional neglect, and parental separation/divorce with MSuds were stronger among men.
Abstract: Background Given growing numbers of older adults with mental and substance use disorders (MSUDs), this study examined the association between ten types of adverse childhood experiences (ACEs) and lifetime MSUDs among those aged 50+ Methods Data (N = 14,738 for the 50+ age group) came from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions Using multivariable binary logistic regression analyses, we examined relationships between ten ACEs and six lifetime MSUDs (major depressive disorder (MDD) and anxiety, post-traumatic stress, alcohol use, drug use, and nicotine use disorders) Gender differences were examined using tests of interaction effects and gender-separate logistic regression models Results Of the sample, 532% of women and 500% of men reported at least one ACE For both genders, parental/other adult's substance abuse was the most prevalent (226%), followed by physical abuse, and emotional neglect Child abuse and neglect and parental/other adult's mental illness and substance abuse had small but consistently significant associations with MSUDs (eg, odds ratio = 128, 95% CI = 112-146 for parental/other adult's substance misuse and MDD) Although the relationship between total number of ACEs and MSUDs was cumulative for both men and women, the associations of physical abuse, sexual abuse, emotional neglect, and parental separation/divorce with MSUDs were stronger among men Conclusions This study underscores the significant yet modest association between ACEs and lifetime MSUDs in late life More research is needed to investigate why ACEs seem to have greater effects on older men and to discern the sources of gender differences in ACEs' effects
110 citations
TL;DR: Age and gender were observed to be associated with MCI, in which age was considered as an impact factor for DR and the strong heterogeneity may result from variations in study design and baselines.
Abstract: Background: It has been reported that up to 42% of the population aged over 60 are affected by mild cognitive impairment (MCI) worldwide. This study aims to investigate the prevalence and progression of MCI through a meta-analysis. Methods: We searched Embase and PubMed for relevant literature. Stable disease rate (SR), reversion rate (RR), dementia rate (DR), and Alzheimer's disease rate (AR) were used to evaluate the progression of MCI. The prevalence and progression rates were both obtained by reported percentile and indirect data analysis. Additionally, we carried out sensitivity analysis of each index by excluding some studies due to influence analysis with the most publication bias. Results: Effect size (ES) was used to present adjusted overall prevalence (16%) and progression rates including SR (45%), RR (15%), DR (34%), and AR (28%) of MCI. Compared with clinic-based outcomes, MCI prevalence, SR, and RR are significantly higher in community, while DR and AR are lower. Despite significant heterogeneity found among the studies, no publication bias was observed. Conclusions: Age and gender were observed to be associated with MCI, in which age was considered as an impact factor for DR. The strong heterogeneity may result from variations in study design and baselines. Standardized MCI criteria were suggested to systematically evaluate MCI in the future.
106 citations
TL;DR: MBI was common in memory clinic patients without dementia and was associated with greater caregiver burden, showing that MBI is a common and clinically relevant syndrome.
Abstract: Background: Mild behavioral impairment (MBI) describes later life acquired, sustained neuropsychiatric symptoms (NPS) in cognitively normal individuals or those with mild cognitive impairment (MCI), as an at-risk state for incident cognitive decline and dementia. We developed an operational definition of MBI and tested whether the presence of MBI was related to caregiver burden in patients with subjective cognitive decline (SCD) or MCI assessed at a memory clinic. Methods: MBI was assessed in 282 consecutive memory clinic patients with SCD (n = 119) or MCI (n = 163) in accordance with the International Society to Advance Alzheimer's Research and Treatment – Alzheimer's Association (ISTAART–AA) research diagnostic criteria. We operationalized a definition of MBI using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Caregiver burden was assessed using the Zarit caregiver burden scale. Generalized linear regression was used to model the effect of MBI domains on caregiver burden. Results: While MBI was more prevalent in MCI (85.3%) than in SCD (76.5%), this difference was not statistically significant (p = 0.06). Prevalence estimates across MBI domains were affective dysregulation (77.8%); impulse control (64.4%); decreased motivation (51.7%); social inappropriateness (27.8%); and abnormal perception or thought content (8.7%). Affective dysregulation (p = 0.03) and decreased motivation (p=0.01) were more prevalent in MCI than SCD patients. Caregiver burden was 3.35 times higher when MBI was present after controlling for age, education, sex, and MCI (p < 0.0001). Conclusions: MBI was common in memory clinic patients without dementia and was associated with greater caregiver burden. These data show that MBI is a common and clinically relevant syndrome.
98 citations
TL;DR: QoL was negatively associated with SCI across studies, however, a frequent limitation of the reviewed literature was the mismatch between the conceptual and operational definitions of SCI and QoL.
Abstract: Background Older adults with subjective cognitive impairment (SCI) experience increased affective symptoms, reduced engagement in a range of activities, as well as more functional problems when compared to those without SCI. These associations suggest that SCI may be detrimental to older adults' quality of life (QoL). The purpose of this paper is to advance understanding of the SCI-QoL relationship through a comprehensive review of the empirical literature relating SCI and QoL. Methods A systematic literature review was conducted in CINAHL, PsycINFO, and PubMed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Eligible articles were appraised using the weight of evidence (WoE) framework to evaluate methodological quality, methodological relevance, and topic relevance. A narrative synthesis of results was conducted, based on conceptual definitions of QoL. Results Eleven articles were identified that met eligibility criteria. WoE ratings ranged from low to high scores. Studies reviewed reported that the presence, greater frequency, or greater severity of SCI is associated with lower QoL regardless of methodological quality rating, sample characteristics (e.g. geographic location, clinical vs. community settings), study design (e.g. cross-sectional vs. longitudinal), and operationalization of SCI or QoL. Conclusion Across studies, QoL was negatively associated with SCI. However, a frequent limitation of the reviewed literature was the mismatch between the conceptual and operational definitions of SCI and QoL. Similarly, SCI measures varied in quality across the reviewed literature. This suggests future empirical work should focus on the appropriate strategies for conceptually and operationally defining these constructs.
98 citations
TL;DR: This is the first epidemiological study to operationalize the recently published diagnostic criteria for MBI and determine prevalence estimates across the spectrum from cognitively normal to MCI and indicate relatively high prevalence of MBI in pre-dementia clinical states and amongst cognitively healthy older adults.
Abstract: Background: A dearth of population-based epidemiological research examines neuropsychiatric symptom (NPS) in sub-clinical populations across the spectrum from normal aging to mild cognitive impairment (MCI) The construct of mild behavioral impairment (MBI) describes the emergence of sustained and impactful NPS in advance of or in combination with MCI This is the first epidemiological study to operationalize the recently published diagnostic criteria for MBI and determine prevalence estimates across the spectrum from cognitively normal to MCI Methods: MBI was assessed in 1,377 older (age range 72–79 years; 52% male; MCI ;= 133; cognitively normal, but-at-risk = 397; cognitively healthy = 847) MBI was assessed in accordance with the ISTAART-AA diagnostic criteria for MBI using the neuropsychiatric inventory Results: 341% of participants met the criteria for MBI High prevalence of MBI across the cognitive spectrum was reported (489% vs 431% vs 276%) Irrespective of level of cognitive impairment, impulse dyscontrol (338% vs 287% vs 172%) and decreased motivation (323% vs 262% vs 163%) were the most frequently met MBI domains MBI was more prevalent in men (χ2 = 498, p = 0026), especially the domains of decreased motivation and impulse dyscontrol Conclusions: This study presents the first population-based prevalence estimates for MBI using the recently published ISTAART-AA diagnostic criteria Findings indicate relatively high prevalence of MBI in pre-dementia clinical states and amongst cognitively healthy older adults Findings were gender-specific, with MBI affecting more men than women Knowing the estimates of these symptoms in the population is essential for understanding and differentiating the very early development of clinical disorders
TL;DR: Late-life leisure activities protect against cognitive impairment among elderly Chinese people, and the protective effects are more profound for educated elderly.
Abstract: BACKGROUND: We examine the association between leisure-time activities and the risk of developing cognitive impairment among Chinese older people, and further investigate whether the association varies by educational level. METHODS: This follow-up study included 6,586 participants (aged 79.5 ± 9.8 years, range 65-105 years, 51.7% female) of the Chinese Longitudinal Healthy Longevity Survey who were aged ≥65 years and were free of cognitive impairment in 2002. Incident cognitive impairment was defined at the 2005 or 2008/2009 survey following an education-based cut-off on the adapted Chinese version of Mini-Mental State Examination (MMSE). Participation in cognitive activities (e.g. reading) and non-exercise physical activity (e.g. housework) was assessed by a self-reported scale. Cox proportional hazard models were employed to examine the association of leisure activities with incident cognitive impairment while controlling for age, gender, education, occupation, residence, physical exercise, smoking, drinking, cardiovascular diseases and risk factors, negative well-being, and physical functioning, and baseline MMSE score. RESULTS: During a five-year follow-up, 1,448 participants developed incident cognitive impairment. Overall, a high level of participation in leisure activities was associated with a 41% decreased risk of cognitive impairment compared to low-level engagement in leisure activities after controlling for age, gender, education, and other confounders. Moreover, there was a significant interaction between leisure activity and educational level, such that the beneficial effect of leisure activities on cognitive function was larger in educated elderly than their uneducated counterparts, and only educated elderly benefited from cognitive activities. CONCLUSIONS: Late-life leisure activities protect against cognitive impairment among elderly Chinese people, and the protective effects are more profound for educated elderly. Language: en
TL;DR: KY group showed short- and long-term improvements in executive functioning as compared to MET, and broader effects on depressed mood and resilience, and should be confirmed in future clinical trials of yoga intervention.
Abstract: Background: Global population aging will result in increasing rates of cognitive decline and dementia. Thus, effective, low-cost, and low side-effect interventions for the treatment and prevention of cognitive decline are urgently needed. Our study is the first to investigate the effects of Kundalini yoga (KY) training on mild cognitive impairment (MCI). Methods: Older participants (≥55 years of age) with MCI were randomized to either a 12-week KY intervention or memory enhancement training (MET; gold-standard, active control). Cognitive (i.e. memory and executive functioning) and mood (i.e. depression, apathy, and resilience) assessments were administered at baseline, 12 weeks and 24 weeks. Results: At baseline, 81 participants had no significant baseline group differences in clinical or demographic characteristics. At 12 weeks and 24 weeks, both KY and MET groups showed significant improvement in memory; however, only KY showed significant improvement in executive functioning. Only the KY group showed significant improvement in depressive symptoms and resilience at week 12. Conclusion: KY group showed short- and long-term improvements in executive functioning as compared to MET, and broader effects on depressed mood and resilience. This observation should be confirmed in future clinical trials of yoga intervention for treatment and prevention of cognitive decline (NCT01983930).
TL;DR: The frequency of NPS is high in MCI and AD and increases with the severity of cognitive decline, and the subgroups of N PS were relatively consistent from MCI to moderate-severe AD.
Abstract: Background: Neuropsychiatric symptoms (NPS), such as depression, apathy, agitation, and psychotic symptoms are common in mild cognitive impairment (MCI) and dementia in Alzheimer's disease (AD). Subgroups of NPS have been reported. Yet the relationship of NPS and their subgroups to different stages of cognitive impairment is unclear. Most previous studies are based on small sample sizes and show conflicting results. We sought to examine the frequency of NPS and their subgroups in MCI and different stages of dementia in AD. Methods: This was a cross-sectional study using data from a Norwegian national registry of memory clinics. From a total sample of 4,571 patients, we included those with MCI or AD (MCI 817, mild AD 883, moderate–severe AD 441). To compare variables across groups ANOVA or χ 2-test was applied. We used factor analysis of Neuropsychiatric Inventory Questionnaire (NPI-Q) items to identify subgroups of NPS. Results: The frequency of any NPS was 87.2% (AD 91.2%, MCI 79.5%; p < 0.001) and increased with increasing severity of cognitive decline. The most frequent NPS in MCI was depression. Apathy was the most frequent NPS in AD across different stages of severity. The factor analysis identified three subgroups in MCI and mild AD, and a fourth one in moderate–severe AD. We labelled the subgroups “depression,” “agitation,” “psychosis,” and “elation.” Conclusions: The frequency of NPS is high in MCI and AD and increases with the severity of cognitive decline. The subgroups of NPS were relatively consistent from MCI to moderate-severe AD. The subgroup elation appeared only in moderate-severe AD.
TL;DR: The positive impact on children of intergenerational programs is proved at both short- and long-term, and despite the different outcomes considered and the variable results, these programs resulted overall beneficial on elderly participants.
Abstract: Background:Elderly are at particular risk of social isolation. This condition significantly affects health; on the contrary, social involvement can be extremely advantageous. In this context, intergenerational programs improve interactions between different ages. Then, we conducted a review regarding intergenerational programs, to summarize the effects of these activities on both elderly and children.Methods:Our review followed the PRISMA statements. We considered papers reporting data about intergenerational programs involving children (preschool and elementary) and elderly.Results:The final selection obtained 27 sources. Ten studies evaluated children's outcomes outlining the positive impact of intergenerational programs upon children's perception of elderly. The effects on older participants were variegated considering well-being, depression, self-reported health, and self-esteem. Moreover, the retrieved studies outlined the importance of a careful organization and of a specific training for all staff members. The staff involved in similar programs appeared, overall, highly satisfied.Discussion:The positive impact on children of intergenerational programs is proved at both short- and long-term. Moreover, despite the different outcomes considered and the variable results, these programs resulted overall beneficial on elderly participants. Finally, similar activities resulted feasible even in case of older adults with dementia.
TL;DR: The findings tentatively suggest that touchscreen-based interventions can improve the psychological well-being of PWD, and possibilities for more rigorous future research are suggested.
Abstract: Background: Dementia can have significant detrimental impacts on the wellbeing of those with the disease and their carers. A range of computer-based interventions, including touchscreen-based interventions have been researched for use with this population in the hope that they might improve psychological wellbeing. This article reviews touchscreen-based interventions designed to be used by people with dementia, with a specific focus in assessing their impact on wellbeing.
Method: The data bases, PsycInfo, ASSIA, Medline, CINAHL and Cochrane were searched for touchscreen-based interventions designed to be used by people with dementia with reported psychological wellbeing outcomes. Methodological quality was assessed using Pluye et al.’s (2011) Mixed Methods Appraisal Tool (MMAT) checklist.
Results: Sixteen papers were eligible. They covered fourteen methodologically diverse interventions. Interventions were reported to be beneficial in relation to mental health, social interaction and sense of mastery. Touchscreen interventions also reportedly benefit informal carers in relation to their perceived burden and the quality of their relationships with the people they care for. Key aspects included the user interface, provision of support, learning style, tailored content, appropriate challenge, ergonomics and users’ dementia progression.
Conclusions: Whilst much of the existing research is relatively small-scale, the findings tentatively suggest that touchscreen based interventions can improve the psychological wellbeing of people with dementia, and possibilities for more rigorous future research are suggested.
TL;DR: The results suggest that Addenbrooke's Cognitive Examination III is a useful neuropsychological test for assessing the cognitive domains of attention, language, memory, and visuospatial function and enables detection of Alzheimer's disease in early stages.
Abstract: Background: Addenbrooke's Cognitive Examination III (ACE-III) is a screening test that was recently validated for diagnosing dementia. Since it assesses attention, language, memory, fluency, and visuospatial function separately, it may also be useful for general neuropsychological assessments. The aim of this study was to analyze the tool's ability to detect early stages of Alzheimer's disease and to examine the correlation between ACE-III scores and scores on standardized neuropsychological tests. Methods: Our study included 200 participants categorized as follows: 25 healthy controls, 48 individuals with subjective memory complaints, 47 patients with amnestic mild cognitive impairment and 47 mild Alzheimer's disease, and 33 patients with other neurodegenerative diseases. Results: The ACE-III memory and language domains were highly correlated with the neuropsychological tests specific to those domains (Pearson correlation coefficient of 0.806 for total delayed recall on the Free and Cued Selective Reminding Test vs. 0.744 on the Boston Naming Test). ACE-III scores discriminated between controls and patients with amnestic mild cognitive impairment (AUC: 0.906), and between controls and patients with mild Alzheimer's disease (AUC: 0.978). Conclusion: Our results suggest that ACE-III is a useful neuropsychological test for assessing the cognitive domains of attention, language, memory, and visuospatial function. It also enables detection of Alzheimer's disease in early stages.
TL;DR: To prevent suicide in older adults would require targeting specific factors for each subgroup while using holistic and comprehensive approaches, according to significant differences in the prevalence of potential risk factors within the three different age groups considered.
Abstract: Background: In the limited research into suicides in older adults, they have been treated as a homogenous group without distinguishing between different age groups This study aimed to compare differences in sociodemographic variables, recent life events, and mental and physical illnesses between three age groups within older adults who died by suicide: young-old (65–74 years), middle-old (75–84 years), and oldest old (85 years and over) in Queensland, Australia, during the years 2000–2012 (N = 978) Methods: The Queensland Suicide Register was utilized for the analysis Annual suicide rates were calculated Odds ratios with 95% confidence intervals and χ 2 tests for trend were calculated to examine differences between the three groups Results: Suicide rates were increasing with age for males, but not for females Hanging and firearms were the predominant methods of suicides However, suffocation by plastic bag and drowning as suicide methods increased with age, in contrast firearms and explosives decreased with age Overall, psychiatric problems, suicidal behavior, legal and financial stressors, and relationship problems decreased significantly with age, meanwhile physical conditions and bereavement increased with age Conclusion: Suicide across older adulthood is not a homogenous phenomenon Our findings showed significant differences in the prevalence of potential risk factors within the three different age groups considered To prevent suicide in older adults would require targeting specific factors for each subgroup while using holistic and comprehensive approaches
TL;DR: Multifaceted interventions directed at primary care physicians and populations, and at-risk elderly individuals in the community may be effective at preventing suicidal behavior and reducing suicidal ideation in older adults.
Abstract: Background: Older people have a high risk of suicide but research in this area has been largely neglected. Unlike for younger age groups, it remains unclear what strategies for prevention exist for older adults. This systematic review assesses the effectiveness of interventions to prevent suicidal behavior and reduce suicidal ideation in this age group. Methods: MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant publications from their dates of inception until 1 April 2016. Studies included in this review report effectiveness data about interventions delivered to older adults to prevent suicidal behavior (suicide, attempted suicide, and self-harm without suicidal intent) or reduce suicidal ideation. A narrative synthesis approach was used to analyze data and present findings. Results: Twenty one studies met the criteria for inclusion in the study. Most programs addressed risk predictors, specifically depression. Effective interventions were multifaceted primary care-based depression screening and management programs; treatment interventions (pharmacotherapy and psychotherapy); telephone counseling for vulnerable older adults; and community-based programs incorporating education, gatekeeper training, depression screening, group activities, and referral for treatment. Most of the studies were of low quality apart from the primary care-based randomized controlled trials. Conclusions: Multifaceted interventions directed at primary care physicians and populations, and at-risk elderly individuals in the community may be effective at preventing suicidal behavior and reducing suicidal ideation in older adults. However, more high quality trials are needed to demonstrate successful interventions.
TL;DR: New and distinctive insights into the relationship between neighborhoods and everyday life for people with dementia are presented that have important implications for the debate on social health and policy concerning dementia friendly communities.
Abstract: BACKGROUND: In this paper, we report progress on "Neighborhoods: our people, our places" an international study about how people living with dementia interact with their neighborhoods. The ideas of ...
TL;DR: A 12-week visual art program developed and evaluated the impact on people living with dementia through a mixed-methods longitudinal investigation highlights the potential for creative aging within dementia care, the benefits of art activities and the influence of the environment.
Abstract: Background: Research reviews highlight methodological limitations and gaps in the evidence base for the arts in dementia care. In response, we developed a 12-week visual art program and evaluated the impact on people living with dementia through a mixed-methods longitudinal investigation.
Methods: One hundred and twenty-five people living with mild to severe dementia were recruited across three research settings in England and Wales (residential care homes, a county hospital, and community venues). Quantitative and qualitative data on quality of life (QoL), communication and perceptions of the program were obtained through interviews and self-reports with participants and their carers. Eight domains of well-being were measured using a standardized observation tool, and data compared to an alternative activity with no art.
Results: Across all sites, scores for the well-being domains of interest, attention, pleasure, self-esteem, negative affect, and sadness were significantly better in the art program than the alternative condition. Proxy-reported QoL significantly improved between baseline and 3-month follow-up, but no improvements in QoL were reported by the participants with dementia. This was contrasted by their qualitative accounts, which described a stimulating experience important for social connectedness, well-being, and inner-strength. Communication deteriorated between baseline and follow-up in the hospital setting, but improved in the residential care setting.
Conclusions: The findings highlight the potential for creative aging within dementia care, the benefits of art activities and the influence of the environment. We encourage dementia care providers and arts and cultural services to work toward embedding art activities within routine care provision.
TL;DR: The current literature suggests that telepresence robots have potential utility for improving social connectedness of people with dementia and their carers, however, more systematic feasibility studies are needed to inform the development of telePresence robots followed by clinical trials to establish efficacy within dementia care.
Abstract: Background: Socially assistive robots are increasingly used as a therapeutic tool for people with dementia, as a means to improve quality of life through social connection. This paper presents a mixed-method integrative review of telepresence robots used to improve social connection of people with dementia by enabling real-time communication with their carers. Methods: A systematic search of Medline, ProQuest, PubMed, Scopus, Web of Science, CINAHL, EMBASE, and the Cochrane library was conducted to gather available evidence on the use of telepresence robots, specifically videoconferencing, to improve social connectedness, in people with dementia. A narrative synthesis was used to analyze the included studies. Results: A review of 1,035 records, identified four eligible peer-reviewed publications, reporting findings about three different mobile telepresence robots. The study designs included qualitative and mixed-methods approaches, focusing primarily on examining the feasibility and acceptability of the telepresence robots within the context of dementia care. These studies reported both positive outcomes of using telepresence robots to connect people with dementia to others, as well as barriers, such as a lack of experience in using a robot and technological issues. Conclusion: Although limited, the current literature suggests that telepresence robots have potential utility for improving social connectedness of people with dementia and their carers. However, more systematic feasibility studies are needed to inform the development of telepresence robots followed by clinical trials to establish efficacy within dementia care.
TL;DR: Through various manifestations, social inappropriateness is frequently the first clinical sign of a neurodegenerative process, especially in AD and bvFTD, years before noticeable impairment on classical neuropsychological assessment and brain atrophy on imaging.
Abstract: Background: New onset of mood and behavioral changes in middle-aged patients are frequently the first manifestations of an unrecognized neurocognitive disorder. Impairment of social cognition, the cognitive ability to process social information coming from others, such as emotions, to attribute mental states to others, and to respond appropriately to them, is often at the origin of behavioral manifestations in neurodegenerative disorders. Methods: This paper reviews the current literature on social cognition impairment in neurocognitive disorders, particularly in prodromal stages of behavioral-variant frontotemporal dementia (bvFTD), Alzheimer's disease (AD), idiopathic Parkinson's disease (IPD), and Lewy body dementia (LBD). The concepts of social cognition will be reviewed, including its impairment and neural basis, its clinical assessment, and the different therapeutic interventions available clinically. Results: Socially inappropriate behaviors, such as loss of empathy, inappropriateness of affect, and disinhibition are frequently reported in prodromal bvFTD and in prodromal AD. Lack of self-control, reduced perception of social cues, such as recognition of facial emotions and sarcastic speech, and impaired Theory of Mind all contribute to the neuropsychiatric symptoms and are secondary to neurodegeneration in specific brain regions. In contrasts to bvFTD and AD, deficits in social cognition in IPD occur later in the course of the disease and are often multifactorial in origin. Conclusions: Through various manifestations, social inappropriateness is frequently the first clinical sign of a neurodegenerative process, especially in AD and bvFTD, years before noticeable impairment on classical neuropsychological assessment and brain atrophy on imaging.
TL;DR: Both frailty and cognitive impairment are predictors of mortality and the effect is cumulative.
Abstract: Background Both physical frailty and cognitive impairment predict death, but the joint effect of these two factors is uncertain. The objectives are to determine if the Mini-mental state examination (MMSE) and the Frailty Index (FI) predict death over a five-year interval after accounting for the effect of the other; and if there is an interaction in this effect. Methods An analysis of an existing prospective cohort study of 1,751 community living older adults followed over a five-year time frame. Age, gender, and education were self-reported. The predictor variables were the FI - a measure of frailty based on the "Accumulation of Deficits" model of frailty; and the MMSE. Cox proportional hazards models were constructed for the outcome of time to death. Results The unadjusted Hazard Ratio (HR) (95% CI) for mortality was 2.17 (1.69, 2.80) for those who were only cognitively impaired, 2.02 (1.53, 2.68) for those who were only frail, and 3.57 (2.75, 4.62) for those who were both frail and cognitively impaired with the reference group of those who were neither frail nor cognitively impaired. Adjusted for age, gender, and education, the HR (95% CI) was 1.49 (1.13. 1.95) for those who were only cognitively impaired, 1.81 (1.35, 2.41) for those who were only frail, and 2.28 (1.69, 3.09) for those who were both frail and cognitively impaired. Conclusions Both frailty and cognitive impairment are predictors of mortality and the effect is cumulative. There was no interaction in this effect.
TL;DR: Twenty two- to twenty four-week treatment with Ginkgo biloba extract EGb 761® improved BPSD (except psychotic-like features) and caregiver distress caused by such symptoms.
Abstract: BACKGROUND In randomized controlled trials, Ginkgo biloba extract EGb 761® has been found to be effective in the treatment of behavioral and psychological symptoms of dementia (BPSD). METHODS To assess the effects of EGb 761® on specific BPSD, we analyzed data from all randomized, placebo-controlled, at least 20-week, trials of EGb 761® enrolling patients with dementia (probable Alzheimer's disease (AD), probable vascular dementia or probable AD with cerebrovascular disease) who had clinically significant BPSD (Neuropsychiatric Inventory (NPI) total score at least 6). Data were pooled and joint analyses of NPI single item composite and caregiver distress scores were performed by meta-analysis with a fixed effects model. RESULTS Four trials involving 1628 patients (EGb 761®, 814; placebo, 814) were identified; treatment duration was 22 or 24 weeks; the daily dose of EGb 761® was 240 mg in all trials. Pooled analyses including data from the full analysis sets of all trials (EGb 761®, 796 patients; placebo, 802 patients) revealed significant superiority of EGb 761® over placebo in total scores and 10 single symptom scores. Regarding caregiver distress scores, EGb 761®-treated patients improved significantly more than those receiving placebo in all symptoms except delusions, hallucinations, and elation/euphoria. The benefit of EGb 761® mainly consists of improvement in symptoms present at baseline, but the incidence of some symptoms was also decreased. CONCLUSIONS Twenty two- to twenty four-week treatment with Ginkgo biloba extract EGb 761® improved BPSD (except psychotic-like features) and caregiver distress caused by such symptoms.
TL;DR: The frequency and severity of behavioral disturbances in patient and caregiver stress accounted for the increased caregiver burden, which suggests that frontotemporal lobar degeneration and dementia with Lewy bodies caregivers should receive more support than is currently available.
Abstract: Background:Very few recent studies are available that compare caregiver burden, sleep quality, and stress in caregivers of different types of dementia. We aimed to investigate caregiver burden, sleep quality, and stress in caregivers of patients with frontotemporal lobar degeneration and dementia with Lewy bodies, as compared with caregivers of patients with Alzheimer's disease.Methods:This study was carried out from March 2011 to January 2014. In total, 492 dyads of patient and caregiver (frontotemporal lobar degeneration, n = 131; dementia with Lewy bodies, n = 36; Alzheimer's disease, n = 325) participated in this study. We compared patients with respect to the Neuropsychiatric Inventory and caregivers with respect to the Zarit Caregiver Burden Interview, Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, and Generalized Anxiety Disorder scale.Results:Frontotemporal lobar degeneration and dementia with Lewy bodies patients presented significantly more neuropsychiatric symptoms compared to Alzheimer's disease patients. Caregivers of frontotemporal lobar degeneration and dementia with Lewy bodies patients experienced significantly more burden compared to Alzheimer's disease caregivers. Furthermore, among caregivers of both frontotemporal lobar degeneration and dementia with Lewy bodies patients burden was predicted by the neuropsychiatric symptoms, PHQ-9 scores, and GAD-7 scores.Conclusions:The frequency and severity of behavioral disturbances in patient and caregiver stress accounted for the increased caregiver burden, which suggests that frontotemporal lobar degeneration and dementia with Lewy bodies caregivers should receive more support than is currently available.
TL;DR: Electroconvulsive therapy may be a promising option for the treatment of aggression and agitation in patients with severe dementia who are refractory to other treatment options, but the limitations of available studies suggest that a cautious approach to future randomized controlled trials is warranted.
Abstract: Background Agitation in patients with dementia increases caretaker burden, increases healthcare costs, and worsens the patient's quality of life. Antipsychotic medications, commonly used for the treatment of agitation in patients with dementia have a box warning from the FDA for elevated mortality risk. Electroconvulsive therapy (ECT) has made significant advances over the past several years, and is efficacious in treating a wide range of psychiatric conditions. We provide a systematic review of published literature regarding the efficacy of ECT for the treatment of agitation in patients with dementia (major neurocognitive disorder). Methods We searched PubMed, Medline, Google Scholar, UptoDate, Embase, and Cochrane for literature concerning ECT for treating agitation in dementia using the title search terms "ECT agitation dementia;" "ECT aggression dementia;" "ECT Behavior and Psychological Symptoms of Dementia;" and "ECT BPSD." The term "dementia" was also interchanged with "Major Neurocognitive Disorder." No time frame restriction was placed. We attempted to include all publications that were found to ensure a comprehensive review. We found 11 papers, with a total (N) of 216 patients. Results Limited to case reports, case series, retrospective chart review, retrospective case-control, and an open label prospective study, ECT has demonstrated promising results in decreasing agitation in patients with dementia. Patients who relapsed were found to benefit from maintenance ECT. Conclusions Available studies are often limited by concomitant psychotropic medications, inconsistent use of objective rating scales, short follow-up, lack of a control group, small sample sizes, and publication bias. A future randomized controlled trial will pose ethical and methodological challenges. A randomized controlled trial must carefully consider the definition of usual care as a comparison group. Well-documented prospective studies and/or additional case series with explicit selection criteria, a wide range of outcome measures, and less selection bias of the study sample that may favor treatment response, is warranted. ECT may be a promising option for the treatment of aggression and agitation in patients with severe dementia who are refractory to other treatment options, but the limitations of available studies suggest that a cautious approach to future randomized controlled trials is warranted.
TL;DR: Given the significant changes in the aged care service-system, it is important to discuss the barriers faced by family caregivers of people with dementia to inform the development of targeted strategies to address the lack of service use among these family caregivers.
Abstract: Background: Family caregivers of people with dementia have significant unmet needs in regard to their caregiving role. Despite this, they are reluctant to utilize services to reduce their burden. The aim of this study was to examine the barriers and facilitators of service use among family caregivers of people with dementia. Method: Semi-structured interviews were conducted with 24 family caregivers of community-dwelling people with dementia. Of these, 12 were partner caregivers (4 men, 8 women) and 12 were offspring caregivers (2 men, 10 women). The interviews were transcribed and analyzed using thematic analysis. Results: Six main barriers and three facilitators were identified. These barriers and facilitators were relevant across many types of services and supports. The barriers were: the inability to find information about relevant services or support, the poor quality or mistrust of the services, the inflexibility of services, caregivers’ beliefs about their obligations to the caregiving role and resistance by the care recipient. Key facilitators were: having good communication with the care recipient, having an “expert” point of contact, and having beliefs about the caregiving role that enabled the use of services. Conclusion: Given the significant changes in the aged care service-system, it is important to discuss the barriers faced by family caregivers of people with dementia. This will inform the development of targeted strategies to address the lack of service use among these family caregivers.
TL;DR: Research to date suggests that psychosis in PrD may be more common than previously thought and impact clinical course negatively, which may reflect the heterogeneous nature of PrD studies to date and the lack of inclusion of patients with late onset psychosis in most clinical studies.
Abstract: Background: Progression of dementia is often associated with the emergence of neuropsychiatric symptoms (NPS), though there is recent evidence that NPS may occur in prodromal dementia (PrD) and impact clinical course Mood and anxiety symptoms are the NPS that tend to occur most frequently in PrD and thus have been most extensively studied Comparatively, there has been little focus on psychotic symptoms in PrD Methods: The authors review the existing literature on psychosis in PrD, including the functional psychosis of early and late onset, with a focus on epidemiology, phenomenology, and clinical course and treatment considerations Results: Patients with psychotic disorders at baseline such as schizophrenia may be more at risk for developing dementia over time, although this is not completely clear Psychotic symptoms are likely more common in PrD than previously understood based on factor analysis studies, although they are much more common in established dementia Variability in findings may reflect the heterogeneous nature of PrD studies to date and the lack of inclusion of patients with late onset psychosis in most clinical studies The presence of psychosis in patients with PrD may be associated with a worse prognosis in terms of mortality and conversion to dementia Conclusions: Research to date suggests that psychosis in PrD may be more common than previously thought and impact clinical course negatively Future studies incorporating patients with late onset psychotic disorders, and focusing on the impact of early recognition and treatment, are required to more fully understand the role of psychosis in PrD
TL;DR: There are some robust positive measures in existence for family caregivers of people living with dementia, however, lack of reporting of the psychometric properties hindered the quality assessment of some outcome measures identified in this review.
Abstract: Background: Family caregivers of people living with dementia can have both positive and negative experiences of caregiving Despite this, existing outcome measures predominately focus on negative aspects of caregiving such as burden and depression This review aimed to evaluate the development and psychometric properties of existing positive psychology measures for family caregivers of people living with dementia to determine their potential utility in research and practice Method: A systematic review of positive psychology outcome measures for family caregivers of people with dementia was conducted The databases searched were as follows: PsychINFO, CINAHL, MEDLINE, EMBASE, and PubMed Scale development papers were subject to a quality assessment to appraise psychometric properties Results: Twelve positive outcome measures and six validation papers of these scales were identified The emerging constructs of self-efficacy, spirituality, resilience, rewards, gain, and meaning are in line with positive psychology theory Conclusions: There are some robust positive measures in existence for family caregivers of people living with dementia However, lack of reporting of the psychometric properties hindered the quality assessment of some outcome measures identified in this review Future research should aim to include positive outcome measures in interventional research to facilitate a greater understanding of the positive aspects of caregiving and how these contribute to well-being