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Huizenga J, Scheffelaar A, Fruijtier A, Wilken JP, Bleijenberg N, Van Regenmortel T. Everyday Experiences of People Living with Mild Cognitive Impairment or Dementia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10828. [PMID: 36078544 PMCID: PMC9518176 DOI: 10.3390/ijerph191710828] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Increasing attention has been paid to the 'voice' of people living with mild cognitive impairment (MCI) or dementia, but there is a lack of clarity about how everyday life is perceived from this insider's perspective. This study aimed to explore the everyday life experiences, challenges and facilitators of individuals with MCI and dementia living at home. A scoping review of qualitative studies, guided by the Joanna Briggs Institute Reviewers Manual, was conducted. Eight databases were searched, resulting in 6345 records, of which 58 papers published between 2011 and 2021 were included. Analysis was carried out by descriptive content analysis. Findings were categorized into seven spheres of everyday life: experiences related to the condition, self, relationships, activities, environment, health and social care and public opinions. The results show many disruptions and losses in everyday life and how people try to accommodate these changes. In all areas of everyday life, people show a deep desire to have reciprocal relationships, stay engaged through participation in activities and have a sense of belonging in the community. However, more research is needed on the factors that promote and impede the sense of reciprocity and belonging.
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Affiliation(s)
- Jacoba Huizenga
- Institute of Social Work, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Aukelien Scheffelaar
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Agnetha Fruijtier
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
| | - Jean Pierre Wilken
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Research Center Healthy & Sustainable Living, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Department Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Tine Van Regenmortel
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
- HIVA—Research Institute for Work and Society, Faculty of Social Sciences, University of Leuven, B-3000 Leuven, Belgium
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52
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Lee AR, McDermott O, Guo B, Roe J, Orrell M. A Self-management App for People Living With Mild Dementia (PRIDE): Protocol for a Pre-Post Feasibility Study. JMIR Res Protoc 2022; 11:e33881. [PMID: 35896033 PMCID: PMC9377472 DOI: 10.2196/33881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/21/2022] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background With the rapid increase in the prevalence of dementia in the United Kingdom and beyond, the emotional, social, and economic burden on individuals, families, and health care services continues to rise. Currently, interventions that enable people living with dementia to better manage their condition and achieve a good quality of life are needed. Objective This study aimed to explore how the Promoting Independence in Dementia (PRIDE) app can promote and support the self-management of people living with mild dementia. Methods Feasibility of a pre-post study design incorporating the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework will be studied. We will use up to 6 National Health Service Trusts as research sites and the Join Dementia Research website and accept self-referrals to recruit 60 to 90 people living with mild dementia. Participants will complete the PRIDE app intervention over 8 weeks with support from a dementia adviser facilitator. Measures exploring mood, physical well-being, and quality of life will be collected at baseline and at follow-ups at 3 and 6 months. Facilitators and National Health Service staff will be invited to complete interviews shortly after the intervention phase. Results Data collection began in June 2021 and is predicted to cease by the end of August 2022. Analysis of the quantitative measures will explore the impact of the PRIDE app on participants’ independence, mood, and quality of life. Interview data will discuss participant experiences, how the use of the app affected them, and if it has the potential to be successfully implemented and maintained in dementia services. Conclusions This study will show the potential reach, effectiveness, and adoption of the PRIDE app intervention in the lives of people with mild dementia. The findings from this study will inform future research on the PRIDE app and any further developments to improve its effectiveness. International Registered Report Identifier (IRRID) DERR1-10.2196/33881
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Affiliation(s)
- Abigail Rebecca Lee
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, Institute of Mental Health, University of Nottingham - Jubilee Campus, Nottingham, United Kingdom
| | - Orii McDermott
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, Institute of Mental Health, University of Nottingham - Jubilee Campus, Nottingham, United Kingdom
| | - Boliang Guo
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, Institute of Mental Health, University of Nottingham - Jubilee Campus, Nottingham, United Kingdom
| | - James Roe
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, Institute of Mental Health, University of Nottingham - Jubilee Campus, Nottingham, United Kingdom
| | - Martin Orrell
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, Institute of Mental Health, University of Nottingham - Jubilee Campus, Nottingham, United Kingdom
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Alvares Pereira G, Sousa I, Nunes MVS. Cultural Adaptation of Cognitive Stimulation Therapy (CST) for Portuguese People with Dementia. Clin Gerontol 2022; 45:891-902. [PMID: 33012271 DOI: 10.1080/07317115.2020.1821857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Portugal is one of the most aged countries in the world and dementia is increasing among the Portuguese population. It is estimated to affect around 200,000 people in Portugal. There is a clear need for non-pharmacological interventions to ameliorate the symptoms of dementia and improve the quality of life. Cognitive Stimulation Therapy (CST), a worldwide well-known program developed in the United Kingdom (UK), is recognized as a cost-effective intervention, with benefits both in cognitive function and quality of life of people with mild to moderate dementia. We tested the feasibility and cultural appropriateness and adapted CST to Portuguese people with dementia. METHODS The Formative Method for Adapting Psychotherapy (FMAP) model for cultural adaptation was used. A focus group discussion with health professionals and caregivers provided the basis for cultural adaptation, as well as feedback from participants, caregivers, and facilitators after a pilot study. RESULTS Some modifications were required, especially related to linguistic issues, in 11 of the 14 CST sessions. The adapted program was found to be acceptable and enjoyable in a small sample of people with dementia in a rehabilitation context. CONCLUSIONS CST seems feasible and culturally appropriate in Portugal. A systematically developed and culturally adapted manual is ready to be used in a large-scale implementation and validation of CST in Portugal. CLINICAL IMPLICATIONS CST is a valid program for the Portuguese culture, contributes to the availability of a structured and effective clinical intervention for PwD in Portugal and to the possibility of comparing programs across countries.
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Affiliation(s)
| | | | - Maria Vânia Silva Nunes
- Institute of Health Sciences- Universidade Católica Portuguesa, Lisbon, Portugal.,Center for Interdisciplinary Research in Health (CIIS), Lisboa, Portugal
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54
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Petralia MC, Mangano K, Quattropani MC, Lenzo V, Nicoletti F, Fagone P. Computational Analysis of Pathogenetic Pathways in Alzheimer’s Disease and Prediction of Potential Therapeutic Drugs. Brain Sci 2022; 12:brainsci12070827. [PMID: 35884634 PMCID: PMC9313152 DOI: 10.3390/brainsci12070827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background. Alzheimer’s disease (AD) is a chronic and progressive neurodegenerative disease which affects more than 50 million patients and represents 60–80% of all cases of dementia. Mutations in the APP gene, mostly affecting the γ-secretase site of cleavage and presenilin mutations, have been identified in inherited forms of AD. Methods. In the present study, we performed a meta-analysis of the transcriptional signatures that characterize two familial AD mutations (APPV7171F and PSEN1M146V) in order to characterize the common altered biomolecular pathways affected by these mutations. Next, an anti-signature perturbation analysis was performed using the AD meta-signature and the drug meta-signatures obtained from the L1000 database, using cosine similarity as distance metrics. Results. Overall, the meta-analysis identified 1479 differentially expressed genes (DEGs), 684 downregulated genes, and 795 upregulated genes. Additionally, we found 14 drugs with a significant anti-similarity to the AD signature, with the top five drugs being naftifine, moricizine, ketoconazole, perindopril, and fexofenadine. Conclusions. This study aimed to integrate the transcriptional profiles associated with common familial AD mutations in neurons in order to characterize the pathogenetic mechanisms involved in AD and to find more effective drugs for AD.
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Affiliation(s)
- Maria Cristina Petralia
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Katia Mangano
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (K.M.); (P.F.)
| | | | - Vittorio Lenzo
- Department of Social and Educational Sciences of the Mediterranean Area, University for Foreigners “Dante Alighieri” of Reggio Calabria, 89125 Reggio Calabria, Italy;
| | - Ferdinando Nicoletti
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (K.M.); (P.F.)
- Correspondence:
| | - Paolo Fagone
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (K.M.); (P.F.)
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Wuttke-Linnemann A, Henrici C, Skoluda N, Nater UM, Endres K, Fellgiebel A. Psychobiological Monitoring of a Home-Based Dyadic Intervention for People Living with Dementia and Their Caregivers: Added Value to Evaluate Treatment Success and Understand Underlying Mechanisms. J Alzheimers Dis 2022; 87:1725-1739. [PMID: 35527544 DOI: 10.3233/jad-210618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research concerning people living with dementia (PwD) and their informal caregivers (ICs) has recently begun to focus on dyadic aspects of psychosocial interventions. OBJECTIVE We adapted a dyadic psychosocial intervention and examined its effects on psychobiological stress in daily life. METHODS Twenty-four PwD-caregiver dyads were visited seven times at home by specialized nursing staff. Momentary subjective stress, salivary cortisol (sCort), and salivary alpha-amylase (sAA) were measured in PwD and ICs before and after each home visit as well as six times per day at two days each at the beginning and end of the intervention as part of an ambulatory assessment. Hair cortisol concentrations (HCC) were measured twice. RESULTS After each home visit session, ICs reported lower subjective stress. sCort was lower in both ICs and PwD, whereas sAA did not change. In daily life, area under the curve (AUCg) concerning sCort secretion indicated that PwD had lower sCort daily output at the end of the intervention, and AUCg concerning subjective stress indicated that both PwD and ICs reported lower subjective stress than at the beginning of the intervention. AUCg concerning sAA did not change over time in either group. HCC did not vary over time but increased with disease severity. CONCLUSION The psychosocial intervention reduced psychobiological stress but affected psychobiological stress measures differently in PwD and ICs. In particular, the discrepancy between subjective and physiological markers of stress in PwD emphasizes the added value to evaluate treatment success and understand underlying mechanisms as a complement to self-reports.
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Affiliation(s)
| | - Clara Henrici
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Nadine Skoluda
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria.,University Research Platform 'The Stress of Life - Processes and Mechanisms Underlying Everyday Life Stress', University of Vienna, Vienna, Austria
| | - Urs M Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria.,University Research Platform 'The Stress of Life - Processes and Mechanisms Underlying Everyday Life Stress', University of Vienna, Vienna, Austria
| | - Kristina Endres
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Andreas Fellgiebel
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.,Hospital for Psychiatry, Psychosomatic and Psychotherapy, Agaplesion Elisabethenstift, Darmstadt, Germany
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56
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Burley CV, Burns K, Lam BCP, Brodaty H. Nonpharmacological approaches reduce symptoms of depression in dementia: A systematic review and meta-analysis. Ageing Res Rev 2022; 79:101669. [PMID: 35714853 DOI: 10.1016/j.arr.2022.101669] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depression is a common psychological symptom associated with dementia. Pharmacological approaches are often used despite two large negative trials of efficacy. This meta-analysis examines nonpharmacological (i.e., psychosocial) approaches for symptoms of depression in people living with dementia and reports statistical and clinical significance. METHODS Relevant studies published between 2012 and 2020 were sourced by searching electronic databases: MEDLINE, EMBASE, PsychINFO, Social Work Abstracts and the Cochrane Central Register of Controlled Trials. Studies were assessed for methodological quality. Random-effects meta-analysis was performed to calculate a pooled effect size (ES) and 95% confidence intervals (CI). RESULTS Overall, 37 nonpharmacological studies were identified including 2,636 participants. The mean quality rating was high (12/14, SD=1.4). Meta-analysis revealed that nonpharmacological approaches were significantly associated with reduced symptoms of depression with a medium effect size (ES=-0.53, 95%CI [-0.72, -0.33], p < 0.0001). There was considerable heterogeneity between studies. Meta-regression revealed this was not driven by intervention type or setting (residential versus community). CONCLUSIONS Nonpharmacological approaches such as reminiscence, cognitive stimulation/ rehabilitation, therapeutic, music-based approaches and education/ training, have the potential to reduce symptoms of depression in dementia.
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Affiliation(s)
- Claire V Burley
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Kim Burns
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Ben C P Lam
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.
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57
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Mountain G, Wright J, Cooper CL, Lee E, Sprange K, Beresford-Dent J, Young T, Walters S, Berry K, Dening T, Loban A, Turton E, Thomas BD, Young EL, Thompson BJ, Crawford B, Craig C, Bowie P, Moniz-Cook E, Foster A. An intervention to promote self-management, independence and self-efficacy in people with early-stage dementia: the Journeying through Dementia RCT. Health Technol Assess 2022; 26:1-152. [PMID: 35536231 DOI: 10.3310/khha0861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are few effective interventions for dementia. AIM To determine the clinical effectiveness and cost-effectiveness of an intervention to promote self-management, independence and self-efficacy in people with early-stage dementia. OBJECTIVES To undertake a randomised controlled trial of the Journeying through Dementia intervention compared with usual care, conduct an internal pilot testing feasibility, assess intervention delivery fidelity and undertake a qualitative exploration of participants' experiences. DESIGN A pragmatic two-arm individually randomised trial analysed by intention to treat. PARTICIPANTS A total of 480 people diagnosed with mild dementia, with capacity to make informed decisions, living in the community and not participating in other studies, and 350 supporters whom they identified, from 13 locations in England, took part. INTERVENTION Those randomised to the Journeying through Dementia intervention (n = 241) were invited to take part in 12 weekly facilitated groups and four one-to-one sessions delivered in the community by secondary care staff, in addition to their usual care. The control group (n = 239) received usual care. Usual care included drug treatment, needs assessment and referral to appropriate services. Usual care at each site was recorded. MAIN OUTCOME MEASURES The primary outcome was Dementia-Related Quality of Life score at 8 months post randomisation, with higher scores representing higher quality of life. Secondary outcomes included resource use, psychological well-being, self-management, instrumental activities of daily living and health-related quality of life. RANDOMISATION AND BLINDING Participants were randomised in a 1 : 1 ratio. Staff conducting outcome assessments were blinded. DATA SOURCES Outcome measures were administered in participants' homes at baseline and at 8 and 12 months post randomisation. Interviews were conducted with participants, participating carers and interventionalists. RESULTS The mean Dementia-Related Quality of Life score at 8 months was 93.3 (standard deviation 13.0) in the intervention arm (n = 191) and 91.9 (standard deviation 14.6) in the control arm (n = 197), with a difference in means of 0.9 (95% confidence interval -1.2 to 3.0; p = 0.380) after adjustment for covariates. This effect size (0.9) was less than the 4 points defined as clinically meaningful. For other outcomes, a difference was found only for Diener's Flourishing Scale (adjusted mean difference 1.2, 95% confidence interval 0.1 to 2.3), in favour of the intervention (i.e. in a positive direction). The Journeying through Dementia intervention cost £608 more than usual care (95% confidence interval £105 to £1179) and had negligible difference in quality-adjusted life-years (-0.003, 95% confidence interval -0.044 to 0.038). Therefore, the Journeying through Dementia intervention had a mean incremental cost per quality-adjusted life-year of -£202,857 (95% confidence interval -£534,733 to £483,739); however, there is considerable uncertainty around this. Assessed fidelity was good. Interviewed participants described receiving some benefit and a minority benefited greatly. However, negative aspects were also raised by a minority. Seventeen per cent of participants in the intervention arm and 15% of participants in the control arm experienced at least one serious adverse event. None of the serious adverse events were classified as related to the intervention. LIMITATIONS Study limitations include recruitment of an active population, delivery challenges and limitations of existing outcome measures. CONCLUSIONS The Journeying through Dementia programme is not clinically effective, is unlikely to be cost-effective and cannot be recommended in its existing format. FUTURE WORK Research should focus on the creation of new outcome measures to assess well-being in dementia and on using elements of the intervention, such as enabling enactment in the community. TRIAL REGISTRATION This trial is registered as ISRCTN17993825. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jessica Wright
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy L Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Research Unit, University of Nottingham, Nottingham, UK
| | | | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katherine Berry
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Tom Dening
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amanda Loban
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emily Turton
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Benjamin D Thomas
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma L Young
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Benjamin J Thompson
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Bethany Crawford
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Claire Craig
- Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Peter Bowie
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | | | - Alexis Foster
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Morton T, Evans SB, Brooker D, Williamson T, Wong G, Tinelli M, Frost F, Bray J, Hullah N. Sustainability of locally driven centres for those affected by dementia: a protocol for the get real with meeting centres realist evaluation. BMJ Open 2022; 12:e062697. [PMID: 35501073 PMCID: PMC9062872 DOI: 10.1136/bmjopen-2022-062697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Improving support for people with early to moderate dementia to live at home in their communities is a global public health goal. Community adult social care is not robust in many parts of the UK, however, with the pandemic increasing pressure on services for this population. Community-led interventions can play a key role in supporting people postdiagnosis, helping delay decline, but many interventions struggle to sustain beyond 1-2 years. Meeting Centres (MCs) are one such intervention, which many UK community groups find attractive and achievable. However, it is not understood how these communities can ensure they are putting in place strategies that will help them sustain in the longer term, beyond start-up phase. METHODS AND ANALYSIS This realist evaluation aims to understand the factors affecting sustainability of MCs in rural areas and learn lessons from MCs that have sustained beyond 3 years. Data will be collected using mixed methods: interviews and group discussions with stakeholders involved at every level in three case study locations in England and Wales, analysed with Soft Systems modelling; a Discrete Choice Experiment exploring what people across the UK value and are willing to pay for MCs, analysed with regression modelling. All data will be synthesised using a Realist logic of analysis to build a theoretical model of how, why, for whom, in what contexts and to what extent MCs can be successfully implemented for the long term. ETHICS AND DISSEMINATION As participants may lack capacity for informed consent, favourable ethical opinion was received from a Health Research Authority research ethics committee. Resulting recommendations will be of interest to stakeholders including those commissioning, planning, running, supporting or attending MCs, as well as policy-makers and healthcare professionals. Knowledge will be shared with emerging MCs to help accelerate scale up of this intervention.
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Affiliation(s)
- Thomas Morton
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Shirley B Evans
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Dawn Brooker
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Tracey Williamson
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Michela Tinelli
- PSSRU, London School of Economics and Political Science, London, UK
| | - Faith Frost
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Jennifer Bray
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Nigel Hullah
- 3 Nations Working Group for Dementia, Swansea, UK
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Bat BKK, Chan JYC, Chan TK, Huo Z, Yip BHK, Wong MCS, Tsoi KKF. Comparing drawing under instructions with image copying for mild cognitive impairment (MCI) or dementia screening: a meta-analysis of 92 diagnostic studies. Aging Ment Health 2022; 26:1019-1026. [PMID: 33999724 DOI: 10.1080/13607863.2021.1922599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Drawing is a major component of cognitive screening for dementia. It can be performed without language restriction. Drawing pictures under instructions and copying images are different screening approaches. The objective of this study was to compare the diagnostic performance between drawing under instructions and image copying for MCI and dementia screening. METHOD A literature search was carried out in the OVID databases with keywords related to drawing for cognitive screening. Study quality and risk of bias were assessed by QUADAS-2. The level of diagnostic accuracy across different drawing tests was pooled by bivariate analysis in a random effects model. The area under the hierarchical summary receiver-operating characteristic curve (AUC) was constructed to summarize the diagnostic performance. RESULTS Ninety-two studies with sample size of 22,085 were included. The pooled results for drawing under instructions showed a sensitivity of 79% (95% CI: 76 - 83%) and a specificity of 80% (95% CI: 77 - 83%) with AUC of 0.87 (95% CI: 0.83 - 0.89). The pooled results for image copying showed a sensitivity of 71% (95% CI: 62 - 79%) and a specificity of 83% (95% CI: 72 - 90%) with AUC of 0.83 (95% CI: 0.80 - 0.86). Clock-drawing test was the screening test used in the majority of studies. CONCLUSION Drawing under instructions showed a similar diagnostic performance when compared with image copying for cognitive screening and the administration of image copying is relatively simpler. Self-screening for dementia is feasible to be done at home in the near future.
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Affiliation(s)
- Baker K K Bat
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce Y C Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Tak Kit Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhaohua Huo
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin H K Yip
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin C S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin K F Tsoi
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China
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Afifi T, Collins N, Rand K, Otmar C, Mazur A, Dunbar NE, Fujiwara K, Harrison K, Logsdon R. Using Virtual Reality to Improve the Quality of Life of Older Adults with Cognitive Impairments and their Family Members who Live at a Distance. HEALTH COMMUNICATION 2022:1-12. [PMID: 35253531 DOI: 10.1080/10410236.2022.2040170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study examines whether using virtual reality (VR) with older adults with mild cognitive impairment (MCI) or mild to moderate dementia with a family member who lives at a distance can improve the quality of life of the older adult and the family member. Twenty-one older adults in a senior living community and a family member (who participated in the VR with the older adult from a distance) engaged in a baseline telephone call, followed by three weekly VR sessions. The VR was associated with improvements in older adults' affect and stress, relationship with their family member, and overall quality of life, compared to baseline. Family members' negative affect, depressive symptoms, and caregiver burden also decreased and their mental health improved after using the VR, compared to baseline. Using the VR, however, did not change their relationship with the older adult. In addition, older adults and family members who experienced the VR sessions as more socially engaging reported better psychological and relational well-being, with older adults also experiencing greater improvements in overall quality of life. Finally, preliminary results suggest that older adults with dementia and their family members might benefit even more from using the VR than older adults with MCI and their family members.
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Affiliation(s)
- Tamara Afifi
- Department of Communication, University of California Santa Barbara
| | - Nancy Collins
- Department of Psychological and Brain Sciences, University of California Santa Barbara
| | - Kyle Rand
- Neuroscience and Biomedical Engineering, Duke University
| | - Chris Otmar
- Department of Communication, University of California Santa Barbara
| | - Allison Mazur
- Department of Communication, University of California Santa Barbara
| | - Norah E Dunbar
- Department of Communication, University of California Santa Barbara
| | - Ken Fujiwara
- Faculty of the Human Sciences, Osaka University of Economics
| | - Kathryn Harrison
- User Experience Researcher, Corporate Applications, Blizzard Entertainment
| | - Rebecca Logsdon
- Departmentof Psychosocial and Community Health, University of Washington
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Integrated Nonpharmacological Intervention for Patients with MCI—A Preliminary Study in Shanghai, China. Int J Integr Care 2022; 22:21. [PMID: 35340346 PMCID: PMC8896240 DOI: 10.5334/ijic.5706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/19/2022] [Indexed: 12/05/2022] Open
Abstract
Objective: Mild cognitive impairment is a transitional state between normal aging and Alzheimer’s and is an internationally recognized pre-stage state of Alzheimer’s. It is the starting point for early detection and intervention in dementia. An empirical study was conducted to determine how medical social workers provide intervention services to older adults with mild cognitive impairment, specific strategies for change, and the effectiveness of the intervention. Methods: This was a quasi-experimental intervention study. Conclusion: Through integrated intervention, the development of cognitive impairment can be significantly delayed, cognitive abilities can be improved (p < .05), and decline in daily living abilities can be significantly delayed (p < .05). At the same time, the mental health of participants can be improved to a certain extent.
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Carbone E, Piras F, Pastore M, Borella E. The Role of Individual Characteristics in Predicting Short- and Long-Term Cognitive and Psychological Benefits of Cognitive Stimulation Therapy for Mild-to-Moderate Dementia. Front Aging Neurosci 2022; 13:811127. [PMID: 35087398 PMCID: PMC8787290 DOI: 10.3389/fnagi.2021.811127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: This study examined the role of individual characteristics in predicting short- and long-term benefits of the Italian version of Cognitive Stimulation Therapy (CST-IT), an evidence-based intervention for people with mild-to-moderate dementia. Materials and Methods: Data were drawn from a sample (N = 123) of people with dementia (PwD) who took part in a multicenter controlled clinical trial of CST-IT. Assessments at pre-test, immediately after completing the treatment, and 3 months later investigated the following outcomes: general cognitive functioning and language, mood and behavior, everyday functioning, and quality of life. Age, education and baseline (pre-test) cognitive functioning, mood (depression) and behavioral and neuropsychiatric symptoms were considered as predictors of any short- and long-term benefits. Results: Linear mixed-effects models showed that different individual characteristics -particularly education and age- influenced the benefits of CST-IT, depending on the outcome measures considered. Higher education predicted larger gains in general cognitive functioning and, along with less severe depressive symptoms, in language (magnification effects). Older age was associated with positive changes in mood (compensation effects). Albeit very modestly, older age was also associated with larger gains in everyday functioning (compensation effects). Gains in quality of life were predicted by older age and lower education (compensation effects). Baseline cognitive functioning, mood and/or behavioral symptoms broadly influenced performance too, but their role again depended on the outcomes considered. Discussion: These findings underscore the importance of considering and further exploring how psychosocial interventions like CST are affected by individual characteristics in order to maximize their efficacy for PwD.
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Affiliation(s)
- Elena Carbone
- Department of General Psychology, University of Padova, Padua, Italy
- *Correspondence: Elena Carbone,
| | - Federica Piras
- Neuropsychiatry Laboratory, Clinical and Behavioral Neurology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Massimiliano Pastore
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
| | - Erika Borella
- Department of General Psychology, University of Padova, Padua, Italy
- Erika Borella,
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Justo-Henriques SI, Pérez-Sáez E, Marques-Castro AE, Carvalho JO. Effectiveness of a year-long individual cognitive stimulation program in Portuguese older adults with cognitive impairment. AGING, NEUROPSYCHOLOGY, AND COGNITION 2022; 30:321-335. [PMID: 35012439 DOI: 10.1080/13825585.2021.2023458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive stimulation is a recommended therapy with positive effects on the cognitive performance of older adults with neurocognitive disorders. However, there are few one-on-one, long-term interventions applied by professionals. The aim of the present study was to determine the effectiveness of 47-week individual cognitive stimulation (iCS) interventions on cognition, mood, instrumental activities of daily living, and quality of life in older adults, with neurocognitive disorders using a single-blind, randomized, parallel two-arm RCT. A sample of 59 older adults with neurocognitive disorders (predominantly Alzheimer's disease), who were non-institutionalized but socially vulnerable, was selected. The intervention group (n = 30) received 47 iCS weekly sessions. The control group (n = 29) maintained their baseline treatments. Outcomes were global cognitive function, cognitive impairment, mood, instrumental activities of daily living, and self-reported quality of life. All participants were assessed at baseline, 25 weeks, and 50 weeks. The results showed a significant effect of the intervention on MMSE, MoCA, GDS-15. Individual cognitive stimulation may have beneficial effects on the cognitive function and mood of older adults with cognitive impairment.
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Affiliation(s)
- Susana I. Justo-Henriques
- Health Sciences Research Unit: Nursing (Uicisa: E), Nursing School of Coimbra (Esenfc), Portugal. Neuropsychologist and Invited Adjunct Professor, Polytechnic Institute of Beja, Beja, Portugal
| | - Enrique Pérez-Sáez
- Neuropsychologist, National Reference Centre for Alzheimer’s and Dementia Care, Imserso, Spain
| | | | - Janessa O. Carvalho
- Neuropsychologist and Associate Professor, Bridgewater State University, Bridgewater, MA, USA
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Krøier JK, McDermott O, Ridder HM. Conceptualizing attunement in dementia care: a meta-ethnographic review. Arts Health 2022; 14:32-48. [DOI: 10.1080/17533015.2020.1827276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Julie Kolbe Krøier
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Orii McDermott
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Hanne Mette Ridder
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
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Koch J, Amos JG, Beattie E, Lautenschlager NT, Doyle C, Anstey KJ, Mortby ME. Non-pharmacological interventions for neuropsychiatric symptoms of dementia in residential aged care settings: An umbrella review. Int J Nurs Stud 2022; 128:104187. [DOI: 10.1016/j.ijnurstu.2022.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
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Halse I, Bjørkløf GH, Engedal K, Selbæk G, Barca ML. Locus of Control and Its Associations with Depressive Symptoms amongst People with Dementia. Dement Geriatr Cogn Disord 2021; 50:258-265. [PMID: 34384076 DOI: 10.1159/000517936] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Depression is common amongst people with dementia. This study examines whether locus of control (LoC), a perceived control construct influential in the coping process, is related to depressive symptoms in this population. METHODS In this prospective observational study, 257 community-dwelling older adults with a confirmed dementia diagnosis were included. At baseline, measures of depressive symptoms, LoC, cognition, independent functional ability, general health, dementia severity, and dementia disease insight were collected. At follow-up, measures of depressive symptoms and cognition were collected. Multiple linear regression using degree of depressive symptoms as measured with Montgomery-Asberg Depression Rating Scale as a dependent variable was applied to assess whether LoC was associated with depressive symptoms at baseline and follow-up while controlling for covariates. RESULTS LoC (p < 0.001), general health (p = 0.003), and insight (p = 0.010) were associated with severity of depressive symptoms at baseline, accounting for 28% of the variance. LoC (p = 0.025) and depressive symptoms (p < 0.001) at baseline were associated with severity of depressive symptoms at follow-up, accounting for 56.3% of the variance. CONCLUSION LoC was significantly associated with severity of depressive symptoms in people with dementia at baseline and at follow-up. Attention to LoC may be valuable for our understanding of depression in people with dementia, and interventions targeting depression could benefit from including a focus on internalizing perceived control. However, these findings are novel, and more research is needed.
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Affiliation(s)
- Ingeborg Halse
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital-Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital-Ullevaal, Oslo, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital-Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maria Lage Barca
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital-Ullevaal, Oslo, Norway
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Di Tella S, Cabinio M, Isernia S, Blasi V, Rossetto F, Saibene FL, Alberoni M, Silveri MC, Sorbi S, Clerici M, Baglio F. Neuroimaging Biomarkers Predicting the Efficacy of Multimodal Rehabilitative Intervention in the Alzheimer's Dementia Continuum Pathology. Front Aging Neurosci 2021; 13:735508. [PMID: 34880742 PMCID: PMC8645692 DOI: 10.3389/fnagi.2021.735508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022] Open
Abstract
In this work we aimed to identify neural predictors of the efficacy of multimodal rehabilitative interventions in AD-continuum patients in the attempt to identify ideal candidates to improve the treatment outcome. Subjects in the AD continuum who participated in a multimodal rehabilitative treatment were included in the analysis [n = 82, 38 Males, mean age = 76 ± 5.30, mean education years = 9.09 ± 3.81, Mini Mental State Examination (MMSE) mean score = 23.31 ± 3.81]. All subjects underwent an MRI acquisition (1.5T) at baseline (T0) and a neuropsychological evaluation before (T0) and after intervention (T1). All subjects underwent an intensive multimodal cognitive rehabilitation (8–10 weeks). The MMSE and Neuropsychiatric Inventory (NPI) scores were considered as the main cognitive and behavioral outcome measures, and Delta change scores (T1–T0) were categorized in Improved (ΔMMSE > 0; ΔNPI < 0) and Not Improved (ΔMMSE ≤ 0; ΔNPI ≥ 0). Logistic Regression (LR) and Random Forest classification models were performed including neural markers (Medial Temporal Brain; Posterior Brain (PB); Frontal Brain (FB), Subcortical Brain indexes), neuropsychological (MMSE, NPI, verbal fluencies), and demographical variables (sex, age, education) at baseline. More than 50% of patients showed a positive effect of the treatment (ΔMMSE > 0: 51%, ΔNPI < 0: 52%). LR model on ΔMMSE (Improved vs. Not Improved) indicate a predictive role for MMSE score (p = 0.003) and PB index (p = 0.005), especially the right PB (p = 0.002) at baseline. The Random Forest analysis correctly classified 77% of cognitively improved and not improved AD patients. Concerning the NPI, LR model on ΔNPI (Improved vs. Not Improved) showed a predictive role of sex (p = 0.002), NPI (p = 0.005), PB index (p = 0.006), and FB index (p = 0.039) at baseline. The Random Forest reported a classification accuracy of 86%. Our data indicate that cognitive and behavioral status alone are not sufficient to identify best responders to a multidomain rehabilitation treatment. Increased neural reserve, especially in the parietal areas, is also relevant for the compensatory mechanisms activated by rehabilitative treatment. These data are relevant to support clinical decision by identifying target patients with high probability of success after rehabilitative programs on cognitive and behavioral functioning.
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Affiliation(s)
- Sonia Di Tella
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | - Maria Caterina Silveri
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,Università degli Studi di Firenze, NEUROFARBA, Firenze, Italy
| | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,Department of Physiopathology and Transplants, Università degli Studi di Milano, Milan, Italy
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Justo-Henriques SI, Pérez-Sáez E, Apóstolo JLA, Carvalho JO. Effectiveness of a Randomized Controlled Trial of Individual Reminiscence Therapy on Cognition, Mood and Quality of Life in Azorean Older Adults with Neurocognitive Disorders. J Clin Med 2021; 10:5395. [PMID: 34830677 PMCID: PMC8619984 DOI: 10.3390/jcm10225395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 12/02/2022] Open
Abstract
Reminiscence therapy (RT) is a form of cognitive stimulation therapy that incorporates discussion of past activities, events, and experiences to stimulate individual memories; it has had some success in treating persons with neurocognitive disorders. This research aims to evaluate the ability of individual RT, using a simple reminiscence format, to improve the overall cognitive function, memory, executive functions, emotional status, and quality of life in older adults with neurocognitive disorders who received social care and support services. A multicenter randomized controlled trial was completed in the Azores archipelago (an independent region of Portugal) using repeated measures (pre-intervention, post-intervention, and follow-up). The intervention group underwent individual RT sessions, twice weekly for 13 weeks, while the control group completed regular activities administered as part of their program. Results did not reveal any significant differences between the intervention and control groups. While results did not reveal significant effects, a number of historical and contextual factors are considered as possible explanations for the lack of effects-namely, data collection occurring during the COVID-19 global pandemic, participant cohort effects, and therapist heterogeneity.
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Affiliation(s)
- Susana I Justo-Henriques
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
| | - Enrique Pérez-Sáez
- National Reference Centre for Alzheimer's and Dementia Care, Imserso, 37008 Salamanca, Spain
| | - João L Alves Apóstolo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
| | - Janessa O Carvalho
- Psychology Department, Bridgewater State University, Bridgewater, MA 02325, USA
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69
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Sousa L, Neves MJ, Moura B, Schneider J, Fernandes L. Music-based interventions for people living with dementia, targeting behavioral and psychological symptoms: A scoping review. Int J Geriatr Psychiatry 2021; 36:1664-1690. [PMID: 34097789 DOI: 10.1002/gps.5568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/06/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Dementia care is a major public health issue worldwide. The management of behavioral and psychological symptoms (BPSD) is one of the hardest challenges in this context. Non-pharmacological strategies, like music-based interventions (Mbi), seem promising options, being considered low-risk, widely available and inclusive. This scoping review aimed at mapping all Mbi used in dementia care, targeting BPSD, and debriefing its components, structure and rationale. Music therapy and other therapeutic music activities were included. METHODS The Arksey and O'Malley framework, Cochrane recommendations and PRISMA checklist were followed. Embase, PubMed, PsycINFO, ASSIA and Humanities Index were searched from first records until the 31st of March 2020. Snowballing process and screening of relevant journals were also undertaken. A panel of experts critically guided the evidence synthesis. RESULTS Overall, 103 studies (34 RCT; 12 NRT; 40 Before/After studies and 17 Case Studies) met inclusion criteria. Basic elements of the Mbi, the rationale supporting its development and hypothesis tested were mostly underreported, thus hampering cross-study comparisons and generalizations. Despite this, available evidence indicates that: it is feasible to deliver Mbi to PwD at very different stages and in different settings - from community to the acute setting - even for non-music therapists; positive or neutral effects in BPSD are often reported but not without exception; individualization seems a critical factor mediating Mbi effects. CONCLUSIONS Detailed intervention and research reporting are essential to interpretation, replication and translation into practice. Ten years after the publication of specific reporting guidelines, this goal is not yet fully achieved in music in dementia care.
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Affiliation(s)
- Lídia Sousa
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of Porto University, Porto, Portugal.,Geriatrics & Mental Health Group, CINTESIS - Center for Health Technologies and Services Research, Porto, Portugal
| | - Maria J Neves
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of Porto University, Porto, Portugal.,Unidade de Saúde Familiar Espinho, ACeS Grande Porto VIII, Portugal
| | - Bárbara Moura
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of Porto University, Porto, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Justine Schneider
- School of Sociology & Social Policy, University of Nottingham, Nottingham, UK
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of Porto University, Porto, Portugal.,Geriatrics & Mental Health Group, CINTESIS - Center for Health Technologies and Services Research, Porto, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar Universitário de S. João, Porto, Portugal
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Tokovska M, Nour MM, Sørensen A, Småland Goth U. Informal caregivers and psychosocial support: Analysis of European Dementia Policy documents. J Public Health Res 2021; 11. [PMID: 34579521 PMCID: PMC8874860 DOI: 10.4081/jphr.2021.2416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/13/2021] [Indexed: 11/23/2022] Open
Abstract
Various countries in Europe have different strategies for promoting care solutions for dementia challenges. The different approaches of Austria, Belgium, Czechia, Denmark, Finland, Germany, Gibraltar, Ireland, Israel, Malta, Nederland, Norway, Sweden and the United Kingdom (Scotland and Wales) were investigated. Dementia has a significant social, psychological and economic impact on the individual, family and society. As the disease progresses dementia sufferers become increasingly dependent. As many dementia sufferers are at home during the initial stages, the physical, emotional, and social demands of the dementia sufferers are often covered by informal caregivers. This study, therefore, aims to investigate the integration of psychosocial interventions for comprehensive care pertaining to informal caregivers of people with dementia in Europe. Furthermore, the study will highlight how implementation of technologies might enable psychosocial support of informal caregivers. The data is based on 15 national dementia strategies from various European countries. Data was based on preexisting coding systems with the predefined keywords and analyzed by qualitative content analysis by four of the authors. Our results show that psychosocial support is provided in various modalities and that informal caregivers need to be supported by a psychosocial approach. Due to this need the national dementia strategies should include measures to reduce the emotional burden of informal caregivers. Psychosocial support provided to informal caregivers in a comprehensive and systematic way is likely to enable informal caregivers to handle the emotional, cognitive, and behavioral consequences of the disease and its treatment, while helping to maintain their work-life balance. Significance for public health This study has important public health impacts on informal caregivers in a European context. The study reveals that the European countries of Alzheimer Europe - especially policymakers, social and healthcare providers and non-government organizations - should update or prepare the necessary national dementia strategies, promote benchlearning, improve international collaboration and systematically manage those who provide psychosocial support.
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Affiliation(s)
| | - Magde Mohamed Nour
- School of Health Science, Kristiania University College, Oslo; Department of Information Science and Media Studies, University of Bergen, Bergen.
| | - Anette Sørensen
- School of Health Science, Kristiania University College, Oslo.
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Barros MPD, Bachi ALL, Santos JDMBD, Lambertucci RH, Ishihara R, Polotow TG, Caldo-Silva A, Valente PA, Hogervorst E, Furtado GE. The poorly conducted orchestra of steroid hormones, oxidative stress and inflammation in frailty needs a maestro: Regular physical exercise. Exp Gerontol 2021; 155:111562. [PMID: 34560197 DOI: 10.1016/j.exger.2021.111562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022]
Abstract
This review outlines the various factors associated with unhealthy aging which includes becoming frail and dependent. With many people not engaging in recommended exercise, facilitators and barriers to engage with exercise must be investigated to promote exercise uptake and adherence over the lifespan for different demographics, including the old, less affluent, women, and those with different cultural-ethnic backgrounds. Governmental and locally funded public health messages and environmental facilitation (gyms, parks etc.) can play an important role. Studies have shown that exercise can act as a conductor to balance oxidative stress, immune and endocrine functions together to promote healthy aging and reduce the risk for age-related morbidities, such as cardiovascular disease and atherosclerosis, and promote cognition and mood over the lifespan. Like a classic symphony orchestra, consisting of four groups of related musical instruments - the woodwinds, brass, percussion, and strings - the aging process should also perform in harmony, with compassion, avoiding the aggrandizement of any of its individual parts during the presentation. This review discusses the wide variety of molecular, cellular and endocrine mechanisms (focusing on the steroid balance) underlying this process and their interrelationships.
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Affiliation(s)
- Marcelo Paes de Barros
- Institute of Physical Activity Sciences and Sports (ICAFE), MSc/PhD Interdisciplinary Program in Health Sciences, Cruzeiro do Sul University, 01506-000 São Paulo, Brazil.
| | - André Luís Lacerda Bachi
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04025-002, Brazil; Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, Brazil
| | | | | | - Rafael Ishihara
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Santos 11015-020, SP, Brazil
| | - Tatiana Geraldo Polotow
- Institute of Physical Activity Sciences and Sports (ICAFE), MSc/PhD Interdisciplinary Program in Health Sciences, Cruzeiro do Sul University, 01506-000 São Paulo, Brazil
| | - Adriana Caldo-Silva
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019) at Faculty of Sport Science and Physical Education, (FCDEF-UC), Portugal
| | - Pedro Afonso Valente
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019) at Faculty of Sport Science and Physical Education, (FCDEF-UC), Portugal
| | - Eef Hogervorst
- Applied Cognitive Research National Centre for Sports and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Guilherme Eustáquio Furtado
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Institute Polytechnic of Maia, Porto, Portugal; University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019) at Faculty of Sport Science and Physical Education, (FCDEF-UC), Portugal.
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Howard EP, Retalic T, Rogan J, Murphy K, Swaminathan S, Altschuler A. ArtontheBrain: Results of a Pilot Project Among Long-Term Care Residents. Res Gerontol Nurs 2021; 14:235-243. [PMID: 34542348 DOI: 10.3928/19404921-20210825-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
For long-term care (LTC) residents, multiple barriers impede access to formal museum-based participa-tory art programming. Capitalizing on available technologies may circumvent common barriers and improve quality of life for those older adults even in the presence of dementia. Targets: A convenience sample of 31 older adults was recruited from the population of residents in one LTC facility. Intervention: ArtontheBrain, a web-based program, engages participants in activities centered on visual artwork, enabling users to learn about artists through activities, such as puzzles, storytelling, and group discussions. Mechanisms of Action: Researchers hypothesized that engagement with ArtontheBrain would benefit perceived quality of life in the domains of meaningful activity engagement and personal relationships and secondarily, improvements in functional performance, mood state, and cognitive performance may occur. Outcomes: Application of a quality of life survey pre and post ArtontheBrain intervention revealed significant improvements within the individual subsample for two activity options: engagement in enjoyable activities on weekends and evenings and explore new skills and interests. Total scores for the personal relationship scale had significant improvements post-intervention for the individual and group subsamples. The individual subsample demonstrated improvement in cognitive performance, which worsened for the group subsample. Mood and functional ability worsened for the entire sample.[Research in Gerontological Nursing, 14(5), 235-243.].
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Mabire JB, Gay MC, Charras K, Vernooij-Dassen M. Impact of a Psychosocial Intervention on Social Interactions between People with Dementia: An Observational Study in a Nursing Home. ACTIVITIES, ADAPTATION & AGING 2021. [DOI: 10.1080/01924788.2021.1966574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | | | - Kevin Charras
- Living lab Vieillissement et Vulnérabilités, Service de Gériatrie, CHU de Rennes, Rennes, France
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Huynh K, Nategh L, Jamadar S, Georgiou-Karistianis N, Lampit A. Cognition-oriented treatments and physical exercise on cognitive function in Huntington’s disease: protocol for systematic review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1976019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Katharine Huynh
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leila Nategh
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sharna Jamadar
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Amit Lampit
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
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Hui EK, Tischler V, Wong GHY, Lau WYT, Spector A. Systematic review of the current psychosocial interventions for people with moderate to severe dementia. Int J Geriatr Psychiatry 2021; 36:1313-1329. [PMID: 34350626 DOI: 10.1002/gps.5554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Dementia, a global epidemic, currently affects 50 million individuals worldwide. There are currently limited effective treatments for moderate to severe dementia, and most treatments focus on reducing symptoms rather than improving positive factors. It is unclear if improvements are not possible due to disease severity. This review examines the efficacy of the current psychosocial interventions for people with moderate to severe dementia, focusing on improving cognition and quality of life (QoL) to evaluate what treatments are working and whether improvements are possible. METHODS A systematic search was conducted using six key databases to identify psychosocial interventions for people with moderate to severe dementia, measuring cognition or QoL in randomized controlled trials (RCTs), published between 2000 and 2020. RESULTS The search identified 4193 studies, and 74 articles were assessed for full-text review. Fourteen RCTs were included and appraised with the Physiotherapy Evidence Database Scale. The included RCTs were moderate in quality. CONCLUSIONS Aromatherapy and reminiscence therapy showed the strongest evidence in improving QoL. There was some evidence that aerobic exercise enhanced cognition, and a multicomponent study improved QoL. However, a quality assessment, using pre-specified criteria, indicated many methodological weaknesses. While we found improvements in cognition and QoL for moderate to severe dementia, results must be interpreted with caution. Future interventions with rigorous study designs are a pressing need and required before we can recommend specific interventions.
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Affiliation(s)
- Esther K Hui
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Victoria Tischler
- European Center for Environment and Human Health, The University of Exeter, Truro, UK
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - W Y Tiffany Lau
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Teupen S, Holle D, Roes M. Types of implementation of the dementia-specific case conference concept WELCOME-IdA in nursing homes: a qualitative process evaluation of the FallDem effectiveness trial. Implement Sci Commun 2021; 2:90. [PMID: 34407887 PMCID: PMC8371834 DOI: 10.1186/s43058-021-00191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Dementia is regularly associated with behavioral and psychological symptoms of dementia (BPSD, also referred to as challenging behavior). Structured dementia-specific case conferences (DSCCs) enable nursing staff in nursing homes (NHs) to analyze and handle the BPSD of residents with dementia. The FallDem trial estimated the effectiveness of the structured DSCC intervention WELCOME-IdA (Wittener model of case conferences for people with dementia – the Innovative dementia-oriented Assessment tool) in NHs in Germany. No significant change in the overall prevalence of challenging behavior was found. A multipart process evaluation was conducted to explain this result. Methods This qualitative process evaluation of the response of individuals, perceived maintenance, effectiveness, and unintended consequences was part of the multipart process evaluation that followed the framework by Grant et al. (Trials 14: 15, 2013). It used the data from semi-structured telephone interviews and focus group interviews with nurses and managers as secondary data. Selected domains of the Consolidated Framework for Implementation Research (CFIR) were used as deductive categories for a directed content analysis. Results The interviewees in all NHs appraised WELCOME-IdA as generating positive change, although it proved important that some adjustments were made to the intervention and the organization. Thirteen CFIR constructs out of the domains intervention characteristics, inner setting, and process proved to be essential for understanding the different course that the implementation of WELCOME-IdA took in each of the four NHs. This is reflected in three types of WELCOME-IdA implementation: (1) priority on adjusting the intervention to fit the organization, (2) priority on adjusting the organization to fit the intervention, and (3) no setting of priorities in adjusting either the organization or the intervention. Conclusion The unsatisfying results of the FallDem effectiveness trial can in part be explained with regard to the interplay between the intervention and the implementation which was revealed in the processes that occurred in the organizations during the implementation of the WELCOME-IdA intervention. Future implementation of WELCOME-IdA should be tailored based on an analysis of the organization’s readiness, resources, and capacities and should also define custom-made intervention and implementation outcomes to measure success. Furthermore, our results confirm that the CFIR can be used beneficially to conduct process evaluations. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00191-0.
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Affiliation(s)
- Sonja Teupen
- German Center for Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany. .,School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Daniela Holle
- German Center for Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany.,Department of Nursing Science, University of Applied Sciences (HS Gesundheit), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Martina Roes
- German Center for Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany.,School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
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77
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Mohd Safien A, Ibrahim N, Subramaniam P, Shahar S, Din NC, Ismail A, Singh DKA, Mat Ludin AF. Randomized Controlled Trials of a Psychosocial Intervention for Improving the Cognitive Function among Older Adults: A Scoping Review. Gerontol Geriatr Med 2021; 7:23337214211025167. [PMID: 34395815 PMCID: PMC8361523 DOI: 10.1177/23337214211025167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022] Open
Abstract
Aim: The goal is to explore available evidence and provide greater clarity to what is described as psychosocial intervention to improve cognitive function among older population with MCI as well as identifying areas for future research. Methods: An electronic literature search of PubMed, Cochrane, Ebscohost, Medline, Scopus, and gray resource was conducted to find articles published in English language between 2010 and September 2020. This review focused on research undertaken using randomized clinical trials study design. We extracted information regarding the publication date, geographical location, study setting, intervention mechanism, type of cognitive measurement used, and outcome of the studies. References of this literature were also reviewed to ensure comprehensive search. Result: Out of 240 potential records found, a total of 27 articles were identified following the first round of screening and deletion of duplicates. Full-text article reviews and analysis in the second round of screening narrowed the selection down to four articles. Another three relevant articles obtained from references were also included making a total of seven articles in the final analysis. Findings: Psychosocial intervention strategies for improvement of cognitive function, done in various setting all over the globe, covered a range of approaches including art therapy, visual art therapy, therapeutic writing therapy, reminiscence activity, and cognitive behavioral approach. Most were conducted in weekly basis within 1-to-2-hour duration of session. Cognitive function of older adult in psychosocial intervention group was significantly improved in two studies. Three studies showed no significant improvement at all in the cognitive function, and another one reported success in improving cognitive function over time in the intervention group than in control group. One study did not describe the interaction effect. Different types of cognitive measurement also were used to quantify different domains of cognitive function in the reviewed studies. Conclusion: The idea of using psychosocial intervention for improving cognitive function has begun to increasingly accepted recently. Findings from the limited studies are encouraging, although the outcome of the cognitive function was mixed. Large-scale and longer duration of psychosocial intervention with bigger sample size is warranted for future studies.
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Affiliation(s)
| | | | | | | | | | - Aniza Ismail
- Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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78
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Ottoboni G, Chirico I, Povolná P, Dostálová V, Holmerová I, Janssen N, Dassen F, de Vugt M, Sánchez-Gómez MC, García-Peñalvo F, Franco-Martin MA, Chattat R. Psychosocial care in dementia in European higher education: Evidence from the SiDECar ("Skills in DEmentia Care") project. NURSE EDUCATION TODAY 2021; 103:104977. [PMID: 34051541 DOI: 10.1016/j.nedt.2021.104977] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 05/25/2023]
Abstract
In dementia care, psychosocial interventions can increase people's quality of life with dementia and their caregivers. Despite their effectiveness, their translation into practice lacks the desirable systematicity. Systematic educational programs on psychosocial interventions in dementia will improve this translation, as it prepares professionals to face the complexity of dementia care. This study aimed to systematically map out the extent to which higher education programs in Europe include teaching activities about psychosocial care of dementia. We collected quantitative and qualitative data about 303 higher education teaching activities on psychosocial care in dementia across Europe. The analysis revealed that the number of teaching activities focusing on psychosocial care in dementia was relative. Although the results reflected UNESCO indications, the teaching activities on psychosocial care in dementia appeared less systematized than optimal. As world health agencies recommend, international higher education systems should consider more psychosocial care topics because they can prepare professionals to respond timely and effectively to dementia patients and caregivers' needs.
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Affiliation(s)
- G Ottoboni
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - I Chirico
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - P Povolná
- Charles University, Faculty of Humanities, Czech Republic; Institute for Postgraduate Medical Education, Prague, Czech Republic.
| | - V Dostálová
- Charles University, Faculty of Humanities, Czech Republic; Institute for Postgraduate Medical Education, Prague, Czech Republic.
| | - I Holmerová
- Charles University, Faculty of Humanities, Czech Republic; Institute for Postgraduate Medical Education, Prague, Czech Republic.
| | - N Janssen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - F Dassen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - M de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, the Netherlands.
| | | | | | | | - R Chattat
- Department of Psychology, University of Bologna, Bologna, Italy.
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Wiegelmann H, Wolf-Ostermann K, Brannath W, Arzideh F, Dreyer J, Thyrian R, Schirra-Weirich L, Verhaert L. Sociodemographic aspects and health care-related outcomes: a latent class analysis of informal dementia care dyads. BMC Health Serv Res 2021; 21:727. [PMID: 34301241 PMCID: PMC8299572 DOI: 10.1186/s12913-021-06708-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/28/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Studies revealed the importance to assess dementia care dyads, composed of persons with dementia and their primary informal caregivers, in a differentiated way and to tailor support services to particular living and care circumstances. Therefore, this study aims first to identify classes of dementia care dyads that differ according to sociodemographic, care-related and dementia-specific characteristics and second, to compare these classes with regard to healthcare-related outcomes. METHODS We used data from the cross-sectional German DemNet-D study (n = 551) and conducted a latent class analysis to investigate different classes of dementia care dyads. In addition, we compared these classes with regard to the use of health care services, caregiver burden (BIZA-D), general health of the informal caregiver (EQ-VAS) as well as quality of life (QoL-AD) and social participation (SACA) of the person with dementia. Furthermore, we compared the stability of the home-based care arrangements. RESULTS Six different classes of dementia care dyads were identified, based on best Bayesian Information Criterion (BIC), significant likelihood ratio test (p < 0.001), high entropy (0.87) and substantive interpretability. Classes were labelled as "adult child parent relationship & younger informal caregiver", "adult child parent relationship & middle aged informal caregiver", "non family relationship & younger informal caregiver", "couple & male informal caregiver of older age", "couple & female informal caregiver of older age", "couple & younger informal caregiver". The classes showed significant differences regarding health care service use. Caregiver burden, quality of life of the person with dementia and stability of the care arrangement differed also significantly between the classes. CONCLUSION Based on a latent class analysis this study indicates differences between classes of informal dementia care dyads. The findings may give direction for better tailoring of support services to particular circumstances to improve healthcare-related outcomes of persons with dementia and informal caregivers.
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Affiliation(s)
- Henrik Wiegelmann
- grid.7704.40000 0001 2297 4381Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Karin Wolf-Ostermann
- grid.7704.40000 0001 2297 4381Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Werner Brannath
- grid.7704.40000 0001 2297 4381Competence Centre for Clinical Trials, University of Bremen and Clinic Bremen-Mitte, Bremen, Germany
| | - Farhad Arzideh
- grid.7704.40000 0001 2297 4381Competence Centre for Clinical Trials, University of Bremen and Clinic Bremen-Mitte, Bremen, Germany
| | - Jan Dreyer
- grid.424247.30000 0004 0438 0426German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Germany
| | - Rene Thyrian
- grid.424247.30000 0004 0438 0426German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Germany
| | - Liane Schirra-Weirich
- grid.466086.a0000 0001 1010 8830Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Cologne, Germany
| | - Lisa Verhaert
- grid.466086.a0000 0001 1010 8830Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Cologne, Germany
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80
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Marquez DX, Aguiñaga S, Vásquez PM, Conroy DE, Erickson KI, Hillman C, Stillman CM, Ballard RM, Sheppard BB, Petruzzello SJ, King AC, Powell KE. A systematic review of physical activity and quality of life and well-being. Transl Behav Med 2021; 10:1098-1109. [PMID: 33044541 DOI: 10.1093/tbm/ibz198] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Maintaining or improving quality of life (QoL) and well-being is a universal goal across the lifespan. Being physically active has been suggested as one way to enhance QoL and well-being. In this systematic review, conducted in part for the 2018 U.S. Health and Human Services Physical Activity Guidelines for Americans Scientific Advisory Committee Report, we examined the relationship between physical activity (PA) and QoL and well-being experienced by the general population across the lifespan and by persons with psychiatric and neurologic conditions. Systematic reviews, meta-analyses, and pooled analyses from 2006 to 2018 were used for the evidence base. Strong evidence (predominantly from randomized controlled trials [RCTs]) demonstrated that, for adults aged 18-65 years and older adults (primarily 65 years and older), PA improves QoL and well-being when compared with minimal or no-treatment controls. Moderate evidence indicated that PA improves QoL and well-being in individuals with schizophrenia and Parkinson's disease, and limited evidence indicated that PA improves QoL and well-being for youth and for adults with major clinical depression or bipolar disorder. Insufficient evidence existed for individuals with dementia because of a small number of studies with mixed results. Future high-quality research designs should include RCTs involving longer interventions testing different modes and intensities of PA in diverse populations of healthy people and individuals with cognitive (e.g., dementia) and mental health conditions (e.g., schizophrenia) to precisely characterize the effects of different forms of PA on aspects of QoL and well-being.
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Affiliation(s)
- David X Marquez
- Department of Kinesiology and Nutrition, Center for Research on Health and Aging, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Susan Aguiñaga
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Priscilla M Vásquez
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - David E Conroy
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Kirk I Erickson
- Department of Psychology, Brain Aging and Cognitive Health Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles Hillman
- Department of Psychology and Department of Physical Therapy, Movement, and Rehabilitation Sciences, Center for Cognitive and Brain Health, Northeastern University, Boston, MA, USA
| | - Chelsea M Stillman
- Department of Psychology, Brain Aging and Cognitive Health Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel M Ballard
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Steven J Petruzzello
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign; Urbana, IL, USA
| | - Abby C King
- Department of Health Research and Policy, Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
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81
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Sousa L, Moura B, McDermott O, Fernandes L. Portuguese translation and cultural adaptation of the Music in Dementia Assessment Scales (MiDAS). NORDIC JOURNAL OF MUSIC THERAPY 2021. [DOI: 10.1080/08098131.2021.1915856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lídia Sousa
- Faculty of Medicine of Porto University, Porto, Portugal
- Center for Health Technologies and Services Research – CINTESIS, Porto, Portugal
- Psychiatry Service, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Bárbara Moura
- Faculty of Medicine of Porto University, Porto, Portugal
- Psychiatry Service, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Orii McDermott
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Lia Fernandes
- Faculty of Medicine of Porto University, Porto, Portugal
- Center for Health Technologies and Services Research – CINTESIS, Porto, Portugal
- Psychiatry Service, Centro Hospitalar Universitário de S. João, Porto, Portugal
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Morton T, Wong G, Atkinson T, Brooker D. Sustaining community-based interventions for people affected by dementia long term: the SCI-Dem realist review. BMJ Open 2021; 11:e047789. [PMID: 34233990 PMCID: PMC8264885 DOI: 10.1136/bmjopen-2020-047789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Community-based support for people with earlier-stage dementia and their care partners, such as regularly meeting groups and activities, can play an important part in postdiagnostic care. Typically delivered piecemeal in the UK, by a variety of agencies with inconsistent funding, provision is fragmented and many such interventions struggle to continue after only a short start-up period. This realist review investigates what can promote or hinder such interventions in being able to sustain long term. METHODS Key sources of evidence were gathered using formal searches of electronic databases and grey literature, together with informal search methods such as citation tracking. No restrictions were made on article type or study design; only data pertaining to regularly meeting, ongoing, community-based interventions were included. Data were extracted, assessed, organised and synthesised and a realist logic of analysis applied to trace context-mechanism-outcome configurations as part an overall programme theory. Consultation with stakeholders, involved with a variety of such interventions, informed this process throughout. RESULTS Ability to continually get and keep members; staff and volunteers; the support of other services and organisations; and funding/income were found to be critical, with multiple mechanisms feeding into these suboutcomes, sensitive to context. These included an emphasis on socialising and person-centredness; lowering stigma and logistical barriers; providing support and recognition for personnel; networking, raising awareness and sharing with other organisations, while avoiding conflict; and skilled financial planning and management. CONCLUSIONS This review presents a theoretical model of what is involved in the long-term sustainability of community-based interventions. Alongside the need for longer-term funding and skilled financial management, key factors include the need for stigma-free, person-centred provision, sensitive to members' diversity and social needs, as well as the need for a robust support network including the local community, health and care services. Challenges were especially acute for small scale and rural groups.
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Affiliation(s)
- Thomas Morton
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Teresa Atkinson
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Dawn Brooker
- Association for Dementia Studies, University of Worcester, Worcester, UK
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Cezar NODC, Ansai JH, Oliveira MPBD, da Silva DCP, Gomes WDL, Barreiros BA, Langelli TDCO, de Andrade LP. Feasibility of improving strength and functioning and decreasing the risk of falls in older adults with Alzheimer's dementia: a randomized controlled home-based exercise trial. Arch Gerontol Geriatr 2021; 96:104476. [PMID: 34260986 DOI: 10.1016/j.archger.2021.104476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the effects of a Home-based multimodal exercise program for older people with Alzheimer's disease (AD-HOMEX) on muscle strength, mobility, the risk of falls and functioning. MATERIALS AND METHODS A trial with a blinded assessor was conducted involving 40 older people with mild to moderate AD randomized to an intervention group (IG) or control group (CG). The IG participated in a 16-week protocol with three 60-minute sessions per week. The sessions were performed at the participant's home by a physiotherapist and involved progressive individualized physical exercises. Muscle strength (5X Sit-to-Stand Test [5XSTS], 30-Second Chair Stand test, isokinetic and hand-grip dynamometer), functioning (DAFS-R and ADL-Q), mobility and the risk of falls (TUG) were assessed at baseline and after training. Intention-to-treat analysis was adopted. RESULTS There was a significant group-evaluation time interaction for the 5XSTS (p = 0.011). The IG demonstrated an improved performance on the 5XSTS (p = 0.020) and a reduced risk of falls (p = 0.000), whereas the CG exhibited a worse functional limitation (p = 0.008) after 16 weeks. The CG had an increased risk of falls (p = 0.006) and worse performance on the ADL-Q (p = 0.047) at the follow-up evaluation. An improvement in the IG and worsening in the CG were found regarding transition patterns between severity levels of functional limitation based on the ADL-Q. CONCLUSIONS Home-based physical exercise for older people with mild to moderate AD is an effective strategy that decreases the risk of falls and improves strength and functioning.
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Affiliation(s)
- Natália Oiring de Castro Cezar
- Department of Physical Therapy, Federal University of São Carlos; Department of Gerontology, Federal University of São Carlos.
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Effects of case management intervention for people with dementia and their carers: A systematic review and meta-analysis of experimental studies. Int J Nurs Stud 2021; 121:104012. [PMID: 34265500 DOI: 10.1016/j.ijnurstu.2021.104012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Case management has been developed and suggested as a method for improving the quality of dementia care by optimising care service and delivery using a feasible and cost-effective approach. However, the effects of case management for improving dementia care remain inconclusive. AIM To analyse the efficacy of case management interventions for people with dementia and their carers. DESIGN Systematic review and meta-analysis. METHODS This study conducted a systematic review of the literature from January 1, 2002, to March 15, 2021, indexed in the following databases: Academic Search Complete, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, OVID, and Web of Science. Intervention studies examining patients with dementia and their carers published in the English language were included. The methodological quality of included studies was evaluated using the PEDro scale. The meta-analysis was performed using a random-effects model to calculate the pooled standardised mean difference (SMD) of case management intervention outcomes for both people with dementia (cognitive function, neuropsychiatric symptoms, and quality of life) and their carers (carer burden). Stata 16.0 was used for statistical analysis. RESULTS A total of eight studies met the eligibility criteria for this study. The results of the quantitative analysis, ranging from 6 to 18 months, showed no significant effect on cognitive function, quality of life over 12 months and longer, and carer burden over time between groups with and without intervention. However, significant improvements were observed for neuropsychiatric symptoms over 12 months and longer and quality of life at six months in the case management group. CONCLUSION Case management appears to have the potential to improve the health outcomes among people with dementia. However, these conclusions are limited due to the lack of conducted studies. Future work examining intervention outcomes remains necessary to explore the effects of interventions on the mental and physical wellbeing of carers.
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Killen A, Flynn D, O'Brien N, Taylor JP. The feasibility and acceptability of a psychosocial intervention to support people with dementia with Lewy bodies and family care partners. DEMENTIA 2021; 21:77-93. [PMID: 34171967 PMCID: PMC8721619 DOI: 10.1177/14713012211028501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives Psychosocial support for people with dementia with Lewy bodies (DLB) and family care partners is frequently lacking, despite the need expressed by those with lived experience. Our objective was to examine the feasibility and acceptability of an intervention designed to build coping capability. Design The design was non-randomised with all participants receiving the intervention. Setting The setting was a Memory Assessment and Management Service in the Northeast of England. Participants Participants comprised 19 dyads consisting of a person with DLB and a family care partner. Intervention The intervention was group-based, with weekly sessions attended for up to four successive weeks. It was informed by Social Cognitive Theory. Measurements Data were collected on recruitment, attendance and attrition, self-efficacy, mood, stress and participant experience. Results Recruitment was achieved with minimal attrition and three successive groups were delivered. Care partners felt more in control and able to cope in at least 3 of 13 areas with 73% feeling this way in eight or more areas. Three themes were identified from post-intervention interviews: people like us, outcomes from being a group member and intervention design. Conclusions A DLB-specific group intervention is acceptable to people with DLB and family care partners, and recruitment is feasible within a specialist service. Participation may enhance understanding of this condition and reduce social isolation. It may improve care partners’ coping capability particularly if targeted towards those with low prior understanding of DLB and more stress. Means of evaluating outcomes for people with DLB need further development.
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Affiliation(s)
- Alison Killen
- Translational and Clinical Research Institute, 5994Newcastle University, Newcastle upon Tyne, UK
| | - Darren Flynn
- School of Health and Life Sciences, 5462Teesside University, Middlesbrough, UK
| | - Nicola O'Brien
- Department of Psychology, 5995Northumbria University, Newcastle, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, 5994Newcastle University, Newcastle upon Tyne, UK
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Alvares-Pereira G, Silva-Nunes MV, Spector A. Validation of the cognitive stimulation therapy (CST) program for people with dementia in Portugal. Aging Ment Health 2021; 25:1019-1028. [PMID: 33089699 DOI: 10.1080/13607863.2020.1836473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cognitive Stimulation Therapy (CST) is considered a gold-standard, evidence-based and cost-effective approach to improve cognitive function and quality of life of people with mild to moderate dementia. AIMS To validate CST for the Portuguese population and test its effectiveness. METHODS A single-blind, multi-center, randomized controlled trial recruited 112 older people with dementia. The primary outcome measure was cognition and secondary measures were quality of life, communication, autonomy, anxiety, depression, and global functioning. We also explored whether CST benefits people differently according to context, gender and level of cognitive reserve. RESULTS Fifty-five people were randomized to the intervention and 57 to the control group. In the post-test, the intervention group significantly improved relative to controls in cognition (ADAS-Cog, p = 0.013), communication (HCS, p = 0.045), behaviour (CAPE-BRS, p = 0.017) and in global dementia rating (CDR, p = 0.008). Quality of life, depression and anxiety had no significant differences. The estimated number needed to treat was four for one to benefit a cognitive improvement (ADAS-Cog). CONCLUSIONS Group CST is valid for the Portuguese population with benefits for people with mild to moderate dementia.
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Affiliation(s)
- G Alvares-Pereira
- Health Sciences Institute, Portuguese Catholic University, Lisboa, Portugal
| | - M V Silva-Nunes
- Health Sciences Institute, Portuguese Catholic University, Lisboa, Portugal.,Interdisciplinary Health Research Center, Catholic University of Portugal, Lisboa, Portugal
| | - A Spector
- Clinical, Educational & Health Psychology, University College London, London, UK
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87
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Gibbor L, Forde L, Yates L, Orfanos S, Komodromos C, Page H, Harvey K, Spector A. A feasibility randomised control trial of individual cognitive stimulation therapy for dementia: impact on cognition, quality of life and positive psychology. Aging Ment Health 2021; 25:999-1007. [PMID: 32252544 DOI: 10.1080/13607863.2020.1747048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to evaluate the feasibility of a 14-session programme of individual Cognitive Stimulation Therapy (iCST) for people with dementia (PWD). It addressed potential limitations in previous literature of iCST and evaluated possible impact on cognition, quality of life (QoL) and positive psychology. METHOD The 14-session iCST programme was developed using existing manuals for group and individual CST and consultation with experts in the field. Thirty-three PWD were recruited from care homes and randomly assigned to iCST (14, 45-min sessions) or treatment as usual (TAU) over seven weeks. Outcomes measures were assessed at baseline and follow-up after the intervention. RESULTS The intervention appeared feasible with high attendance to sessions, minimal levels of attrition, and ease of recruitment. Analysis of covariance indicated significant improvements in cognition (Alzheimer's Disease Assessment Scale-Cognitive subscale) for PWD receiving iCST compared to TAU. There were no significant differences between groups on follow-up scores on the standardised Mini Mental State Examination, measures of positive psychology or self- and proxy- reported QoL. CONCLUSION A 14-session programme of iCST delivered by professionals was feasible and acceptable to PWD and may provide benefits to cognition. A larger randomised control trial would be necessary to fully evaluate intervention impact on cognition, as well as QoL and positive psychology.
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Affiliation(s)
- Luke Gibbor
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lycia Forde
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lauren Yates
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stavros Orfanos
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Harriet Page
- The Therapy and Activities Team, Royal Hospital Chelsea, London, UK
| | - Kate Harvey
- The Therapy and Activities Team, Royal Hospital Chelsea, London, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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88
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Gibbor L, Yates L, Volkmer A, Spector A. Cognitive stimulation therapy (CST) for dementia: a systematic review of qualitative research. Aging Ment Health 2021; 25:980-990. [PMID: 32252561 DOI: 10.1080/13607863.2020.1746741] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cognitive Stimulation Therapy (CST) is a well-established intervention for people with dementia shown to improve cognition and quality of life. Past research includes development of a longer term 'maintenance CST' and an individual CST programme. Previous reviews of CST have focused on quantitative outcomes or excluded certain formats of CST. This review aimed to fill this gap by evaluating how the voices of facilitators, carers and people with dementia in qualitative studies of CST can contribute to our understanding of its implementation and how it is experienced. METHODS The current systematic review explored the experience and perspectives of people with dementia, facilitators and carers. Thematic Analysis was used to analyse this data, alongside guidance on synthesising qualitative findings. RESULTS A systematic literature search retrieved 10 relevant studies using qualitative methodology. Eighteen themes were generated, which were grouped into three categories: 'Acceptability and feasibility', 'Features of CST' and 'Key outcomes'. CONCLUSIONS To our knowledge, this is the only review to explore solely qualitative studies of CST. Findings provided insight into the shared features, outcomes and factors affecting implementation, and suggested theories for discrepancies between quantitative and qualitative findings in the literature. Some of the common themes were also in keeping with past reviews.
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Affiliation(s)
- Luke Gibbor
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lauren Yates
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Anna Volkmer
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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89
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Field B, Coates E, Mountain G. What influences uptake of psychosocial interventions by people living with early dementia? A qualitative study. DEMENTIA 2021; 20:2668-2688. [PMID: 33956547 PMCID: PMC8723173 DOI: 10.1177/14713012211007397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Health policy promotes post-diagnostic support for people affected by dementia.
Evidence suggests psychosocial interventions can effectively support people living with
dementia after diagnosis. Yet, what influences uptake of psychosocial interventions by
people with early dementia is poorly understood. This research aimed to identify
influences on uptake of psychosocial interventions by people with early dementia. Methods Sixteen face-to-face semi-structured interviews with people with early dementia, either
alone or with a family member(s), were completed. Twelve staff participated in
semi-structured interviews or a focus group. Thematic analysis and triangulation enabled
identification of overall themes across different participant groups and interview
types. Main Findings Four overarching themes influencing uptake were identified: (1) adjusting to a
diagnosis, (2) appeal of activities and perception of benefit, (3) service and societal
context, and (4) relationships and communication. Individual responses to diagnosis,
experiences of dementia and dementia services influenced uptake. Group interventions
were discussed the most by all participants. Group interventions offering social
contact, peer support, information, enjoyable activities and mental stimulation were
valued. However, group interventions specifically aimed at people with dementia did not
appeal to all. Ability to travel and convenience of locations were important. Continuing
with community activities not focused on dementia was valued. Stigma around dementia
appeared to discourage uptake. Emotional and practical support from family was key to
facilitating uptake as were the relationships between people with dementia and
staff. Conclusion A complex interplay of individual, service and societal influences affect uptake of
psychosocial interventions by people with early dementia. How interventions and which
services can enable people with early dementia remain engaged in their everyday lives
needs consideration. Further research examining uptake of specific interventions
commonly offered to people living with early dementia is needed. Involving people with
early dementia in designing interventions aiming to support them is paramount.
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Affiliation(s)
- Becky Field
- School of Health and Related Research (ScHARR), 7315University of Sheffield, UK
| | - Elizabeth Coates
- School of Health and Related Research (ScHARR), 7315University of Sheffield, UK
| | - Gail Mountain
- Centre for Applied Dementia Research, University of Bradford, UK; School of Health and Related Research (ScHARR), 7315University of Sheffield, UK
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Lima-Silva TB, Barbosa MEDC, Zumkeller MG, Verga CER, Prata PL, Cardoso NP, de Moraes LC, Brucki SMD. Cognitive training using the abacus: a literature review study on the benefits for different age groups. Dement Neuropsychol 2021; 15:256-266. [PMID: 34345368 PMCID: PMC8283869 DOI: 10.1590/1980-57642021dn15-020014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022] Open
Abstract
The literature indicates that cognitive stimulation interventions have shown promising results. Abacus represents a tool with great potential in such interventions.
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Affiliation(s)
- Thais Bento Lima-Silva
- Group of Cognitive and Behavioral Neurology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
| | | | | | | | - Patrícia Lessa Prata
- Group of Cognitive and Behavioral Neurology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
| | | | | | - Sonia Maria Dozzi Brucki
- Group of Cognitive and Behavioral Neurology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
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91
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Dementia trials, outcomes, and outcome measurement instruments for people living with dementia and family carers - considerations on how to improve the "gold standard". Int Psychogeriatr 2021; 33:327-330. [PMID: 33970067 DOI: 10.1017/s1041610220003749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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92
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Evaluation of intervention fidelity of a complex psychosocial intervention Lifestyle Matters: a randomised controlled trial. BMJ Open 2021. [PMCID: PMC8039267 DOI: 10.1136/bmjopen-2020-043478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectivesRobust research of complex interventions designed to promote mental well-being in later life is required to inform service development. An essential component is ensuring that such interventions are delivered as intended. We present a detailed description of the design and implementation of a fidelity assessment within a trial of one such intervention (Lifestyle Matters). The findings help to explain the trial results and also inform the design of embedded fidelity assessments within future evaluations of complex interventions.DesignWe conducted a mixed-method fidelity assessment embedded as part of a multicentre pragmatic randomised controlled trial. A conceptual fidelity framework was developed from the Behaviour Change Consortium framework. From this the fidelity assessment was designed. The resulting instrument assessed the following parameters: intervention design, training, supervision; and delivery, receipt and enactment of the intervention.InterventionThe Lifestyle Matters intervention was designed to assist older people to improve and sustain mental well-being through participation in meaningful activity. The aim is to enable participants to engage in both new and neglected activities through a mix of facilitated group meetings and individual sessions.ResultsThe fidelity assessment demonstrated that the intervention was delivered as per protocol for the group component and was tailored to meet individual needs. There was substantial inter-rater agreement for training; and group member performance 0.72; and moderate agreement for facilitator performance 0.55. It was not possible to determine whether small declines seen in facilitator performance were due to facilitator drift or moderating factors such as group dynamics or participant characteristics.ConclusionsThe assessment methods adequately measured criteria identified as being significant indicators of fidelity. Adherence during training, delivery and supervision was good. The subjective nature of identification and rating observed behaviours was the main challenge. Future research should explore alternative methods of assessing fidelity in trials of complex interventions.Trial registration numberISRCTN67209155.
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Chirico I, Chattat R, Dostálová V, Povolná P, Holmerová I, de Vugt ME, Janssen N, Dassen F, Sánchez-Gómez MC, García-Peñalvo FJ, Franco-Martín MA, Ottoboni G. The Integration of Psychosocial Care into National Dementia Strategies across Europe: Evidence from the Skills in DEmentia Care (SiDECar) Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073422. [PMID: 33806158 PMCID: PMC8036745 DOI: 10.3390/ijerph18073422] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
There is evidence supporting the use of psychosocial interventions in dementia care. Due to the role of policy in clinical practice, the present study investigates whether and how the issue of psychosocial care and interventions has been addressed in the national dementia plans and strategies across Europe. A total of 26 national documents were found. They were analyzed by content analysis to identify the main pillars associated with the topic of psychosocial care and interventions. Specifically, three categories emerged: (1) Treatment, (2) Education, and (3) Research. The first one was further divided into three subcategories: (1) Person-centred conceptual framework, (2) Psychosocial interventions, and (3) Health and social services networks. Overall, the topic of psychosocial care and interventions has been addressed in all the country policies. However, the amount of information provided differs across the documents, with only the category of ‘Treatment’ covering all of them. Furthermore, on the basis of the existing policies, how the provision of psychosocial care and interventions would be enabled, and how it would be assessed are not fully apparent yet. Findings highlight the importance of policies based on a comprehensive and well-integrated system of care, where the issue of psychosocial care and interventions is fully embedded.
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Affiliation(s)
- Ilaria Chirico
- Department of Psychology, University of Bologna, 40126 Bologna, Italy; (R.C.); (G.O.)
- Correspondence:
| | - Rabih Chattat
- Department of Psychology, University of Bologna, 40126 Bologna, Italy; (R.C.); (G.O.)
| | - Vladimíra Dostálová
- Faculty of Humanities, Charles University, 182 00 Prague, Czech Republic; (V.D.); (P.P.); (I.H.)
- Institute for Postgraduate Medical Education, Charles University, 100 00 Prague, Czech Republic
| | - Pavla Povolná
- Faculty of Humanities, Charles University, 182 00 Prague, Czech Republic; (V.D.); (P.P.); (I.H.)
- Institute for Postgraduate Medical Education, Charles University, 100 00 Prague, Czech Republic
| | - Iva Holmerová
- Faculty of Humanities, Charles University, 182 00 Prague, Czech Republic; (V.D.); (P.P.); (I.H.)
- Institute for Postgraduate Medical Education, Charles University, 100 00 Prague, Czech Republic
| | - Marjolein E. de Vugt
- Alzheimer Centrum Limburg, Maastricht University, 6229 MD Maastricht, The Netherlands; (M.E.d.V.); (N.J.); (F.D.)
| | - Niels Janssen
- Alzheimer Centrum Limburg, Maastricht University, 6229 MD Maastricht, The Netherlands; (M.E.d.V.); (N.J.); (F.D.)
| | - Fania Dassen
- Alzheimer Centrum Limburg, Maastricht University, 6229 MD Maastricht, The Netherlands; (M.E.d.V.); (N.J.); (F.D.)
| | - María Cruz Sánchez-Gómez
- Psycho-Sciences Research Group of IBSAL, Salamanca University, 37007 Salamanca, Spain; (M.C.S.-G.); (F.J.G.-P.); (M.A.F.-M.)
| | - Francisco José García-Peñalvo
- Psycho-Sciences Research Group of IBSAL, Salamanca University, 37007 Salamanca, Spain; (M.C.S.-G.); (F.J.G.-P.); (M.A.F.-M.)
| | - Manuel A. Franco-Martín
- Psycho-Sciences Research Group of IBSAL, Salamanca University, 37007 Salamanca, Spain; (M.C.S.-G.); (F.J.G.-P.); (M.A.F.-M.)
| | - Giovanni Ottoboni
- Department of Psychology, University of Bologna, 40126 Bologna, Italy; (R.C.); (G.O.)
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Stoner CR, Lakshminarayanan M, Durgante H, Spector A. Psychosocial interventions for dementia in low- and middle-income countries (LMICs): a systematic review of effectiveness and implementation readiness. Aging Ment Health 2021; 25:408-419. [PMID: 31814427 PMCID: PMC8026009 DOI: 10.1080/13607863.2019.1695742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Despite wide uptake in high-income countries (HICs), less is known about the effectiveness and implementation of psychological, social and cognitive interventions in low- and middle-income countries (LMICs). Despite this, such interventions are increasingly used. The aim of this review was to appraise the effectiveness and implementation readiness of psychosocial interventions for people with dementia in LMICs. METHODS A systematic search of databases from 1998-2019. Studies were rated on two scales assessing quality and implementation readiness. RESULTS Seventeen articles describing 11 interventions in six countries were evaluated. Interventions included Cognitive Stimulation Therapy (CST), a Multidisciplinary Cognitive Rehabilitation Programme (MCRP), singing interventions, occupational therapy and reminiscence therapy. The quality of included studies was variable, and many had low sample sizes. Evidence for improving both cognition and quality of life was found in two interventions: Cognitive Stimulation Therapy (CST) and a Multidisciplinary Cognitive Rehabilitation Programme (MCRP). Implementation issues were more likely to be explored in studies of Cognitive Stimulation Therapy (CST) than in any other intervention. CONCLUSIONS Of the included studies here, CST appears to be the most implementation ready, improving both cognition and quality of life with implementation readiness effectively explored in two LMIC countries: India and Tanzania.
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Affiliation(s)
- Charlotte R. Stoner
- Research Department of Clinical Educational and Health Psychology, University College London (UCL), London, UK,CONTACT Charlotte R. Stoner
| | - Monisha Lakshminarayanan
- Dementia Care in Schizophrenia Research Foundation (DEMCARES in SCARF), Chennai, Tamil Nadu, India
| | - Helen Durgante
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Aimee Spector
- Research Department of Clinical Educational and Health Psychology, University College London (UCL), London, UK
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Sprange K, Beresford-Dent J, Mountain G, Craig C, Mason C, Berry K, Wright J, Majid S, Thomas B, Cooper CL. Assessing fidelity of a community based psychosocial intervention for people with mild dementia within a large randomised controlled trial. BMC Geriatr 2021; 21:119. [PMID: 33573589 PMCID: PMC7879661 DOI: 10.1186/s12877-021-02070-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Understanding intervention delivery as intended, particularly in complex interventions, should be underpinned by good quality fidelity assessment. We present the findings from a fidelity assessment embedded as part of a trial of a complex community-based psychosocial intervention, Journeying through Dementia (JtD). The intervention was designed to equip individuals with the knowledge and skills to successfully self-manage, maintain independence, and live well with dementia and involves both group and individual sessions. The methodological challenges of developing a conceptual framework for fidelity assessment and creating and applying purposely designed measures derived from this framework are discussed to inform future studies. METHODS A conceptual fidelity framework was created out of core components of the intervention (including the intervention manual and training for delivery), associated trial protocols and pre-defined fidelity standards and criteria against which intervention delivery and receipt could be measured. Fidelity data collection tools were designed and piloted for reliability and usability. Data collection in four selected sites (fidelity sites) was via non-participatory observations of the group aspect of the intervention, attendance registers and interventionist (facilitator and supervisor) self-report. RESULTS Interventionists from all four fidelity sites attended intervention training. The majority of group participants at the four sites (71%) received the therapeutic dose of 10 out of 16 sessions. Weekly group meeting attendance (including at 'out of venue' sessions) was excellent at 80%. Additionally, all but one individual session was attended by the participants who completed the intervention. It proved feasible to create tools derived from the fidelity framework to assess in-venue group aspects of this complex intervention. Results of fidelity assessment of the observed groups were good with substantial inter-rater reliability between researchers KAPPA 0.68 95% CI (0.58-0.78). Self-report by interventionists concurred with researcher assessments. CONCLUSIONS There was good fidelity to training and delivery of the group aspect of the intervention at four sites. However, the methodological challenges of assessing all aspects of this complex intervention could not be overcome due to practicalities, assessment methods and ethical considerations. Questions remain regarding how we can assess fidelity in community-based complex interventions without impacting upon intervention or trial delivery. TRIAL REGISTRATION ISRCTN17993825 .
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Affiliation(s)
- Kirsty Sprange
- Nottingham Clinical Trials Unit, Faculty of Medicine, University of Nottingham, Building 42, Nottingham, NG7 2RD, UK.
| | | | - Gail Mountain
- University of Bradford, Bradford, West Yorkshire, BD7 1DP, UK
| | - Claire Craig
- Sheffield Hallam University, City Campus, Sheffield, S1 1WB, UK
| | - Clare Mason
- University of Bradford, Bradford, West Yorkshire, BD7 1DP, UK
| | - Katherine Berry
- Manchester Academic Health Science Centre, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Jessica Wright
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, S1 4DP, UK
| | - Shazmin Majid
- Institute of Mental Health, Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Ben Thomas
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, S1 4DP, UK
| | - Cindy L Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, S1 4DP, UK
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96
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Sprange K, Beresford-Dent J, Mountain G, Thomas B, Wright J, Mason C, Cooper CL. Journeying through Dementia Randomised Controlled Trial of a Psychosocial Intervention for People Living with Early Dementia: Embedded Qualitative Study with Participants, Carers and Interventionists. Clin Interv Aging 2021; 16:231-244. [PMID: 33574660 PMCID: PMC7872215 DOI: 10.2147/cia.s293921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/09/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify the barriers and facilitators to the implementation of a complex psychosocial intervention though a study exploring the experiences of participants, carers and interventionists during a trial. METHODS Individual semi-structured interviews were conducted with participants, their carers, and interventionists from a sample of recruiting sites that took part in the Journeying through Dementia randomized controlled trial (RCT). Interview data were transcribed and analysed using framework analysis. Co-researcher data analysis workshops were also conducted to explore researcher interpretations of the data through the lens of those with lived experience of dementia. Triangulation enabled comparison of findings from the interviews with findings from the co-researcher workshops. RESULTS Three main themes emerged from the interview data: being prepared; intervention engagement; and participation and outcomes from engagement. From these themes, a number of factors that can moderate delivery and receipt of the intervention as intended were identified. These were context and environment; readiness, training, skills and competencies of the workforce; identifying meaningful participation and relationships. CONCLUSION This study highlighted that the observed benefit of the intervention was nuanced for each individual. Mechanisms of change were influenced by a range of individual, social and contextual factors. Future research should therefore consider how best to identify and measure the multifaceted interplay of mechanisms of change in complex interventions. TRIAL REGISTRATION ISRCTN17993825.
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Affiliation(s)
- Kirsty Sprange
- Nottingham Clinical Trials Unit, Faculty of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | | | - Gail Mountain
- University of Bradford, Bradford West Yorkshire, BD7 1DP, UK
| | - Ben Thomas
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, S1 4DP, UK
| | - Jessica Wright
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, S1 4DP, UK
| | - Clare Mason
- University of Bradford, Bradford West Yorkshire, BD7 1DP, UK
| | - Cindy L Cooper
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, S1 4DP, UK
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97
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Huang HC, Tseng YM, Chen YC, Chen PY, Chiu HY. Diagnostic accuracy of the Clinical Dementia Rating Scale for detecting mild cognitive impairment and dementia: A bivariate meta-analysis. Int J Geriatr Psychiatry 2021; 36:239-251. [PMID: 32955146 DOI: 10.1002/gps.5436] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/16/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The Clinical Dementia Rating (CDR) Scale comprising global score (CDR-GS) and sum of boxes scores (CDR-SB) is commonly used in staging cognitive impairment; however, its diagnostic accuracy is not well clarified. The meta-analysis aimed to investigate the diagnostic accuracy of the CDR for mild cognitive impairment (MCI) and dementia in older populations. METHODS Studies examining the diagnostic accuracy of the CDR for MCI or dementia against reference standards were included from seven electronic databases. The bivariate analysis with a random-effects model was adopted to calculate the pooled sensitivity and specificity of the CDR for MCI and dementia. RESULTS Fifteen studies investigating the diagnostic accuracy of the CDR-GS (n = 13) or CDR-SB (n = 5) for MCI or dementia were included. The pooled sensitivity and specificity of the CDR-GS for MCI were 93% and 97%, respectively. With respect to dementia, the CDR-GS had superior pooled specificity compared to the CDR-SB (99% vs. 94%), while similar sensitivities were found between the CDR-GS and CDR-SB (both 87%). Significant moderators of an old age, a high educational level, a high prevalence of MCI or dementia, being in a developing country, and a lack of informants' observations may affect the estimation of the sensitivity or specificity of the CDR. CONCLUSIONS Evidence supports the CDR being useful for detecting MCI and dementia; applying the CDR for staging cognitive impairment in at risk populations should be considered. Furthermore, including objective observations from relevant informants or proxies to increase the accuracy of the CDR for dementia is suggested.
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Affiliation(s)
- Hui-Chuan Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yu-Min Tseng
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yi-Chun Chen
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
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98
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Vernooij-Dassen M, Moniz-Cook E, Verhey F, Chattat R, Woods B, Meiland F, Franco M, Holmerova I, Orrell M, de Vugt M. Bridging the divide between biomedical and psychosocial approaches in dementia research: the 2019 INTERDEM manifesto. Aging Ment Health 2021; 25:206-212. [PMID: 31771338 DOI: 10.1080/13607863.2019.1693968] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To provide a new perspective on integrated biomedical and psychosocial dementia research. BACKGROUND Dementia is being recognized as a multifactorial syndrome, but there is little interaction between biomedical and psychosocial approaches. A way to improve scientific knowledge is to seek better understanding of the mechanisms underlying the interaction between biomedical and psychosocial paradigms. One rationale for integrating biomedical and psychosocial research is the discordance between neuropathology and cognitive functioning. The concept of social health might bridge the two paradigms. It relates to how social resources influence the dynamic balance between capacities and limitations. HYPOTHESES Social health can act as the driver for accessing cognitive reserve, in people with dementia through active facilitation and utilization of social and environmental resources. Thereby we link lifestyle social and opportunities to the brain reserve hypothesis. MANIFESTO We provide a Manifesto on how to significantly move forward the dementia research agenda.
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Affiliation(s)
- Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esme Moniz-Cook
- Faculty of Health Sciences, School of Health & Social Work, University of Hull, Hull, UK
| | - Frans Verhey
- Alzheimer Centrum Limburg, School of Mental Health & Neurosciences/Psychiatry and Psychology/MUMC, Maastricht, The Netherlands
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Bob Woods
- Dementia Services Development Centre, DSDC Wales, Bangor University, Ardudwy, Bangor, UK
| | - Franka Meiland
- Department of Psychiatry, Amsterdam University Medical Centers, Location VUmc, APH Research Institute, Amsterdam, the Netherlands
| | - Manuel Franco
- Department Psychiatry, University Rio Hortega Hospital (Valladolid) and Zamora Hospital (Zamora), Spain.,Psychiatric and Mental Health Department, University Rio Hortega Hospital and Zamora Hospital, Zamora, Spain
| | - Iva Holmerova
- Charles University FHS CELLO and Gerontologicke Centrum, Kobylisy, Czechia
| | - Martin Orrell
- The Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - Marjolein de Vugt
- Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, the Netherlands
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99
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Wang Y, Chi I, Zhan Y, Chen W, Li T. Effectiveness of Resilience Interventions on Psychosocial Outcomes for Persons With Neurocognitive Disorders: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:709860. [PMID: 34489759 PMCID: PMC8416755 DOI: 10.3389/fpsyt.2021.709860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Neurocognitive disorders, such as mild cognitive impairment (MCI), dementia, and Alzheimer's disease, not only harm people's cognitive function but also lead to negative emotions, poor quality of life (QOL), and unsatisfactory level of well-being. Resilience can be defined as a dynamic and amendable process, which maintains or improves life satisfaction and quick recovery from own dilemma. However, no meta-analysis of randomized controlled trials (RCTs) has thus far examined the effectiveness of resilience interventions among persons with neurocognitive disorders, and the results of RCTs were inconsistent. This systematic review aimed to assess the effectiveness of resilience interventions on psychosocial outcomes among persons with neurocognitive disorders. Methods: Nine electronic Chinese and English databases (the Cochrane Library, PsycINFO, Web of Science, PubMed, Medline, Eric, JSTOR, CNKI, and WANGFANG) were searched through April 2021. Only RCTs were included, and the quality of the included studies was assessed by the Cochrane "Risk of Bias" tool. Meta-analysis was carried out on psychosocial outcomes, and heterogeneity was investigated by subgroup and sensitivity analysis. RevMan 5.4 was used for meta-analysis. Results: Fourteen RCT studies were identified, representing a total of 2,442 participants with neurocognitive disorders. The risk of bias was high or unclear for most included studies in the domains of allocation concealment, blinding participants, and interventionists. Meta-analysis showed that heterogeneity was low or moderate. There were significant differences in favor of resilience interventions compared with control on the outcome of QOL, using the Quality of Life-Alzheimer Disease scale (QOL-AD) [I 2 = 36%, standardized mean difference (SMD) = 0.14, 95% CI (0.02, 0.26), p = 0.02], and no significant differences on depression, using the Cornell Scale for Depression in Dementia (CSDD) [I 2 = 41%, SMD = -0.14, 95% CI (-0.34, 0.05), p = 0.16], and neuropsychiatric symptoms using the Neuropsychiatric Inventory Questionnaire (NPI-Q) [I 2 = 62%, SMD = -0.10, 95% CI (-0.37, -0.16), p ≤ 0.46]. Conclusions: Resilience interventions had a significant benefit on QOL but no significant benefit on depression and neuropsychiatric behavioral symptoms. More evidence is needed to answer questions about how to implement resilience interventions and how to evaluate their effectiveness.
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Affiliation(s)
- Ying Wang
- School of Philosophy and Sociology, Lanzhou University, Lanzhou, China.,Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, China
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States
| | - Yuning Zhan
- School of Economics and Management, Hangzhou Normal University, Hangzhou, China
| | - Wenjang Chen
- School of Philosophy and Sociology, Lanzhou University, Lanzhou, China
| | - Tongtong Li
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States
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100
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Casey D, Gallagher N, Devane D, Woods B, Murphy K, Smyth S, Newell J, Murphy AW, Clarke C, Foley T, Timmons F, Dröes RM, O’Halloran M, Windle G, Irving Lupton K, Domegan C, O’Shea E, Dolan P, Doyle P. The feasibility of a Comprehensive Resilience-building psychosocial Intervention (CREST) for people with dementia in the community: protocol for a non-randomised feasibility study. Pilot Feasibility Stud 2020; 6:177. [PMID: 33292667 PMCID: PMC7667740 DOI: 10.1186/s40814-020-00701-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A dementia diagnosis can prevent people from participating in society, leading to a further decline in cognitive, social and physical health. However, it may be possible for people with dementia to continue to live meaningful lives and continue to participate actively in society if a supportive psychosocial environment exists. Resilience theory, which focuses on strengthening personal attributes and external assets in the face of serious challenges, may provide a scaffold on which an inclusive multifaceted psychosocial supportive environment can be built. This protocol paper describes a study to determine the feasibility of conducting a multifaceted complex resilience building psychosocial intervention for people with dementia and their caregivers living in the community. METHODS This is a non-randomised feasibility study. Ten participants with dementia and their primary caregivers living in the community will be recruited and receive the CREST intervention. The intervention provides (a) a 7-week cognitive stimulation programme followed by an 8-week physical exercise programme for people with dementia and (b) a 6-week educational programme for caregivers. Members of the wider community will be invited to a dementia awareness programme and GP practices to a dementia training workshop. Trained professionals will deliver all intervention components. Outcomes will assess the feasibility and acceptability of all study processes. The feasibility and acceptability of a range of outcomes to be collected in a future definitive trial, including economic measurements, will also be explored. Finally, social marketing will be used to map a route toward stigma change in dementia for use in a subsequent trial. Quantitative feasibility outcome assessments will be completed at baseline and after completion of the 15-week intervention while qualitative data will be collected at recruitment, baseline, during and post-intervention delivery. CONCLUSION This feasibility study will provide evidence regarding the feasibility and acceptability of a comprehensive multifaceted psychosocial intervention programme for people with dementia and their caregivers (CREST). The results will be used to inform the development and implementation of a subsequent RCT, should the findings support feasibility. TRIAL REGISTRATION ISRCTN25294519 Retrospectively registered 07.10.2019.
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Affiliation(s)
- Dympna Casey
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Niamh Gallagher
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Declan Devane
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, Wales
| | - Kathy Murphy
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - Siobhán Smyth
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
| | - John Newell
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - Andrew W. Murphy
- Department of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Fergus Timmons
- The Alzheimer Society of Ireland, Temple Road, Blackrock, Co. Dublin Ireland
| | - Rose-Marie Dröes
- Department of Psychiatry, VU University Medical Center, A.J. Ernststraat 1187 (kamer D0.03), Amsterdam, The Netherlands
| | - Martin O’Halloran
- College of Engineering & Informatics, National University of Ireland Galway, Galway, Ireland
| | - Gill Windle
- School of Health Sciences, Bangor University, Bangor, Wales
| | - Kate Irving Lupton
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Christine Domegan
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Eamon O’Shea
- Centre for Economic & Social Research on Dementia, ILAS Building, National University of Ireland, Galway, Ireland
| | - Pat Dolan
- UNESCO Child and Family Research Centre, School of Political Science and Sociology, National University of Ireland, Galway, Ireland
| | - Priscilla Doyle
- School of Nursing & Midwifery, National University of Ireland Galway, Aras Moyola, Galway, Ireland
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