The prevalence of dementia and depression in Taiwanese institutionalized leprosy patients, and the effectiveness evaluation of reminiscence therapy--a longitudinal, single-blind, randomized control study

Effects of reminiscence therapy in people with dementia: A systematic review and meta-analysis

WHAT IS KNOWN ABOUT ON THE SUBJECT?: Alternative option was developed to improve care due to the increasing costs of care cost and the number of people diagnosed with dementia. Reminiscence therapy is a commonly implemented alternative option used in long-term care facilities. Reminiscence therapy is designed for cognitive decline that is also known as life review. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Reminiscence therapy, known as psychosocial interventions in dementia care, can be used to assist people with dementia recollect prior events, activities, and experiences in order to improve their cognitive, mood, and overall well-being. Reminiscence therapy increased cognitive function and quality of life and reduced depressive and neuropsychiatric symptoms among people with dementia. Reminiscence therapy may be considered a useful non-pharmacological intervention for people with dementia living in nursing homes or other long-term care facilities. The development of a global standard protocol for the application of reminiscence therapy may be necessary for future randomized controlled trials (RCTs). ABSTRACT: Introduction Reminiscence therapy is an alternative to pharmaceutical intervention provided during long-term care, especially for individuals with dementia. However, the effects of reminiscence therapy in dementia care remain inconclusive. Aim The goal of this study is to examine the effects of reminiscence therapy implementation in people with dementia. Design Systematic literature review and meta-analysis were conducted in accordance with the PRISMA guidelines. Methods This study searched systematically using 6 databases. The eligibility criteria included patients with dementia, applied reminiscence therapy, randomized controlled trials or quasi-experimental studies, and published in the English language. The PEDro scale was used to assess the methodological quality of the included studies. The meta-analysis was performed using a random-effects model to calculate the pooled effects of reminiscence therapy. Stata 16.0 was used for statistical analysis. Result A total of 29 studies met the eligibility criteria, including 3102 participants. Overall, reminiscence therapy increased cognitive functions and quality of life and decreased depression and neuropsychiatric symptoms. Implication for Practice Reminiscence therapy may be considered a useful non-pharmacological intervention for people with dementia living in nursing homes or other long-term care facilities. A standard protocol for reminiscence therapy may be necessary for future studies.

Neuronal Damage and Neuroinflammation, a Bridge Between Bacterial Meningitis and Neurodegenerative Diseases

Bacterial meningitis is an inflammation of the meninges which covers and protects the brain and the spinal cord. Such inflammation is mostly caused by blood-borne bacteria that cross the blood-brain barrier (BBB) and finally invade the brain parenchyma. Pathogens such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae are the main etiological causes of bacterial meningitis. After trafficking across the BBB, bacterial pathogens in the brain interact with neurons, the fundamental units of Central Nervous System, and other types of glial cells. Although the specific molecular mechanism behind the interaction between such pathogens with neurons is still under investigation, it is clear that bacterial interaction with neurons and neuroinflammatory responses within the brain leads to neuronal cell death. Furthermore, clinical studies have shown indications of meningitis-caused dementia; and a variety of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease and Huntington's disease are characterized by the loss of neurons, which, unlike many other eukaryotic cells, once dead or damaged, they are seldom replaced. The aim of this review article is to provide an overview of the knowledge on how bacterial pathogens in the brain damage neurons through direct and indirect interactions, and how the neuronal damage caused by bacterial pathogen can, in the long-term, influence the onset of neurodegenerative disorders.

Activity limitations in leprosy and their association to cognition and neuropsychiatric symptoms

OBJECTIVES

to analyze activity limitations in patients with leprosy and their association to cognition and neuropsychiatric symptoms.

METHODS

this cross-sectional design study included sixty patients with multibacillary leprosy assisted at a reference center. Participants were divided according to their physical disability and submitted to instruments assessing daily activities (basic and instrumental), cognitive functions, and neuropsychiatric symptoms. The order of the instruments was random to avoid any interference of test sequence on the results.

RESULTS

fifty-five percent of the participants presented physical disabilities. All patients were independent in performing basic activities but sixty-six percent presented difficulties in performing instrumental activities. Cognitive decline and neuropsychiatric symptoms were seen in advanced stages of the disease, but they were more associated to patient age than to leprosy.

CONCLUSIONS

leprosy patients presented physical disabilities and difficulties in performing instrumental daily activities. Cognitive decline and neuropsychiatric symptoms were more associated to aging than to leprosy itself.

The impact of leprosy on the mental wellbeing of leprosy-affected persons and their family members - a systematic review

Leprosy has long-term consequences related to impairment and stigma. This includes a major impact on mental health. This study aims to consolidate current evidence regarding the mental health impact of leprosy on affected persons and their family members. In addition, determinants influencing mental health outcomes among leprosy-affected persons and effective interventions are examined. A keyword-based search was conducted in PubMed, Web of Science, Scopus, PsycINFO, Infolep and InfoNTD; additional literature was also considered. Articles presenting primary data involving leprosy-affected persons or their family members experiencing mental conditions were included. Independent extraction of articles was executed using predefined data fields. Articles were sorted according to relevance. In total, 65 studies were included in this systematic review. Multiple psychiatric morbidities have been identified among leprosy-affected persons, including depression, anxiety disorders and suicide (attempts). Additional factors were found that may impact mental health. Moreover, studies found that demographic factors, lifestyle and disease-specific factors and stigma and discrimination impact mental health. Depressive symptoms and low self-esteem were identified among children of leprosy-affected persons. In addition, interventions were identified that could improve the mental wellbeing of leprosy patients. Depressive disorders and anxiety disorders were found to be very common among persons affected by leprosy. Feelings such as fear, shame and low self-esteem are also experienced by those affected, and their children. Further research is necessary to ensure that mental health impact is included when determining the burden of disease for leprosy, and to relieve this burden.

The stress and coping experiences among Chinese rural older adults in welfare housing: through the lens of life review

Purposes: Responding to the growing needs of the largest aging population in the world, China has been experimenting interventions introduced from other countries to serve its older citizens. Using the life review approach, this study aimed to understand stress and coping experiences of a group of rural older adults living in public welfare housing, and to identify the effect of life review on their perceptions of quality of life. Methods: This study used an experimental research design with qualitative interviews. Analyses mainly focused on qualitative interview data of participants in the experimental group (n=24). Quantitative analyses were conducted to compare changes in the measure of quality of life between the experimental group and the control group (n=22). Results: Qualitative analyses indicated that salient life course stressors among rural Chinese old adults included financial strains, health concerns, and loss of loved ones. Such stressors were intertwined with historical and social changes they experienced in China. Coping strategies developed to survive a harsh young adulthood were used to deal with aging challenges and adaption to the welfare housing. Quantitative analysis found those who went through life review reported significant improvement in perceived quality of life compared to the control group. Discussion: Life review showed preliminary acceptability and effectiveness among the most disadvantaged and marginalized older group in China. It suggests this approach can be adapted to help understand life experience of older adults from different socioeconomic and cultural backgrounds, and to bring about positive changes in their wellbeing.

Benchmarks for Evaluating Life Review and Reminiscence Therapy in Alleviating Depression among Older Adults

The efficacy of reminiscence and life review (LR) therapy in alleviating depression among older adults is well established. However, providers in nonresearch settings might implement these interventions inadequately, and such settings rarely can evaluate their outcomes using control groups. Alternatively, evaluators in such settings can calculate a within-group effect size and then compare it with average within-group effect size benchmarks derived from the randomized clinical trials (RCTs) supporting the intervention's effectiveness. This study developed these within-group effect size benchmarks. A search of RCTs from five systematic reviews and meta-analyses, and more recent RCTs published through 2016, yielded 25 studies that met inclusion criteria. Hedge's g for LR recipients and waitlist controls were .598 and -.20, respectively, and .568 and -.012 for reminiscence theory. These benchmarks offer an approach for evaluating the implementation of LR and reminiscence therapy when control groups are infeasible.

The effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer patients: Randomized controlled trial

BACKGROUND

Alzheimer is a disease leading to various neuropsychiatric behavioral disorders, and the most common symptom observed during the prognosis of Alzheimer's disease is dysmnesia. The aim of the present study is to investigate the effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer's patients.

METHODS

The present study was a randomized controlled single blind study with two groups, which was designed in the experimental pretest-posttest pattern in the city of Konya, Turkey. It was decided to include a total of 60 elderly individuals. Information form that evaluated socio-demographic characteristics and disease history of individuals in intervention and control groups and was developed by the researcher. Standardized Mini-Mental State Examination (SMMSE), Cornell Scale for Depression in Dementia, and the Quality of Life in Alzheimer's Disease (QOL-AD) Scale were used to collect the data. Reminiscence therapy was applied once a week and lasted for 8 weeks. Every session took 60 minutes. Groups consisted of six people.

RESULTS

Mini-Mental Test, depression, and quality of life mean scores of the elderly in intervention group before reminiscence therapy program increased after the administration, and the difference was statistically significant (P < 0.05). In the intergroup comparison, a significant difference was found between elderly individuals' posttest Mini-Mental Test, depression, and quality of life mean scores (P < 0.05).

CONCLUSIONS

Our results suggest that regular reminiscence therapy should be considered for inclusion as routine care for the improvement of cognitive functions, depressive symptoms, and quality of life in elderly people with Alzheimer.

Verbal responses, depressive symptoms, reminiscence functions and cognitive emotion regulation in older women receiving individual reminiscence therapy

AIMS AND OBJECTIVES

To examine the effectiveness of individual reminiscence therapy in community-dwelling older women with depressive symptoms and to explore the characteristics of participants' verbalisation in the process.

BACKGROUND

Previous studies have found reminiscence was related to depression and anxiety. Although reminiscence therapy is widely used to reduce depression, little is known about how it works, and the content of verbalisations might provide one explanation.

DESIGN

The study employed a one-group pretest-post-test design.

METHODS

Twenty-seven participants underwent 6-week interventions of individual reminiscence therapy at home that were conducted by one nurse and induced through seeing old photographs. The Geriatric Depression Scale, Zung Self-rating Anxiety Scale, Reminiscence Functions Scale and Cognitive Emotion Regulation Questionnaire were used to measure the emotional states, reminiscence functions and cognitive emotion regulation strategies. Participants' verbalisations were categorised using the Client Behavior System.

RESULTS

Reminiscence therapy relieved depression and anxiety. Both the reminiscence function and cognitive emotion regulation became more favourable after interventions. Furthermore, higher frequencies of recounting, cognitive-behavioural exploration and affective exploration were noted in the process. Participants with more severe depressive symptoms tended to display a higher frequency of affective exploration. The reduction in depression, self-negative reminiscence and negative-focused emotion regulation were respectively associated with verbalisations.

CONCLUSIONS

Individual reminiscence therapy might relieve negative emotion and improve reminiscence function and cognitive emotion regulation. The participants' verbalisation is worthy of our attention, due to its correlation with the severity of depression and its mitigating effects on the depression, anxiety, self-negative reminiscence and negative-focused regulation in older women. The results contribute to our understanding of the therapeutic procedure and suggest a need for more research on the therapeutic processes.

RELEVANCE TO CLINICAL PRACTICE

Study on processes could help training novice clinical interveners so that reminiscence therapy can work better on emotional disorders in clinical practice.

Therapeutic workshops and psychosocial rehabilitation for institutionalised leprosy patients

Leprosy is still a major public health problem and psychosocial rehabilitation services for patients suffering from the disease remain insufficient. This study aimed to assess the impact of therapeutic workshops on quality of life and symptoms of depression among institutionalised leprosy patients. The Beck Depression Inventory (BDI) and generic World Health Organization Quality of Life questionnaire (WHOQOL-BREF) were used before and after the implementation of a series of therapeutic workshops over a period of six months. Sixty-two patients participated in the study. Almost all of the sample were elderly and had a low level of education. There was a significant reduction in the symptoms of depression scores after the intervention (p < 0,001) and a positive impact was shown for the psychological (p = 0,001), physical (p = 0,03) and environment (p < 0,001) domains, but not for the social relationships (p = 0,124) domain. Therapeutic workshops appear to a useful tool for psychosocial rehabilitation work with leprosy patients.

Reminiscence Therapy Improves Cognitive Functions and Reduces Depressive Symptoms in Elderly People With Dementia: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

Cognitive function impairments and depressive symptoms are common in elderly people with dementia. Previous meta-analyses of outdated and small-scale studies have reported inconsistent results regarding the effects of reminiscence therapy on cognitive functions and depressive symptoms; therefore, we conducted a meta-analysis by including more recent randomized controlled trials (RCTs) with large sample sizes to investigate the immediate and long-term (6-10 months) effects of reminiscence therapy on cognitive functions and depressive symptoms in elderly people with dementia.

REVIEW METHODS

Electronic databases, including PubMed, Medline, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, ProQuest, Google Scholar, and Chinese databases were searched to select eligible articles. Primary outcome measures included the scores of cognitive functions and depressive symptoms. In total, 12 RCT studies investigating the effects of reminiscence therapy on cognitive functions and depressive symptoms in elderly people with dementia were included. Two reviewers independently extracted data. All analyses were performed using a random-effects model.

RESULTS

Reminiscence therapy had a small-size effect on cognitive functions (g = 0.18, 95% confidence interval [CI] 0.05-0.30) and a moderate-size effect on depressive symptoms (g = -0.49, 95% CI -0.70 to -0.28) in elderly people with dementia. Long-term effects of reminiscence therapy on cognitive functions and depressive symptoms were not confirmed. Moderator analysis revealed that institutionalized elderly people with dementia exhibited greater improvement in depressive symptoms than community-dwelling people with dementia did (g = -0.59 vs. -0.16, P = .003).

CONCLUSIONS

This meta-analysis confirms that reminiscence therapy is effective in improving cognitive functions and depressive symptoms in elderly people with dementia. Our findings suggest that regular reminiscence therapy should be considered for inclusion as routine care for the improvement of cognitive functions and depressive symptoms in elderly people with dementia, particularly in institutionalized residents with dementia.

A systematic review of the use of technology for reminiscence therapy

As the segment of the population 65 years of age or older continues to grow, the number of individuals with dementia increases proportionally, highlighting the need to design therapies that meet the social and emotional needs of people with dementia. Information and communication technologies (ICT) are potential venues for supporting the delivery of such therapies, including reminiscence therapy (RT), which is a non-pharmacological intervention involving the prompting of past memories, often with artifacts such as old photographs or music for therapeutic benefits such as the facilitation of social interactions or the increase of self-esteem. This paper systematically examines the scientific literature on the use of ICT for facilitating RT to assess the current state of the evidence and identify future trends. We searched the PubMed (1966-2013), ACM (1954-2013), and PsycINFO (1908-2013) repositories using the keywords dementia and reminiscence. Three hundred eighty-six articles were retrieved, 44 of which met the inclusion and exclusion criteria. Findings of the systematic review include that there are benefits to using ICT for RT interventions. Some of these benefits are access to rich and engaging multimedia reminiscence materials, opportunities for people with dementia to participate in social interactions and take ownership of conversations, and a reduction of barriers due to motor deficits during interactions with media. Future studies should explore the types and content of media beneficial to individuals at different stages of dementia.

Mental distress and podoconiosis in Northern Ethiopia: a comparative cross-sectional study

Background

The stigma, deformity and disability related to most neglected tropical diseases may lead to poor mental health. We aimed to assess the comorbidity of podoconiosis and mental distress.

Methods

A comparative cross-sectional study was conducted in 2012, including 346 people with podoconiosis and 349 healthy neighbourhood controls. Symptoms of mental distress were assessed using the validated Amharic translation of the Kessler-10 scale (K10). A linear regression analysis was conducted to identify factors associated with mental distress.

Results

The mean K10 score was 15.92 (95% CI: 15.27 to 16.57) in people with podoconiosis and 14.49 (95% CI: 13.85 to 15.12) in controls (average K10 scores 1.43 points higher [95% CI: 0.52 to 2.34]). In multivariate linear regression of K10 scores, the difference remained significant when adjusted for gender, income, alcohol use, age, place of residence and family history of mental illness. In the adjusted model, people with podoconiosis had K10 scores 1.37 points higher than controls (95% CI: 0.64 to 2.18). Other variables were also associated with high K10 scores: women had K10 scores 1.41 points higher than men (95% CI: 0.63 to 2.18). Those with family history of mental illness had K10 scores 3.56 points higher than those without (95% CI: 0.55 to 6.56).

Conclusions

This study documented a high burden of mental distress among people with podoconiosis compared with healthy controls. Taking this finding in the context of the high stigma and reduced quality of life, we recommend integration of psychosocial care into the current morbidity management of podoconiosis.

Mental disorders in leprosy: an underdiagnosed and untreated population

OBJECTIVE

To describe the frequency of psychiatric comorbidities in leprosy patients and check if they had been previously diagnosed and were in psychiatric care.

METHOD

The study was conducted with a sample of 120 leprosy patients being treated at two reference hospitals for leprosy in Salvador, Bahia, Brazil. Survey participants were more than 18 years of age, had a confirmed diagnosis of leprosy and was undergoing antimicrobial treatment. Patients were evaluated face-to-face with a socio-demographic questionnaire and the Mini-International Neuropsychiatric Interview (MINI-Plus) in Portuguese. The period of data collection was between October 2009 and June 2012.

RESULTS

The assessment using the MINI-Plus showed that 34 (28.3%) patients did not receive any psychiatric diagnosis and 86 (71.7%) met the criteria for at least one. Of these 86 patients, 25 (20.8%) had one diagnosis, 26 (21.7%) had two diagnoses and the rest, 35 (29.2%), had three or more psychiatric diagnoses. All patients with a moderate or high risk of suicide had one or more psychiatric comorbidities.

CONCLUSION

Leprosy patients have a high prevalence of psychiatric comorbidities. Furthermore, most of them had no previous psychiatric diagnosis and the majority was not undergoing treatment.

The effect of early group psychotherapy on depressive symptoms and quality of life among residents of an apartment building for seniors

BACKGROUND

The aim of this study was to investigate the effectiveness of group psychotherapy on depressive symptoms and four domains of quality of life in the elderly.

METHODS

Ninety-six elderly persons were selected from one apartment building for seniors. The 15-question version of the Geriatric Depression Scale was used to screen for depressive symptoms. The treatment and control groups each comprised 12 subjects. The treatment group received one session of group psychotherapy each week for 8 weeks. The 24-item Hamilton Depression Rating Scale and the World Health Organization Quality of Life-BREF scale were used for assessment at the beginning of group psychotherapy and during the fourth and eighth weeks.

RESULTS

The Hamilton Depression Rating Scale score decreased significantly in the treatment group by the eighth week of group psychotherapy compared to the control group (4.9 ± 3.6 vs 17.6 ± 6.4, respectively; P < 0.0001). The World Health Organization Quality of Life-BREF score decreased significantly in the control group by the eighth week compared to the treatment group (95.3 ± 9.9 vs 80.2 ± 10.6, respectively; P = 0.002) with Hamilton Depression Rating Scale interaction (χ(2) = 2.11, P = 0.146). Analysis of the four quality of life domains showed significant differences in the psychological and social domains (P = 0.004 and P = 0.004, respectively) but not in the physical and environmental domains (P = 0.133 and P = 0.147, respectively).

CONCLUSIONS

These findings suggest that studies of the outcome of group psychotherapy must control for depressive symptoms. Quality of life may have been mediated by depression in this preliminary study.

Discovering disease-disease associations by fusing systems-level molecular data

The advent of genome-scale genetic and genomic studies allows new insight into disease classification. Recently, a shift was made from linking diseases simply based on their shared genes towards systems-level integration of molecular data. Here, we aim to find relationships between diseases based on evidence from fusing all available molecular interaction and ontology data. We propose a multi-level hierarchy of disease classes that significantly overlaps with existing disease classification. In it, we find 14 disease-disease associations currently not present in Disease Ontology and provide evidence for their relationships through comorbidity data and literature curation. Interestingly, even though the number of known human genetic interactions is currently very small, we find they are the most important predictor of a link between diseases. Finally, we show that omission of any one of the included data sources reduces prediction quality, further highlighting the importance in the paradigm shift towards systems-level data fusion.

Neglected tropical diseases and mental health: a perspective on comorbidity

Mental health conditions will be the largest contributor to the global health burden by 2030. Our review suggests that neglected tropical diseases (NTDs) predispose individuals to poor mental health. Factors predisposing to poor mental health include stigma and discrimination, exclusion from participating fully in society, reduced access to health and social services, lack of educational opportunities, exclusion from income-generation and employment opportunities, and restrictions in exercising civil and political rights. These characteristics are all features of NTDs, but the mental health of these sufferers has been ignored. This review raises an issue of concern and highlights the opportunities for research by psychiatrists and psychologists on NTDs.