Cognitive Profiles of Individuals with Dementia and Healthy Elderly: The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA-G)

Comparing the effects of olfactory-based sensory stimulation and board game training on cognition, emotion, and blood biomarkers among individuals with dementia: A pilot randomized controlled trial

Olfactory dysfunction can indicate early cognitive decline and is associated with dementia symptoms. We developed an olfactory-based sensory stimulation program and investigated its effects on cognition and emotion, and board game training were used as a comparison. In this parallel design pilot study, 30 participants with mild to moderate dementia were equal randomly assigned to the control (CONT), olfactory stimulation with cognitive training (OS), and board game (BG) groups. Two participants were withdrawn from CONT and OS groups, respectively. The intervention was a 12-week program with one 30-min session twice a week. We employed a blood-based biomarker technique and several cognitive and psychological tests to measure basal and after-intervention values. No significant differences were observed between the groups after intervention, as measured using the Mini-Mental State Examination, Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), Top International Biotech Smell Identification Test, and Geriatric Depression Scale (GDS). The results showed that the OS group had a lower plasma Tau level than the other groups following intervention, whereas the CONT group had a significantly increased plasma amyloid ß1-42 level. OS participants had a lower concentration ratio of plasma Tau and amyloid Aß1-42 and showed more stable or improved cognition, olfactory function, and mood state. Both the OS and BG groups had a higher percentage of participants with stable or improved cognition and emotion. Taken together, these results suggest that olfactory-based sensory stimulation can be a beneficial intervention for patients with dementia.

Minimal Clinically Important Difference of the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G) in People With Dementia

IMPORTANCE

The Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G) can provide multifaceted and comprehensive measures of cognitive function with reduced literacy demands; however, its minimal clinically important difference (MCID) has not been determined for interpreting the change scores.

OBJECTIVE

To establish the LOTCA-G MCID for people with dementia.

DESIGN

Psychometric field study.

SETTING

Data were collected in communities.

PARTICIPANTS

Forty-nine participants with mild to moderate dementia who were enrolled in previous research investigating the effects of cognitive stimulation-related interventions with equivalent training hours.

OUTCOMES AND MEASURES

The Mini-Mental State Examination and LOTCA-G were used to assess cognitive function before and after the interventions. The anchor-based and distribution-based approaches were used to estimate the LOTCA-G MCID.

RESULTS

Using the anchor-based method, we defined 16 participants as the improvement group, with a mean change score of 5.75 points (the first MCID estimate). The second MCID estimate was 6.23 points, which we calculated from the 49 participants by using the distribution-based method with the medium effect size.

CONCLUSIONS AND RELEVANCE

Current results suggest that a LOTCA-G change score greater than 5.75 points should be considered as meaningful change for people with dementia. It is important to consider the LOTCA-G MCID as one of the indexes for determining the success of interventions in people with dementia.

WHAT THIS ARTICLE ADDS

This study is the first to report the LOTCA-G MCID for dementia. Establishing an MCID for standardized cognitive assessment tools for the aging population can be used to support evidence-based practice in rehabilitation clinics.

Promoting functional independence in people with Alzheimer's disease: Outcomes of a home-based occupational therapy intervention in Spain

Nonpharmacologic therapies such as occupational therapy (OT) are promising for people with Alzheimer's disease (AD). However, more research is needed to better understand the effectiveness of home-based OT programs. This pilot study aimed to assess the effects of a home-based, high-intensity and multicomponent OT intervention on the activities of daily living of people with AD in Spain. The secondary objective was to examine its impact on the cognitive functions. A multiple-baseline intrasubject design was used. Twenty-one community-dwelling older adults with mild AD (mean age 78.6 years) and their primary caregivers participated in a 12-week home-based OT program. This intervention was replicated for 8 weeks after a 1.5-month intervention withdrawal period. The intervention followed a holistic, biopsychosocial and client-centred approach and consisted of the following components: meaningful activities/tasks, cognitive stimulation, activation of psychomotor and sensory skills, home modification, caregiver counselling and training in daily living skills. Functional independence was the primary outcome (Barthel Index). The cognitive functions were assessed by the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G). Data were analysed using nonparametric tests. Main results showed that after completing the OT program, 6.5 months after the moment of inclusion, the level of functional independence improved significantly and the effect size was large. Moreover, there was a significant moderate-to-substantial improvement in several cognitive functions after each of the two intervention periods: place orientation, time orientation and attention/concentration. In summary, the findings give a great deal of information as a basis for further research. This study provides evidence that an intensive home-based OT intervention has a positive influence on daily activities and some cognitive functions, suggesting that this program may be beneficial as a nonpharmacological supplementary tool in health and social care for people with AD living in the community.

Effect of the recreational life review program on patients with dementia in an outpatient clinic: a preliminary study

The purpose of this study is to investigate the effect of the Life Review Program-Taiwan (LRP-TW) on outpatients with mild to moderate dementia. Ten individuals were selected through purposive sampling and tested using a single group pretest-posttest design. The Mini-Mental State Examination (MMSE), the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G) and the Geriatric Depression Scale-Short Form (GDS-SF) were used as outcome measures. The total scores and three subtests of the LOTCA-G revealed significant differences after the intervention. Affective function remained stable through the experiment. The LRP-TW may offer a clinical intervention program for supporting cognitive and mental performance in individuals with dementia.

Supporting the Loewenstein occupational therapy cognitive assessment using distributed user interfaces

PURPOSE

Improve the quantity and quality of information obtained from traditional Loewenstein Occupational Therapy Cognitive Assessment Battery systems to monitor the evolution of patients' rehabilitation process as well as to compare different rehabilitation therapies.

METHODS

The system replaces traditional artefacts with virtual versions of them to take advantage of cutting edge interaction technology. The system is defined as a Distributed User Interface (DUI) supported by a display ecosystem, including mobile devices as well as multi-touch surfaces. Due to the heterogeneity of the devices involved in the system, the software technology is based on a client-server architecture using the Web as the software platform.

RESULTS

The system provides therapists with information that is not available (or it is very difficult to gather) using traditional technologies (i.e. response time measurements, object tracking, information storage and retrieval facilities, etc.).

CONCLUSIONS

The use of DUIs allows therapists to gather information that is unavailable using traditional assessment methods as well as adapt the system to patients' profile to increase the range of patients that are able to take this assessment. Implications for Rehabilitation Using a Distributed User Interface environment to carry out LOTCAs improves the quality of the information gathered during the rehabilitation assessment. This system captures physical data regarding patient's interaction during the assessment to improve the rehabilitation process analysis. Allows professionals to adapt the assessment procedure to create different versions according to patients' profile. Improves the availability of patients' profile information to therapists to adapt the assessment procedure.

Dynamic Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (DLOTCA–G): Assessing Change in Cognitive Performance

OBJECTIVE. We studied the internal consistency reliability and construct validity of the new Dynamic Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (DLOTCA–G), a dynamic version of the Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (LOTCA–G), and examined the properties of the mediation system.

METHOD. Participants included 61 clients hospitalized after stroke in three rehabilitation centers (mean age = 77.6 yr, standard deviation [SD] = 6.2) and 52 healthy control participants (mean age = 77.8 yr, SD = 6.4). All participants were assessed with the DLOTCA–G.

RESULTS. Internal consistency reliability showed moderate to high α coefficient levels in all domains (αs = .68–.85) except the Memory domain (α = .26). Both groups benefitted from mediation, but the stroke clients needed more concrete levels of mediation (Levels 3–5).

CONCLUSION. The addition of mediation to the LOTCA–G is effective in providing insights into clients’ cognitive status and learning potential. Our findings are similar to the results of the validation study for the DLOTCA for adults and support the use and benefits of the dynamic version.

Dynamic Lowenstein Occupational Therapy Cognitive Assessment: Evaluation of Potential to Change in Cognitive Performance

OBJECTIVE. We studied the psychometric properties of the dynamic version of the Lowenstein Occupational Therapy Cognitive Assessment (DLOTCA) and examined the most frequent level of mediation used for planning for intervention.

METHOD. Participants included 83 clients hospitalized after first stroke (mean age = 57.7, standard deviation = 8.33) and 45 healthy control participants. All were assessed with the DLOTCA after providing informed consent.

RESULTS. Interrater reliability showed high correlations between all pairs of raters. Internal consistency reliability showed moderate to high αs (.602–.813) for all domains except Visual Perception. We found significant differences between the groups of participants before mediation; both benefited from mediation, showing moderate to high effect sizes. Stroke clients needed higher levels of mediation.

CONCLUSION. The DLOTCA is effective in providing insight into whether participants need mediation and the level and type of assistance they require. The DLOTCA provides guidance for planning intervention for people with cognitive disabilities.