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Layton N, Devanny C, Hill K, Swaffer K, Russell G, Low LF, Lee DCA, Cations M, Skouteris H, Mc O'Connor C, Collyer TA, Neves BB, Andrew NE, Haines T, Srikanth VK, Petersen A, Callisaya ML. The Right to Rehabilitation for People With Dementia: A Codesign Approach to Barriers and Solutions. Health Expect 2024; 27:e70036. [PMID: 39318228 DOI: 10.1111/hex.70036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 08/20/2024] [Accepted: 09/06/2024] [Indexed: 09/26/2024] Open
Abstract
INTRODUCTION People with dementia of all ages have a human right to equal access to quality health care. Despite evidence regarding its effectiveness, many people living with dementia are unable to access rehabilitation for promoting function and quality of life. Conducted in Australia, this study was designed to (1) explore barriers to access to dementia rehabilitation and (2) identify solutions that improve access to rehabilitation. METHODS People living with dementia (n = 5) and care partners (n = 8) and health professionals (n = 13) were recruited nationally. Experience-based codesign across three virtual workshops was used to understand barriers and design solutions to improve access to rehabilitation treatments. Socio-ecological analyses, using the Levesque Access to Health care framework, were applied to findings regarding barriers and to aid selection of solutions. RESULTS There was high attendance (92.3%) across the three workshops. Barriers were identified at a user level (including lack of knowledge, transport, cost and difficulty navigating the health, aged care and disability sectors) and health service level (including health professional low dementia knowledge and negative attitudes, inequitable funding models and non-existent or fragmented services). Solutions focused on widespread dementia education and training, including ensuring that people with dementia and their care partners know about rehabilitation therapies and that health professionals, aged care and disability co-ordinators know how to refer to and deliver rehabilitation interventions. Dementia care navigators, changes to Australia's public funding models and specific dementia rehabilitation programmes were also recommended. CONCLUSIONS Barriers to accessing rehabilitation for people with dementia exist at multiple levels and will require a whole-community and systems approach to ensure change. PATIENT OR PUBLIC CONTRIBUTION People with living experience (preferred term by those involved) were involved at two levels within this research. A Chief Investigator living with dementia was involved in the design of the study and writing of the manuscript. People with living experience, care partners and service providers were participants in the codesign process to identify barriers and design potential solutions.
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Affiliation(s)
- Natasha Layton
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Catherine Devanny
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Keith Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Kate Swaffer
- University of South Australia, Adelaide, South Australia, Australia
| | - Grant Russell
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Den-Ching A Lee
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Claire Mc O'Connor
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- HammondCare, Centre for Positive Ageing, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Taya A Collyer
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Barbara Barbosa Neves
- Sydney Centre for Healthy Societies, University of Sydney, Sydney, New South Wales, Australia
| | - Nadine E Andrew
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Terry Haines
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- School of Public and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Velandai K Srikanth
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Peninsula Health, Melbourne, Victoria, Australia
| | - Alan Petersen
- Sociology, School of Social Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michele L Callisaya
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
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Ryan SM, Brady O. Cognitive stimulation in activities of daily living for individuals with mild-to-moderate dementia (CS-ADL): Study protocol for a randomised controlled trial. PLoS One 2024; 19:e0309337. [PMID: 39226247 PMCID: PMC11371241 DOI: 10.1371/journal.pone.0309337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 07/27/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Multi-component CS programs incorporating practice of activities of daily living (ADL) into intervention have reported benefits for ADL outcomes in individuals living with mild-to-moderate dementia. A randomised controlled trial (RCT) within community occupational therapy services in Ireland, is planned to evaluate the effects of CS-ADL, an ADL-focused, multi-component CS program, on ADL outcomes for individuals living with mild-to-moderate dementia. METHOD A single-blind RCT with a calculated sample size of 34 participants has been planned to compare the effects of CS-ADL versus treatment as usual on the outcomes of basic ADLs and instrumental ADLs. Cognition, mood, communication, and quality of life will also be evaluated as secondary outcomes. CS-ADL sessions will run once weekly for a total of seven weeks, lasting approximately two hours each. Outcome data will be collected at baseline, within sessions and post-intervention at week eight. Descriptive statistics will be used to analyse the data. This study has been registered at clinicaltrials.gov (NCT06147479). DISCUSSION CS programs are commonly conducted by occupational therapists working with individuals living with mild-to-moderate dementia. This study aims to demonstrate the effectiveness of a multi-component CS program delivered through an occupational therapy lens, potentially influencing the approach to CS and ADL interventions undertaken by occupational therapists.
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Affiliation(s)
- Simone M. Ryan
- Discipline of Occupational Therapy, School of Health Sciences, Áras Moyola, University of Galway, Galway, Ireland
| | - Orla Brady
- Discipline of Occupational Therapy, School of Health Sciences, Áras Moyola, University of Galway, Galway, Ireland
- Primary Care, HSE, Trim, Meath, Ireland
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Luque-Uría Á, Calvo MV, Visioli F, Fontecha J. Milk fat globule membrane and its polar lipids: reviewing preclinical and clinical trials on cognition. Food Funct 2024; 15:6783-6797. [PMID: 38828877 DOI: 10.1039/d4fo00659c] [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: 06/05/2024]
Abstract
In most parts of the world, life expectancy is increasing thanks to improved healthcare, public health policies, nutrition, and treatment. This increase in lifespan is often not accompanied by an increase in health span, which severely affects people as they age. One notable consequence of this is the increasing prevalence of neurodegenerative diseases such as mild cognitive impairment, dementia, and Alzheimer's disease. Therefore, dietary and pharmaceutical measures must be taken to reduce the burden of such pathologies. Among the different types of nutrients found in the diet, lipids and especially polar lipids are very important for cognition due to their abundance in the brain. Amid the most studied sources of polar lipids, milk fat globule membrane (MFGM) stands out as it is abundant in industrial by-products such as buttermilk. In this narrative review, we discuss the latest, i.e. less than five years old, scientific evidence on the use of MFGM and its polar lipids in cognitive neurodevelopment in early life and their potential effect in preventing neurodegeneration in old age. We conclude that MFGM is an interesting, abundant and exploitable source of relatively inexpensive bioactive molecules that could be properly formulated and utilized in the areas of neurodevelopment and cognitive decline. Sufficiently large randomized controlled trials are required before health-related statements can be made. However, research in this area is progressing rapidly and the evidence gathered points to biological, health-promoting effects.
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Affiliation(s)
- Álvaro Luque-Uría
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL, CSIC-UAM), Madrid 28049, Spain.
| | - María V Calvo
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL, CSIC-UAM), Madrid 28049, Spain.
| | - Francesco Visioli
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy.
- IMDEA-Food, Madrid 28049, Spain
| | - Javier Fontecha
- Food Lipid Biomarkers and Health Group, Institute of Food Science Research (CIAL, CSIC-UAM), Madrid 28049, Spain.
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Faieta J, Ebuenyi ID, Devos H, Reynolds CF, Rodakowski J. The Role of Rehabilitation for Early-Stage Alzheimer's Disease and Related Dementias: Practice and Priorities. Arch Phys Med Rehabil 2024; 105:792-795. [PMID: 37757939 DOI: 10.1016/j.apmr.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/10/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
The World Health Organization describes rehabilitation as interventions that focus on addressing disability through optimizing functional ability for individuals living with various health challenges in their unique daily life contexts. Rehabilitation services are typically seeking to enhance functional capacity and health, either in concert with, or in place of pharmacologic interventions. These services typically fall into 2 categories, restorative, where the client endeavors to return to a prior level of independent function, and compensatory, where s/he may not. In the latter case, clients might receive, and be trained to use, technology aids or other external supports to enable them to engage in a safe, healthy, and meaningful day-to-day life. For some populations, however, even enhanced functional capacity can present in the form of an insidious, albeit slower decline. So, what is, or should, rehabilitation's role be in progressive neurologic conditions? Specifically, what are the policy and practice implications of rehabilitation for (not in the presence of, but for) the care of persons living with neurodegenerative conditions such as Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD)?
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Affiliation(s)
- Julie Faieta
- Department of Rehab Science & Technology, University of Pittsburgh, Pittsurgh, PA.
| | - Ikenna D Ebuenyi
- Department of Rehab Science & Technology, University of Pittsburgh, Pittsurgh, PA
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, The University of Kansas Medical Center, Kansas City, KA
| | - Charles F Reynolds
- University of Pittsburgh School of Medicine, Pittsurgh, PA; School of Public Health, University of Pittsburgh, Pittsurgh, PA
| | - Juleen Rodakowski
- Department of Occupational Therapy, University of Pittsburgh, Pittsurgh, PA
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Lin TH, Liao YC, Tam KW, Chan L, Hsu TH. Effects of music therapy on cognition, quality of life, and neuropsychiatric symptoms of patients with dementia: A systematic review and meta-analysis of randomized controlled trials. Psychiatry Res 2023; 329:115498. [PMID: 37783097 DOI: 10.1016/j.psychres.2023.115498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
Dementia is a major cause of disability and dependency. Pharmacological interventions are commonly provided to patients with dementia to delay the deterioration of cognitive functions but cannot alter the course of disease. Nonpharmacological interventions are now attracting increasing scholarly interest. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we aim to assess the effectiveness of music-based therapies on the cognition, quality of life (QoL), and neuropsychiatric symptoms of patients with dementia through a systematic review and meta-analysis of randomized controlled trials (RCTs). The PubMed, Embase, and Cochrane databases were searched for reports of RCTs examining the effectiveness of music-based therapies for dementia published as of April 2023. A total of 674 articles were screened, and 22 trials from 21 studies (1780 patients) met the eligibility criteria. In 15 trials, music-based therapies significantly improved the cognition of patients with dementia compared with non-music therapies. In 11 trials, music-based therapies also significantly improved the QoL of patients with dementia compared with non-music therapies. In six trials, music-based therapies significantly improved patients' neuropsychiatric symptoms compared with non-music therapies. In conclusion, music-based therapy is recognized as a safe and effective alternative approach for patients with dementia.
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Affiliation(s)
- Ting-Han Lin
- school of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Yin-Chun Liao
- Center for General Education, Chung Shan Medical University, Taichung City, Taiwan
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang-Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei City, Taiwan; Center For Evidence-Based Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Lung Chan
- Department of Neurology, Taipei Medical University-Shuang-Ho Hospital, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Tzu-Herng Hsu
- Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang-Ho Hospital, New Taipei City, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
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Day S. Frameworks for cultural adaptation of psychosocial interventions: A systematic review with narrative synthesis. DEMENTIA 2023; 22:1921-1949. [PMID: 37515347 PMCID: PMC10644683 DOI: 10.1177/14713012231192360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Psychosocial dementia interventions may be less effective when used with populations for whom they were not initially intended. Cultural adaptation of interventions aims to increase effectiveness of interventions by enhancing cultural relevance. Use of theoretical frameworks may promote more systematic cultural adaptation. The aim of this review was to provide a comprehensive synthesis of published cultural adaptation frameworks for psychosocial interventions to understand important elements of cultural adaptation and guide framework selection. METHOD Five scientific databases, grey literature and reference lists were searched to January 2023 to identify cultural adaptation frameworks for psychosocial interventions. Papers were included that presented cultural adaptation frameworks for psychosocial interventions. Data were mapped to the framework for reporting adaptations and modifications to evidence-based interventions, then analysed using thematic synthesis. RESULTS Twelve cultural adaptation frameworks met inclusion criteria. They were mostly developed in the United States and for adaptation of psychological interventions. The main elements of cultural adaptation for psychosocial interventions were modifying intervention content, changing context (where, by whom an intervention is delivered) and consideration of fidelity to the original intervention. Most frameworks suggested that key intervention components must be retained to ensure fidelity, however guidance was not provided on how to identify or retain these key components. Engagement (ways to reach and involve recipients) and cultural competence of therapists were found to be important elements for cultural adaptation. CONCLUSIONS Comprehensive frameworks are available to guide cultural adaptation of psychosocial dementia interventions. More work is required to articulate how to ensure fidelity during adaptation, including how to identify and retain key intervention components.
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Affiliation(s)
- Sally Day
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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7
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Hersant H, He S, Maliha P, Grossberg G. Over the Counter Supplements for Memory: A Review of Available Evidence. CNS Drugs 2023; 37:797-817. [PMID: 37603263 DOI: 10.1007/s40263-023-01031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
In 2021, the Global Brain Health Supplement Industry Market size was valued at US$7.6 billion. It is predicted to increase to US$15.59 billion by 2030. Memory and its enhancement are a segment of the market that comprised the highest global revenue share in 2021. In the USA alone, dietary supplement sales reached US$18 billion in 2018. The US Food and Drug Administration (FDA) does not have the authority to approve dietary supplements' safety, effectiveness, or labeling before products go on the market. The FDA often does not even review supplements before they go to market. Supplement manufacturers are thus responsible for ensuring their products are safe and that their claims are truthful. An extensive review of current supplements on the market was performed by surveying memory products for sale at local and national pharmacies and grocery stores. A list of 103 supplements was compiled and the ingredients in these memory supplements were reviewed. The 18 most common ingredients in these supplements were identified. Each of the supplements included at least one of the 18 most common ingredients. Scientific data relative to these ingredients and their effect on memory was searched using PubMed and Cochrane library databases. Currently, there is no compelling evidence for use of apoaequorin, coenzyme Q10, coffee extracts, L-theanine, omega-3 fatty acids, vitamin B6, vitamin B9, or vitamin B12 supplementation for memory. On the other hand, there is some current evidence for memory benefit from supplementation with ashwagandha, choline, curcumin, ginger, Lion's Mane, polyphenols, phosphatidylserine, and turmeric. There are current studies with mixed results regarding the benefit of carnitine, gingko biloba, Huperzine A, vitamin D, and vitamin E supplementation for memory. Dietary supplements geared toward improving cognition are a billion-dollar industry that continues to grow despite lacking a solid scientific foundation for their marketing claims. More rigorous studies are needed relative to the long-term use of these supplements in homogenous populations with standardized measurements of cognition. Health care providers need to be aware of any and all supplements their older adult patients may be consuming and be educated about their side effects and interactions with prescription medications. Lastly, the FDA needs to take an active position relative to monitoring marketed supplements regarding safety, purity and claims of efficacy.
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Affiliation(s)
- Haley Hersant
- Department of Psychiatry & Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Boulevard, Saint Louis, MO, 63104, USA.
| | - Sean He
- Department of Psychiatry & Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Boulevard, Saint Louis, MO, 63104, USA
| | - Peter Maliha
- Department of Psychiatry & Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Boulevard, Saint Louis, MO, 63104, USA
| | - George Grossberg
- Department of Psychiatry & Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Boulevard, Saint Louis, MO, 63104, USA
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Harwood RH, Goldberg SE, Brand A, van Der Wardt V, Booth V, Di Lorito C, Hoare Z, Hancox J, Bajwa R, Burgon C, Howe L, Cowley A, Bramley T, Long A, Lock J, Tucker R, Adams EJ, O'Brien R, Kearney F, Kowalewska K, Godfrey M, Dunlop M, Junaid K, Thacker S, Duff C, Welsh T, Haddon-Silver A, Gladman J, Logan P, Pollock K, Vedhara K, Hood V, Das Nair R, Smith H, Tudor-Edwards R, Hartfiel N, Ezeofor V, Vickers R, Orrell M, Masud T. Promoting Activity, Independence, and Stability in Early Dementia and mild cognitive impairment (PrAISED): randomised controlled trial. BMJ 2023; 382:e074787. [PMID: 37643788 PMCID: PMC10463053 DOI: 10.1136/bmj-2023-074787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To determine the effectiveness of an exercise and functional activity therapy intervention in adults with early dementia or mild cognitive impairment compared with usual care. DESIGN Randomised controlled trial. SETTING Participants' homes and communities at five sites in the United Kingdom. PARTICIPANTS 365 adults with early dementia or mild cognitive impairment who were living at home, and family members or carers. INTERVENTION The intervention, Promoting activity, Independence, and Stability in Early Dementia and mild cognitive impairment (PrAISED), was a specially designed, dementia specific, rehabilitation programme focusing on strength, balance, physical activity, and performance of activities of daily living, which was tailored and progressive and addressed risk and the psychological needs of people with dementia. Up to 50 therapy sessions were provided over 12 months. The control group received usual care plus a falls risk assessment. Procedures were adapted during the covid-19 pandemic. MAIN OUTCOME MEASURES The primary outcome was score on the carer (informant) reported disability assessment for dementia scale 12 months after randomisation. Secondary outcomes were self-reported activities of daily living, physical activity, quality of life, balance, functional mobility, fear of falling, frailty, cognition, mood, carer strain, service use at 12 months, and falls between months 4 and 15. RESULTS 365 patient participants were randomised, 183 to intervention and 182 to control. The median age of participants was 80 years (range 65-95), median Montreal cognitive assessment score was 20 out of 30 (range 13-26), and 58% (n=210) were men. Intervention participants received a median of 31 therapy sessions (interquartile range 22-40) and reported completing a mean 121 minutes of PrAISED exercise each week. Primary outcome data were available for 149 intervention and 141 control participants. Scores on the disability assessment for dementia scale did not differ between groups: adjusted mean difference -1.3, 95% confidence interval -5.2 to 2.6; Cohen's d effect size -0.06, 95% confidence interval -0.26 to 0.15; P=0.51). Upper 95% confidence intervals excluded small to moderate effects on any of the range of outcome measures. Between months 4 and 15 the intervention group experienced 79 falls and the control group 200 falls (adjusted incidence rate ratio 0.78, 95% confidence interval 0.5 to 1.3; P=0.3). CONCLUSION The intensive PrAISED programme of exercise and functional activity training did not improve activities of daily living, physical activity, or quality of life; reduce falls; or improve any other secondary health status outcomes, despite good uptake. Future research should consider alternative approaches to maintaining ability and wellbeing in people with dementia. TRIAL REGISTRATION ISRCTN Registry ISRCTN15320670.
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Affiliation(s)
- Rowan H Harwood
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Sarah E Goldberg
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Andrew Brand
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Veronika van Der Wardt
- Department of General, Preventative and Rehabilitation Medicine, Philipps-Universität Marburg 35032 Marburg, Germany
| | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Claudio Di Lorito
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Jennie Hancox
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Rupinder Bajwa
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Clare Burgon
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Louise Howe
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Alison Cowley
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Trevor Bramley
- Nottinghamshire Healthcare NHS Foundation Trust, Lings Bar Hospital, Gamston, Nottingham, UK
| | - Annabelle Long
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Juliette Lock
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Rachael Tucker
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Emma J Adams
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Rebecca O'Brien
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Fiona Kearney
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Katarzyna Kowalewska
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | | | | | - Kehinde Junaid
- Mental Health Services for Older People, Nottinghamshire Healthcare NHS Foundation Trust, Highbury Hospital, Nottingham, UK
| | - Simon Thacker
- Centre for Research and Development, Derbyshire Healthcare NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Carol Duff
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Tomas Welsh
- The RICE Centre, Research Institute for the Care of Older People, Royal United Hospital, Bath, UK
| | - Annette Haddon-Silver
- Oxford Health NHS Foundation Trust, Research and Development, Warneford Hospital, Oxford, UK
| | - John Gladman
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Kavita Vedhara
- Centre for Academic Primary Care, Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Victoria Hood
- Nottinghamshire Healthcare NHS Foundation Trust, Lings Bar Hospital, Gamston, Nottingham, UK
| | - Roshan Das Nair
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- SINTEF, Torgarden, Trondheim, Norway
| | - Helen Smith
- Nottinghamshire Healthcare NHS Foundation Trust, Lings Bar Hospital, Gamston, Nottingham, UK
| | - Rhiannon Tudor-Edwards
- Centre for Health Economics and Medicines Evaluation, College of Health and Behavioural Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Ned Hartfiel
- Centre for Health Economics and Medicines Evaluation, College of Health and Behavioural Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Victory Ezeofor
- Centre for Health Economics and Medicines Evaluation, College of Health and Behavioural Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Robert Vickers
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Martin Orrell
- Mental Health Services for Older People, Nottinghamshire Healthcare NHS Foundation Trust, Highbury Hospital, Nottingham, UK
- Institute for Mental Health, University of Nottingham, Nottingham, UK
| | - Tahir Masud
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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Ryan SM, Chockalingam M, Brady O. 'Experiences of patients and their informal caregivers with cognitive stimulation programs for dementia: A qualitative systematic review protocol'. PLoS One 2023; 18:e0287851. [PMID: 37379290 DOI: 10.1371/journal.pone.0287851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Cognitive stimulation, an individual or group intervention approach aiming to improve cognitive and social functioning among individuals with mild-to-moderate dementia, is often considered a complex intervention. The patient's experience of a complex intervention is unique and often determines its effectiveness. This proposed qualitative systematic review aims to comprehensively synthesise the experiences of individuals with dementia and their informal caregivers who have participated in cognitive stimulation programs, identifying perceived benefits, challenges, barriers, and facilitators to this approach to intervention. METHODS This review will consider qualitative studies that evaluate the experiences of individuals with a diagnosis of dementia and/or the informal caregivers of individuals with dementia who have participated in a cognitive stimulation program. Searches will be conducted across MEDLINE (Ovid), Embase (Elsevier), PsycINFO, Scopus, CINAHL (EBSCO) and Web of Science. Quality of eligible studies will be assessed using the JBI Critical Appraisal Checklist for Qualitative Research, and a standardised data extraction tool in JBI SUMARI will be used to extract data from relevant studies. The meta-aggregation approach will be used to pool qualitative research findings, which will then be synthesised to produce a single set of findings in narrative format. DISCUSSION This qualitative systematic review will identify and synthesise the evidence regarding the experiences of individuals with dementia who have taken part in a cognitive stimulation program and the experience of their informal caregivers. As a variety of cognitive stimulation programs exist, our findings will summarise the experiences of these interventions to inform the future development and delivery of cognitive stimulation programs. TRIAL REGISTRATION PROSPERO registration number: CRD42022383658.
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Affiliation(s)
- Simone M Ryan
- Department of Occupational Therapy, School of Health Sciences, University of Galway, Galway, Ireland
| | - Manigandan Chockalingam
- Department of Occupational Therapy, School of Health Sciences, University of Galway, Galway, Ireland
| | - Orla Brady
- Department of Occupational Therapy, School of Health Sciences, University of Galway, Galway, Ireland
- Trim Primary Care Centre, Knightsbridge Village, Trim, Co. Meath, Ireland
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Chan AHY, Hikaka JA, To E, Cullum S, Ma'u E, Ryan B, Rivera-Rodriguez C, Cheung G. Anti-dementia medication use in Aotearoa New Zealand: An exploratory study using health data from the Integrated Data Infrastructure (IDI). Aust N Z J Psychiatry 2023; 57:895-903. [PMID: 36053008 DOI: 10.1177/00048674221121091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Anti-dementia medications such as acetylcholinesterase inhibitors are an important part of the management pathway for dementia. However, there are limited data in New Zealand that have examined the rates and patterns of use of funded anti-dementia medication and how use differs with ethnicity, age and sex. METHODS This was a retrospective population-based descriptive study. Using the Integrated Data Infrastructure, we identified individuals of all ages coded for a diagnosis of dementia and estimated the proportion dispensed funded anti-dementia medication - donepezil tablets and rivastigmine patches - between 1 July 2016 and 30 June 2020. Rates of medication use in five main ethnic groups (Māori, Pacific peoples, Asian, European, and Middle Eastern, Latin American and African) in the <65, 65-79 and 80 and over (80+) age groups were compared and also between males and females in all sub-groups. Log-binomial models were used to calculate relative risks to determine any differences in anti-dementia medication use in the five ethnic groups and the three age groups and between males and females in each of the four study years. RESULTS Overall, one-third of the dementia population received a funded anti-dementia medication in the total population (all ages) between 2016 and 2020. Donepezil tablets were dispensed in 31.6-34.0% and rivastigmine patches in 1.4-2.1% across the four study years. Compared to people of European ethnicity, Māori, Pacific peoples, and Middle Eastern, Latin American and African groups were less likely to be dispensed an anti-dementia medication (Māori: relative risk = 0.79-0.81, p < 0.0001; Pacific peoples: relative risk = 0.72-0.74, p < 0.0001; Middle Eastern, Latin American and African: relative risk = 0.73-0.78, p < 0.05). Compared to the age 80+ group, the 65-79 age group was more likely (relative risk = 1.50-1.54, p < 0.0001), while the age <65 group was less likely (relative risk = 0.67-0.71, p < 0.0001) to be dispensed an anti-dementia medication. There were no statistically significant differences in anti-dementia medication use between males and females. CONCLUSION This study provides important information about funded anti-dementia medication use in New Zealand and how this differs by ethnicity, age and sex. Despite higher dementia prevalence in Māori and Pacific peoples, these groups were less likely to receive funded anti-dementia medication.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jo Anna Hikaka
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Edith To
- Department of Statistics, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Etuini Ma'u
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Brigid Ryan
- Department of Anatomy and Medical Imaging, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Gary Cheung
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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O'Connor CM, Poulos CJ, Kurrle S, Anstey KJ. Bridging the gap: Study protocol for development of an implementation strategy for evidence-informed reablement and rehabilitation for community-dwelling people with dementia. Arch Gerontol Geriatr 2023; 108:104943. [PMID: 36701945 DOI: 10.1016/j.archger.2023.104943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Extensive research supports the use of goal-directed reablement and rehabilitation interventions to address a range of physical, functional, cognitive and behavioural needs of people living with dementia. Despite this, evidence-informed multidisciplinary reablement and rehabilitation interventions are not being offered in usual dementia care across Australia. An examination is needed of how best to implement reablement and rehabilitation interventions within the community-based dementia care sector. METHODS Drawing on implementation science, this study uses a four-phase mixed-methods retrospective and prospective approach: (1) clinical audit to evaluate current clinical practice, and through focus groups with practitioners, identify practitioner-led goals and targets for practice change; (2) Delphi survey to converge opinions from the diverse stakeholders involved in reablement in dementia, to reach national consensus around an implementation strategy; (3) hybrid pragmatic effectiveness-implementation pilot will facilitate testing of the implementation strategy in parallel with exploring effectiveness of the reablement intervention specifically within a real-world Australian community aged care context; (4) implementation capacity building. DISCUSSION This study will result in a freely available, nationally relevant implementation protocol, designed and tailored via input from key stakeholders over a series of iterative project activities. By testing this protocol via a pilot implementation-effectiveness study, we will generate national information about effectiveness of evidence-informed reablement programs for people living with dementia across various community aged care settings. Outcomes have potential to influence policy and drive widespread practice change, increasing access to evidence-informed reablement and rehabilitation for people living with dementia across Australia.
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Affiliation(s)
- Claire Mc O'Connor
- University of New South Wales, School of Psychology, Sydney, Australia; HammondCare, Centre for Positive Ageing, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; University of New South Wales, Ageing Futures Institute, Sydney, Australia.
| | - Christopher J Poulos
- HammondCare, Centre for Positive Ageing, Sydney, Australia; University of New South Wales, School of Population Health, Sydney, Australia
| | | | - Kaarin J Anstey
- University of New South Wales, School of Psychology, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; University of New South Wales, Ageing Futures Institute, Sydney, Australia
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12
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Ford E, Milne R, Curlewis K. Ethical issues when using digital biomarkers and artificial intelligence for the early detection of dementia. WILEY INTERDISCIPLINARY REVIEWS. DATA MINING AND KNOWLEDGE DISCOVERY 2023; 13:e1492. [PMID: 38439952 PMCID: PMC10909482 DOI: 10.1002/widm.1492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 03/06/2024]
Abstract
Dementia poses a growing challenge for health services but remains stigmatized and under-recognized. Digital technologies to aid the earlier detection of dementia are approaching market. These include traditional cognitive screening tools presented on mobile devices, smartphone native applications, passive data collection from wearable, in-home and in-car sensors, as well as machine learning techniques applied to clinic and imaging data. It has been suggested that earlier detection and diagnosis may help patients plan for their future, achieve a better quality of life, and access clinical trials and possible future disease modifying treatments. In this review, we explore whether digital tools for the early detection of dementia can or should be deployed, by assessing them against the principles of ethical screening programs. We conclude that while the importance of dementia as a health problem is unquestionable, significant challenges remain. There is no available treatment which improves the prognosis of diagnosed disease. Progression from early-stage disease to dementia is neither given nor currently predictable. Available technologies are generally not both minimally invasive and highly accurate. Digital deployment risks exacerbating health inequalities due to biased training data and inequity in digital access. Finally, the acceptability of early dementia detection is not established, and resources would be needed to ensure follow-up and support for those flagged by any new system. We conclude that early dementia detection deployed at scale via digital technologies does not meet standards for a screening program and we offer recommendations for moving toward an ethical mode of implementation. This article is categorized under:Application Areas > Health CareCommercial, Legal, and Ethical Issues > Ethical ConsiderationsTechnologies > Artificial Intelligence.
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Affiliation(s)
- Elizabeth Ford
- Department of Primary Care and Public HealthBrighton and Sussex Medical SchoolBrightonUK
| | - Richard Milne
- Kavli Centre for Ethics, Science and the PublicUniversity of CambridgeCambridgeUK
- Engagement and SocietyWellcome Connecting ScienceCambridgeUK
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13
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Ryan S, Brady O. Cognitive stimulation and activities of daily living for individuals with mild-to-moderate dementia: A scoping review. Br J Occup Ther 2023. [DOI: 10.1177/03080226231156517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Introduction: Dementia is a progressive syndrome that interferes with the individual’s ability to perform activities of daily living (ADL). Cognitive stimulation (CS) is a non-pharmacological approach aimed to mitigate the impact of dementia symptoms. While CS has been shown to provide benefits for cognition and quality of life, the evidence supporting its use in improving ADL outcomes is reduced. The aim of this review was to chart what is known from the literature about the use of CS in improving ADL outcomes. Method: A scoping review of the use of CS in improving ADL outcomes for individuals with mild-to-moderate dementia was conducted, following a scoping review methodological framework. Eight databases were searched, including all articles published up until June 2022. Findings: A three-step search strategy yielded 788 results. Following screening and review, 36 papers met the inclusion criteria for this review. Studies were charted and discussed in the areas of (1) cognitive stimulation therapy; (2) group CS programmes; (3) multi-component CS interventions; (4) individual CS programmes and (5) other types of CS. Conclusion: The review identified a range of CS programmes from across 13 countries worldwide. Multi-component CS interventions involving ADL-focused activities reported the most benefits for ADL outcomes.
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Affiliation(s)
- Simone Ryan
- Discipline of Occupational Therapy, University of Galway, Ireland
| | - Orla Brady
- Discipline of Occupational Therapy, University of Galway, Ireland
- HSE, Mental health Services, Longford/Westmeath, Ireland
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14
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de Campos DL, Queiroz LY, Fontes-Junior EA, Pinheiro BG, da Silva JKR, Maia CSF, Maia JGS. Aniba canelilla (Kunth) Mez essential oil and its primary constituent, 1-nitro-2-phenylethane, inhibits acetylcholinesterase and reverse memory impairment in rodents. JOURNAL OF ETHNOPHARMACOLOGY 2023; 303:116036. [PMID: 36493997 DOI: 10.1016/j.jep.2022.116036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Aniba canelilla, distributed in the Amazon region, stands out for its diverse economic and medicinal applications. Studies of the A. canelilla essential oil and its primary constituent, 1-nitro-2-phenylethane, have confirmed its anti-inflammatory, antinociceptive, anti-hypertensive potential, and anticholinesterase, among other therapeutic activities. AIM OF THE STUDY In addition, the present work aims to evaluate the potential of oil and NPE in the learning and memory of rodents. MATERIAL AND METHODS The oil was hydrodistilled and analyzed by GC and GC-MS. The learning and memory action in mice was evaluated through the scopolamine-induced cognitive deficit model, followed by behavioral analysis using Morris's water maze paradigm. RESULTS Oil provided a yield of 0.5%, and in its chemical composition, 1-nitro-2-phenylethane (NPE) (76.2%) and methyleugenol (19.6%) were identified as primary constituents. Oil fractionation furnished NPE with 99.4%, which was used to evaluate its effects in animal models. Wistar rats were submitted to the mnemonic impairment-scopolamine-induced protocol for 7 days. The oil, NPE, and the positive control donepezil were administered from the 8th to 12th days. Morris water maze results demonstrated that oil and NPE reversed spatial learning and long-term memory similarly induced by muscarinic antagonist scopolamine to donepezil, the positive control. CONCLUSION These beneficial effects have led the work to further investigations of the oil and NPE to elucidate their pharmacological mechanism, focusing on the cholinergic pathway of the central nervous system and opening up to the knowledge of other adjacent mechanisms, whose results are still under analysis.
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Affiliation(s)
- Daniele L de Campos
- Laboratório de Farmacologia da Inflamação e Comportamento, Universidade Federal do Pará, 66075-110, Belém, PA, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Pará, 66075-110, Belém, PA, Brazil.
| | - Letícia Y Queiroz
- Laboratório de Farmacologia da Inflamação e Comportamento, Universidade Federal do Pará, 66075-110, Belém, PA, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Pará, 66075-110, Belém, PA, Brazil.
| | - Enéas A Fontes-Junior
- Laboratório de Farmacologia da Inflamação e Comportamento, Universidade Federal do Pará, 66075-110, Belém, PA, Brazil.
| | - Bruno G Pinheiro
- Centro de Ciências Biológicas, Universidade do Estado do Pará, 66087-662, Belém, PA, Brazil.
| | - Joyce Kelly R da Silva
- Programa de Pós-Graduação em Química, Universidade Federal do Pará, 66075-900, Belém, PA, Brazil.
| | - Cristiane Socorro F Maia
- Laboratório de Farmacologia da Inflamação e Comportamento, Universidade Federal do Pará, 66075-110, Belém, PA, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Pará, 66075-110, Belém, PA, Brazil.
| | - José Guilherme S Maia
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Pará, 66075-110, Belém, PA, Brazil; Programa de Pós-Graduação em Química, Universidade Federal do Maranhão, 65080-040, São Luís, MA, Brazil.
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Gawas CG, Mathur S, Wani M, Tabassum H. Nigella sativa and its nano-mediated approach toward management of neurodegenerative disorders: A review. IBRAIN 2023; 9:111-123. [PMID: 37786518 PMCID: PMC10529340 DOI: 10.1002/ibra.12091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 10/04/2023]
Abstract
Nigella sativa L., also known as black seed or black cumin, is a plant that has been used for centuries. In the past, this flowering plant was used as a food preservative and medicinal herb. A vital component of Nigella sativa, thymoquinone (TQ), plays a significant therapeutic role in the management of most diseases, including cancer, diabetes mellitus, hypertension, inflammation, gastrointestinal disorders, and neurodegenerative disorders. Neurodegenerative disorders are primarily caused by neurotransmitter hypoactivity, particularly insufficient serotonin activity. It has been discovered that many medicinal herbs and their active compounds have therapeutic value. Black cumin seeds have been used to heal ailments and its history traces back to ancient times such as ancient Babylonia. They can be used applied to alleviate edema, hair loss, and bruising, and consumd to treat stomach issues. It is one of the most feasible and effective medicinal plants. The use of nanoformulations based on Nigella sativa and TQ to treat neurodegenerative diseases (NDs) has yielded promising outcomes. Customized administration of nanoparticle (NP) systems and nanomedicine are two of the many options for drug delivery to the central nervous system (CNS) that are attracting increasing interest. Delivering a therapeutic and diagnostic substance to a particular location is the core target of NPs. Because of their distinct cell uptake and trafficking mechanisms, NPs can reduce the amount that accumulates in undesirable organs. The focus of the current review is on recent studies on the various neuroprotective properties of Nigella sativa as well as nanoformulations for NDs and the brain's uptake of NPs. The review summarizes the In vivo, In vitro, and In silico studies on the protective effects of black cumin against neurodegenerative disorders.
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Affiliation(s)
- Chaitali G. Gawas
- Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil VidyapeethPuneMaharashtraIndia
| | - Sakshi Mathur
- Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil VidyapeethPuneMaharashtraIndia
| | - Minal Wani
- Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil VidyapeethPuneMaharashtraIndia
| | - Heena Tabassum
- Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil VidyapeethPuneMaharashtraIndia
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Park D, Son KJ, Jeong E, Kim H, Lee SY, Kim JH, Kim HS. Effects of Socioeconomic Status and Residence Areas on Long-Term Survival in Patients With Early-Onset Dementia: The Korean National Health Insurance Service Database Study. J Korean Med Sci 2022; 37:e354. [PMID: 36536548 PMCID: PMC9763705 DOI: 10.3346/jkms.2022.37.e354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Early-onset dementia (EOD) is still insufficiently considered for healthcare policies. We investigated the effect of socio-environmental factors on the long-term survival of patients with EOD. METHODS This retrospective cohort study utilized the Korean National Health Insurance Database from 2007 to 2018. We enrolled 3,825 patients aged 40 to 65 years old with all types of dementia newly diagnosed in 2009 as EOD cases. We defined socioeconomic status using the national health insurance premium (NHIP) levels. Residential areas were classified into capital, metropolitan, city, and county levels. All-cause mortality was the primary outcome. Kaplan-Meier curves and log-rank tests were employed. Further, Cox-proportional hazards models were established. RESULTS The mean survival of the fourth NHIP level group was 96.31 ± 1.20 months, whereas that of the medical-aid group was 85.53 ± 1.30 months (P < 0.001). The patients living in the capital had a mean survival of 95.73 ± 1.34 months, whereas those living in the county had 89.66 ± 1.75 months (P = 0.035). In the Cox-proportional hazards model, the medical-aid (adjusted hazard ratio [aHR], 1.67; P < 0.001), first NHIP level (aHR, 1.26; P = 0.012), and second NHIP level (aHR, 1.26; P = 0.008) groups were significantly associated with a higher long-term mortality risk. The capital residents exhibited a significantly lower long-term mortality risk than did the county residents (aHR, 0.82; P = 0.041). CONCLUSION Socioeconomic status and residential area are associated with long-term survival in patients with EOD. This study provides a rational basis for establishing a healthcare policy for patients with EOD.
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Affiliation(s)
- Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, Korea
- Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang, Korea
| | - Kang Ju Son
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Korea
| | - Eunhwan Jeong
- Department of Neurology, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Haejong Kim
- Department of Neurology, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Su Yun Lee
- Department of Neurology, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Jong Hun Kim
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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Begde A, Jain M, Hogervorst E, Wilcockson T. Does physical exercise improve the capacity for independent living in people with dementia or mild cognitive impairment: an overview of systematic reviews and meta-analyses. Aging Ment Health 2022; 26:2317-2327. [PMID: 34951548 PMCID: PMC9662184 DOI: 10.1080/13607863.2021.2019192] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To summarise existing systematic reviews which assessed the effects of physical exercise on activities of daily living, walking, balance and visual processing in people with dementia or mild cognitive impairment. METHODS In this overview of systematic reviews and meta-analyses, seven electronic databases were searched to identify eligible reviews published between January 2015 and April 2021. RESULTS A total of 30 systematic reviews were identified and included in the overview. The most frequent type of exercise for the intervention group was multimodal exercises. Mind-body exercises, exergames, dance intervention and aerobic exercise were other exercise types. Most of the reviews reported that exercise is significantly effective for improving activities of daily living (SMD 95%CI, from 0.27 to 1.44), walking (SMD 95%CI, from 0.08 to 2.23), balance (SMD 95%CI, from 0.37 to 2.24) and visuospatial function (SMD 95%CI, from 0.16 to 0.51), which are among the most leading determinants of independent living in individuals with dementia or mild cognitive impairment. CONCLUSION Evidence has shown that exercise (especially multicomponent exercise programmes including cognitive, physical and multitasking exercises) with sufficient intensity improves the activities of daily living skills. Exercise also improves walking, balance and visual processing, which can provide a more independent life for people with dementia and mild cognitive impairment. Cognitively impaired people should therefore be encouraged to exercise regularly in order to be more independent. UNLABELLED Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2019192.
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Affiliation(s)
- Ahmet Begde
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK,CONTACT Ahmet Begde
| | - Manisha Jain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Eef Hogervorst
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Thomas Wilcockson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Imaoka Y, Hauri L, Flury A, de Bruin ED. Linking cognitive functioning and postural balance control through virtual reality environmental manipulations. Front Aging Neurosci 2022; 14:954050. [PMID: 36118684 PMCID: PMC9476829 DOI: 10.3389/fnagi.2022.954050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Dementia is becoming a relevant problem worldwide. A simple screening at an early stage will be important to detect the risk of developing dementia. Vestibular dysfunction is likely to be associated with cognitive impairment. Since head-mounted display (HMD) virtual reality (VR) technology has the potential to activate the vestibular function, assessing postural sway with visual stimulation using HMD VR technology could be potentially useful for dementia screening. Objective The purpose of this study is to evaluate the effect of HMD-based VR visual stimuli on posture in older adults and the relationship between the stimulated body sway behaviors and cognitive performance. Method Using a cross-sectional study design, we investigated the effect of an optokinetic design-based room with stripes (OKR) VR environment oscillating forwards and backwards at 23/60Hz. Center of pressure (COP) displacement was measured in older adults aged 65 years and over in the OKR VR environment. The frequency response of COP was compared to the cognitive performance of the Montreal Cognitive Assessment (MoCA). Results 20 healthy older adults (70.4 ± 4.9 years; 27.2 ± 1.6 MoCA score) and 3 people with mild cognitive impairment (74.7 ± 4.0 years; 20.3 ± 2.1 MoCA score) were assessed. The results reveal that the oscillating OKR VR environment induced different postural sway in the anterior-posterior direction in the real world. Correlation analysis shows that the cognitive test score was associated with the frequency response of stimulated postural sway in the anterior-posterior direction (frequency Band 1 of 0−0.5Hz related to the visual and vestibular systems: rs = 0.45, P = 0.03). Conclusion Outcomes would suggest that a potential link may emerge between cognition and posture when the HMD-based VR visual stimuli are applied. The simple screening of stimulated postural sway could explain cognitive functioning. Further studies are warranted to clarify the vestibular system and spatial cognitive function more specifically in the proposed assessment system.
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Affiliation(s)
- Yu Imaoka
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- *Correspondence: Yu Imaoka
| | - Laura Hauri
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andri Flury
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Laboratory, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- School of Health Professions, Eastern Switzerland University of Applied Sciences, St.Gallen, Switzerland
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Rahja M, Air T, Ahern S, Ward SA, Caughey GE, Sluggett JK, Cations M, Lin X, Wallis K, Crotty M, Inacio M. Primary and Secondary Care Related Quality Indicators for Dementia Care Among Australian Aged Care Users: National Trends, Risk Factors, and Variation. J Alzheimers Dis 2022; 88:1511-1522. [DOI: 10.3233/jad-220336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Studies related to clinical quality indicators (CQIs) in dementia have focused on hospitalizations, medication management, and safety. Less attention has been paid to indicators related to primary and secondary care. Objective: To evaluate the incidence of primary and secondary care CQIs for Australians with dementia using government-subsidized aged care. The examined CQIs were: comprehensive medication reviews, 75+ health assessments, comprehensive geriatric assessments, chronic disease management plans, general practitioner (GP) mental health treatment plans, and psychiatrist attendances. Methods: Retrospective cohort study (2011–2016) of 255,458 individuals. National trend analyses estimated incidence rates and 95% confidence intervals (CI) using Poisson or negative binomial regression. Associations were assessed using backward stepwise multivariate Poisson or negative binomial regression model, as appropriate. Funnel plots examined geographic and PRAC facility variation. Results: CQI incidence increased in all CQIs but medication reviews. For the overall cohort, 75+ health assessments increased from 1.07/1000 person-days to 1.16/1000 person-days (adjusted incidence rate ratio (aIRR) = 1.03, 95% CI 1.02–1.03).Comprehensive geriatric assessments increased from 0.24 to 0.37/1000 person-days (aIRR = 1.12, 95% CI 1.10–1.14). GP mental health treatment plans increased from 1.30 to 2.1/1000 person-days (aIRR = 1.13, 95% CI 1.12–1.15). Psychiatric attendances increased from 0.09 to 0.11/1000 person-days (aIRR = 1.05, 95% CI 1.03–1.07). Being female, older, having fewer comorbidities, and living outside a major city were associated with lower likelihood of using the services. Large geographical and facility variation was observed (0–92%). Conclusion: Better use of primary and secondary care services to address needs of individuals with dementia is urgently needed.
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Affiliation(s)
- Miia Rahja
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia
| | - Tracy Air
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Parkville, VIC, Australia
| | - Stephanie A. Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Gillian E. Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Janet K. Sluggett
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, SA, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, Australia
| | - Xiaoping Lin
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Kasey Wallis
- Department of Epidemiology and Preventive Medicine, Monash University, Parkville, VIC, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia
| | - Maria Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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20
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Guzmán-Ramos K, Osorio-Gómez D, Bermúdez-Rattoni F. Cognitive impairment in alzheimer’s and metabolic diseases: A catecholaminergic hypothesis. Neuroscience 2022; 497:308-323. [DOI: 10.1016/j.neuroscience.2022.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 12/16/2022]
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21
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Cations M, Day S, Laver K, Withall A, Draper B. Post-diagnosis young-onset dementia care in the National Disability Insurance Scheme. Aust N Z J Psychiatry 2022; 56:270-280. [PMID: 33982630 DOI: 10.1177/00048674211011699] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Post-diagnosis service delivery for young-onset dementia (with onset prior to 65 years) recently moved to the disability system in an attempt to address systemic barriers to best practice in aged care. The objective of this study was to examine experiences and satisfaction with disability services so far among people with young-onset dementia and their care partners and identify strategies for service and system improvement. METHODS The 151 participating Australians living with young-onset dementia or providing informal care to a person with young-onset dementia were recruited via social media, advocacy bodies and specialist medical clinics. A cross-sectional online survey asked participants to provide a timeline of their interactions with the disability system so far and rate their satisfaction with the disability system, aged care and disability services. RESULTS Participants reported a mean age at symptom onset of 55 years. In all, 53% were diagnosed with Alzheimer's disease and 25% were diagnosed with frontotemporal dementia. Sixty percent had received an approved plan from the National Disability Insurance Scheme, although 3% were rejected. More than 27% waited longer than 6 months to receive their plan, and half waited at least a month post-approval to access services. Less than 30% agreed that the National Disability Insurance Scheme understands dementia, and fewer than half felt that the process of accessing National Disability Insurance Scheme funding is easy and fast enough. Nonetheless, respondents remained overwhelmingly in favour of young-onset dementia services remaining in the disability system rather than in aged care. CONCLUSIONS While people with young-onset dementia and their care partners strongly agree with their inclusion in the National Disability Insurance Scheme, a relatively low level of experience with dementia in the disability workforce and a lack of integration with the healthcare and aged care systems continue to create important barriers for accessing the services they need.
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Affiliation(s)
- Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, SA, Australia
| | - Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, SA, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Brian Draper
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
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22
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Zhou S, Chen S, Liu X, Zhang Y, Zhao M, Li W. Physical Activity Improves Cognition and Activities of Daily Living in Adults with Alzheimer's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1216. [PMID: 35162238 PMCID: PMC8834999 DOI: 10.3390/ijerph19031216] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this meta-analysis was to examine the effects of physical activity (PA) on cognition and activities of daily living in adults with Alzheimer's Disease (AD). METHODS Six electronic databases (MEDLINE, CINAHL, PsycArticles, SPORTDiscus, EMBASE and CNKI) were used to search for potential studies from inception until October 2021. Randomized controlled trials (RCTs) investigating the effect of physical activity (PA) on cognition and activities of daily living in AD patients compared to a control condition were included. The effect sizes were synthesized using a random effects model with a 95% confidence interval (CI). RESULTS Sixteen articles including 945 participants (aged 70 to 88 years, 34.6% male) met the inclusion criteria. The pooled effect sizes demonstrated that PA intervention was associated with significant improvements in global cognition (Standard Mean Difference (SMD) = 0.41, 95% CI [0.24, 0.58], p < 0.01) and activities of daily living (SMD = 0.56, 95% CI [0.32, 0.79], p < 0.01) in AD patients. Subgroup analyses suggested that PA for 3-4 times per week for 30-45 min for more than 12 weeks had a relatively strong effect on improving global cognition in AD patients. The sensitivity analysis showed robust results. CONCLUSIONS The findings from the current meta-analysis suggested that AD patients can improve their global cognition and Activities of Daily Living (ADL) through engaging in aerobic and mixed exercise (aerobic and anaerobic exercise).
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Affiliation(s)
- Shengwen Zhou
- Department of Chinese Martial Arts, College of Sport Science, Hunan University of Science and Engineering, Yongzhou 425100, China;
| | - Sitong Chen
- Institute for Health and Sport, Victoria University, Melbourne 8001, Australia;
| | - Xiaolei Liu
- Chinese Traditional Regimen Exercise Intervention Research Center, Beijing Sport University, Beijing 100084, China;
| | - Yanjie Zhang
- Health and Exercise Science Laboratory, Institute of Sports Science, Seoul National University, Seoul 08826, Korea;
- Physical Education Unit, School of Humanities and Social Science, The Chinese University of Hong Kong—Shenzhen, Shenzhen 518172, China
| | - Mengxian Zhao
- School of Physical Education, Shenzhen University, Shenzhen 518060, China;
| | - Wenjiao Li
- Physical Education Unit, School of Humanities and Social Science, The Chinese University of Hong Kong—Shenzhen, Shenzhen 518172, China
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23
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Taraldsen K, Helbostad JL, Follestad T, Bergh S, Selbæk G, Saltvedt I. Gait, physical function, and physical activity in three groups of home-dwelling older adults with different severity of cognitive impairment - a cross-sectional study. BMC Geriatr 2021; 21:670. [PMID: 34852786 PMCID: PMC8638089 DOI: 10.1186/s12877-021-02598-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background The research on associations between gait, physical function, physical activity (PA), and cognitive function is growing. Still, clinical assessments of cognitive function and motor function is often kept separate. In this study, we aimed to look at a broad range of measures of gait, physical function, and PA in three groups of home-dwelling older adults with no or questionable dementia, mild dementia, and moderate/severe dementia. Methods This cross-sectional study included 100 home-dwelling older adults, recruited from an outpatient geriatric memory clinic. Severity of dementia was categorised using the clinical dementia rating scale (CDR), with no or questionable dementia (CDR score 0 and 0.5), mild dementia (CDR score 1) and moderate/severe dementia (CDR score 2 and 3). We used thigh worn accelerometers to measure daily PA, the Short Physical Performance Battery (SPPB) to measure physical function, and an electronic gait mat to evaluate gait characteristics. Associations between severity of dementia and measures of PA, physical function, and gait characteristics were assessed by linear regression. Results Participants’ (mean age 78.9 (SD 6.7) years, 57% women) average gait speed was 0.93 m/sec, and average upright time was 301 min/day. Statistically significant associations were found for the severity of dementia and gait speed (p=0.002), step time (p=0.001), physical function (SPPB, p=0.007), and PA (upright time, p=0.031), after adjusting for age. Overall, having no or questionable dementia was associated with faster gait speed (mean difference 0.163 (95% CI: 0.053 to 0.273)), shorter step time (-0.043 (-0.082 to -0.005)), better SPPB score (1.7 (0.5 to 2.8)), and longer upright time (78.9 (18.9 to 139.0)), compared to those with mild dementia. Furthermore, having no or questionable dementia was also associated with faster gait speed and better SPPB scores, as compared to those with moderate to severe dementia. No evidence of any differences was found between the participants with the mild dementia versus the moderate to severe dementia. Conclusions After adjusting for age, we found that the no or questionable dementia group to be associated with better gait and physical function, and more PA, as compared with the two groups with mild or moderate/severe dementia. Evaluation of gait, physical function, and PA can add clinically important information of everyday functioning in memory clinics meeting geriatric patients, but investigations on how to use these results to guide interventions are still needed.
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Affiliation(s)
- Kristin Taraldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway. .,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Clinic of Clinical Service, St Olav University Hospital, Trondheim, Norway.
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sverre Bergh
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St Olav University Hospital, Trondheim, Norway
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24
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Jetsonen V, Kuvaja-Köllner V, Välimäki T, Selander T, Martikainen J, Koivisto AM. Total cost of care increases significantly from early to mild Alzheimer's disease: 5-year ALSOVA follow-up. Age Ageing 2021; 50:2116-2122. [PMID: 34255025 PMCID: PMC8581391 DOI: 10.1093/ageing/afab144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION We studied the costs of formal and informal care in relation to Alzheimer's disease (AD) progression. METHODS 231 persons with AD with a family caregiver were followed up for 5 years. The Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB) was used to measure AD progression. Health and social care unit costs were used for formal care costs. An opportunity cost method for lost leisure time was applied to analyse the cost of informal care. RESULTS Total cost of care in early stage AD (CDR-SB ≤ 4) was 16,448€ (95% CI 13,722-19,716) annually. In mild (CDR-SB 4.5-9), moderate (CDR-SB 9.5-15.5) and severe (CDR-SB ≥ 16) AD, the total costs were 2.3, 3.4 and 4.4 times higher, respectively. A one-unit increase in CDR-SB increased the total, formal and informal costs by 15, 11 and 18%, respectively. CONCLUSIONS Compared to early AD, the costs of total, formal and informal care are remarkably higher already in mild AD. This finding emphasises early diagnosis, interventions and family support for persons with AD and their caregivers.
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Affiliation(s)
- Viivi Jetsonen
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Virpi Kuvaja-Köllner
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio Finland
| | | | - Anne M Koivisto
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
- Department of Neurosciences, University of Helsinki, Helsinki, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
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25
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Roman Meller M, Patel S, Duarte D, Kapczinski F, de Azevedo Cardoso T. Bipolar disorder and frontotemporal dementia: A systematic review. Acta Psychiatr Scand 2021; 144:433-447. [PMID: 34390495 DOI: 10.1111/acps.13362] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To detail the biological, clinical and neurocognitive characteristics differentiating bipolar disorder (BD) from frontotemporal dementia (FTD) and to investigate whether BD is a risk factor for FTD. METHODS A total of 16 studies were included in this systematic review. Five studies described biological and/or neurocognitive characteristics between patients with BD and FTD, and 11 studies investigated whether BD was a risk factor for FTD. RESULTS Individuals with FTD presented higher levels of serum neurofilament light chain, greater grey matter reduction in frontal, parietal and temporal lobes, and increased slow wave oscillations in channels F3, F4, T3, T5, T4 and T6 within an electroencephalogram (EEG), relative to individuals with BD. Patients with FTD presented greater deficits in executive function and theory of mind compared to patients with BD in a euthymic state, and more deficits in verbal fluency compared to patients with BD in a current mood episode. Patients with BD in a current mood episode showed greater impairment in attention, working memory, verbal memory and executive function relative to individuals with FTD. In addition, retrospective studies showed that 10.2%-11.6% of patients with behavioural variant FTD (bvFTD) had a preceding history of BD. CONCLUSION Biological and neurocognitive characteristics help to distinguish between BD and FTD, and it may help to reach a more precise diagnosis. In addition, individuals with BD are at higher risk of developing FTD. More studies are needed to identify the predictors of the conversion between BD to FTD.
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Affiliation(s)
- Marina Roman Meller
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Swara Patel
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, Ontario, Canada
| | - Dante Duarte
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil.,Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Taiane de Azevedo Cardoso
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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26
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Feasibility and Effectiveness of a Biography-Based Physical Activity Intervention in Institutionalized People With Dementia: Quantitative and Qualitative Results From a Randomized Controlled Trial. J Aging Phys Act 2021; 30:237-251. [PMID: 34426552 DOI: 10.1123/japa.2020-0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/19/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022]
Abstract
The objective of this multicenter randomized controlled trial was to evaluate the feasibility and effectiveness of a physical activity intervention for institutionalized people with dementia, individualized by capacity and biography. The intervention group (n = 34; age: mean = 86.09 years; 79.40% female; mean Mini-Mental State Examination value = 18.59) participated in a multicomponent training program, which included daily activities, dancing, gardening, and sports/games, twice weekly for 3 months. The control group (n = 29; age: mean = 86.34 years; 75.90% female; mean Mini-Mental State Examination value = 19.90) received standard care. Feasibility was evaluated by means of focus groups and feedback questionnaires. Functional performance (Short Physical Performance Battery and Timed Up and Go Test), activities of daily living, and gait were outcomes for effectiveness. A high adherence rate (80.46%) and uniformly positive feedback indicate that the piloted training program is feasible. The results show preliminary effectiveness on functional performance (Short Physical Performance Battery mean t0 = 3.15; mean t1 = 4.50; p = .006) and gait (e.g., velocity mean t0 = 46.97; mean t1 = 58.04; p = .007).
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27
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O'Connor CMC, Rowlands A, Poulos CJ. Development of an assessment guide to evaluate meaningful outcomes for people living with dementia who are engaged in reablement programs. Disabil Rehabil 2021; 44:6042-6054. [PMID: 34369257 DOI: 10.1080/09638288.2021.1960437] [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: 10/20/2022]
Abstract
PURPOSE Clinical practice guidelines for dementia recommend the provision of rehabilitative or reablement interventions that support functioning. This project sought to develop an assessment guide, centring on goal attainment scaling (GAS), for practitioners to measure attainment of meaningful outcomes for people living with dementia participating in reablement programs. MATERIALS AND METHODS To assist in guide development, two focus groups (people impacted by dementia [n = 10]) explored priority reablement goals. Two further focus groups (allied health practitioners [n = 11]) explored understanding and experience using GAS, opinions on what goals would be realistic, and how an assessment guide could best support practice. RESULTS The key focus group themes that emerged and which underpinned guide development were: 'what is possible'; 'who sets the goals'; 'practitioner perspectives on using GAS'. Leisure was a key goal priority for people impacted by dementia, and echoed by practitioners. The assessment guide is structured around three steps: choosing goals (using focus group derived Reablement Goal Lists); defining goals (using a new Dementia-specific SMART Framework); scoring goals (using GAS-Light). CONCLUSIONS Providing a structured approach to evaluation of reablement programs for people living with dementia could lead to more consistent service provision, improved outcomes and opportunities for benchmarking.Implications for RehabilitationDementia is a leading cause of disability in older people.Rehabilitative interventions such as reablement are recommended to support functioning in people living with dementia, but there is currently no consistent method of selecting and evaluating attainment of meaningful outcomes.This study describes the reablement goals identified by people impacted by dementia as being most important, along with allied health practitioner views on goal-setting and the use of Goal Attainment Scaling (GAS).Study findings were used to develop a structured assessment guide employing three steps: choosing reablement goals; defining those goals using a new dementia-specific SMART Framework; and scoring goals using GAS-Light.A consistent approach to goal selection and evaluation of attainment for people impacted by dementia participating in reablement programs may lead to more effective rehabilitative interventions in this group.
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Affiliation(s)
- Claire M C O'Connor
- HammondCare, Centre for Positive Ageing, Sydney, Australia.,School of Population Health, The University of New South Wales, Sydney, Australia
| | | | - Christopher J Poulos
- HammondCare, Centre for Positive Ageing, Sydney, Australia.,School of Population Health, The University of New South Wales, Sydney, Australia
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28
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Quick SM, Snowdon DA, Lawler K, McGinley JL, Soh SE, Callisaya ML. Physiotherapists' and physiotherapy students' attitudes and beliefs about working with people with dementia: a mixed methods systematic review protocol. JBI Evid Synth 2021; 19:1971-1976. [PMID: 34400598 DOI: 10.11124/jbies-20-00303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review is to explore the attitudes and beliefs of physiotherapists and physiotherapy students working with people with dementia. A second objective is to explore their knowledge and confidence in this area. INTRODUCTION Dementia is a leading cause of disability. It poses a challenge to individuals and health systems due to the complex nature of its presentation. With a growing body of evidence supporting physiotherapists' role in the care of people with dementia, it is important to understand their knowledge, confidence, attitudes, and beliefs in managing this role. INCLUSION CRITERIA The review will consider quantitative, qualitative, and mixed-methods studies that include physiotherapists and physiotherapy students who have worked or had a clinical placement in any setting where people with dementia might access physiotherapy care. Studies investigating one or more of the following topics will be included: knowledge, confidence, attitudes, and beliefs about working with people with any type of dementia. METHODS MEDLINE (Ovid), CINAHL (EBSCO), Embase (Ovid), Emcare, PsycINFO (Ovid), Scopus, Web of Science, Informit, ERIC (ProQuest), ProQuest Dissertations, and Google Scholar will be searched without a date limit for studies published in English. All study types will be screened for inclusion and critically appraised for methodological quality by two independent reviewers. Methodological quality will be assessed using the appropriate JBI critical appraisal checklist for each study type. Data will be extracted using standardized JBI tools for mixed methods systematic reviews. A convergent integrated approach to synthesis and integration will be used. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020181845.
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Affiliation(s)
- Stephen M Quick
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Vic, Australia.,Academic Unit, Peninsula Health, Melbourne, Vic, Australia
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Vic, Australia.,Academic Unit, Peninsula Health, Melbourne, Vic, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, University of Melbourne, Melbourne, Vic, Australia
| | - Sze-Ee Soh
- Department of Physiotherapy, Monash University, Melbourne, Vic, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Vic, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Vic, Australia.,Academic Unit, Peninsula Health, Melbourne, Vic, Australia.,Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tas, Australia
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29
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Svedin F, Brantnell A, Farrand P, Blomberg O, Coumoundouros C, von Essen L, Åberg AC, Woodford J. Adapting a guided low-intensity behavioural activation intervention for people with dementia and depression in the Swedish healthcare context (INVOLVERA): a study protocol using codesign and participatory action research. BMJ Open 2021; 11:e048097. [PMID: 34272221 PMCID: PMC8287613 DOI: 10.1136/bmjopen-2020-048097] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Dementia is a worldwide health concern with incident rates continuing to increase. While depression prevalence is high in people with dementia and psychological interventions such as cognitive behavioural therapy (CBT) are effective, access to psychological interventions remains limited. Reliance on traditional CBT for people with dementia and depression may present difficulties given it is a complex psychological approach, costly to deliver, and professional training time is lengthy. An alternative approach is behavioural activation (BA), a simpler psychological intervention for depression. The present study seeks to work with people with dementia, informal caregivers, community stakeholders, and healthcare professionals, to adapt a guided low-intensity BA intervention for people with dementia and depression, while maximising implementation potential within the Swedish healthcare context. METHODS AND ANALYSIS A mixed methods study using codesign, principles from participatory action research (PAR) and normalisation process theory to facilitate the cultural relevance, appropriateness and implementation potential of the intervention. The study will consist of four iterative PAR phases, using focus groups with healthcare professionals and community stakeholders, and semi-structured interviews with people with dementia and informal caregivers. A content analysis approach will be adopted to analyse the transcribed focus groups and semi-structured interviews recordings. ETHICS AND DISSEMINATION The study will be conducted in accordance with the Declaration of Helsinki and data handled according to General Data Protection Regulation. Written informed consent will be obtained from all study participants. In accordance with the Swedish Health and Medical Services Act, capacity to consent will be examined by a member of the research team. Ethical approval has been obtained from the Swedish Ethical Review Authority (Dnr: 2020-05542 and Dnr: 2021-00925). Findings will be published in an open access peer-reviewed journal, presented at academic conferences, and disseminated among lay and healthcare professional audiences.
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Affiliation(s)
- Frida Svedin
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anders Brantnell
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Division of Industrial Engineering and Management, Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Paul Farrand
- Clinical Education Development and Research (CEDAR), University of Exeter, Exeter, Devon, UK
| | - Oscar Blomberg
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Chelsea Coumoundouros
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Cristina Åberg
- Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Medical Science, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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30
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Russo MJ, Cohen G, Campos J, Allegri RF. COVID-19 y adultos mayores con deterioro cognitivo: ¿puede influir el aislamiento social en la enfermedad? NEUROLOGÍA ARGENTINA 2021. [PMCID: PMC8285268 DOI: 10.1016/j.neuarg.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introducción y objetivo En Argentina, la calidad del cuidado que los adultos mayores con cuadros crónicos de deterioro cognitivo reciben, está siendo afectada por la pandemia de COVID-19. Nuestro objetivo fue estudiar en qué medida la cuarentena afectó el bienestar y los síntomas conductuales de sujetos con demencia que viven en la comunidad y sus cuidadores luego de las 8 semanas iniciales de aislamiento obligatorio. Métodos Familiares de 119 pacientes con demencia tipo Alzheimer (DTA) o trastornos relacionados que viven en la comunidad fueron invitados a participar de forma anónima y voluntaria de una encuesta exploratoria, de tipo transversal o sincrónica, y con formato electrónico. Se utilizó estadística descriptiva y el test de Chi-cuadrado con un valor de significación de p < 0,05 para analizar las diferencias según la severidad de la demencia. Resultados La edad media de los sujetos con demencia fue de 81,16 años (± 7,03), el 35% tenían > 85. El 67% tenía DTA y el 26% demencia mixta. El 34,5% tenían demencia leve, 32% moderada y 33% severa. En el 67% de los casos, el cuidador principal era familiar. Se observó un aumento de ansiedad (43%), insomnio (28%), depresión (29%), empeoramiento de la marcha (41%) y aumento del uso de psicofármacos. La frecuencia de síntomas conductuales fue mayor en sujetos con demencia leve (p < 0,05). En casi todos los casos la rehabilitación fue suspendida durante la cuarentena. Hubo un aumento significativo de la sobrecarga del cuidador durante la pandemia (t = −8,657; p < 0,001). Conclusiones Tanto los sujetos con demencia que viven en la comunidad como sus cuidadores mostraron un empeoramiento de su bienestar y estado de salud durante la pandemia de COVID-19, debido a una combinación multifactorial de aislamiento social, ausencia de rehabilitación, aumento del estrés del cuidador, miedo de contraer la enfermedad entre otras causas. Es necesario desarrollar un plan de acción coordinado y urgente que involucre a las familias de los pacientes, las autoridades sanitarias y el personal de salud que habitualmente atiende a estos pacientes para mitigar el impacto negativo de la cuarentena y epidemia en la salud de los sujetos con demencia que viven en la comunidad.
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Gebhard D, Mir E. What Moves People Living With Dementia? Exploring Barriers and Motivators for Physical Activity Perceived by People Living With Dementia in Care Homes. QUALITATIVE HEALTH RESEARCH 2021; 31:1319-1334. [PMID: 33825572 PMCID: PMC8182331 DOI: 10.1177/10497323211002822] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
There is a lack of intervention promoting physical activity targeted toward people living with dementia because their input has not been prioritized in the development of exercise programs. The aim of this study is to investigate motivators and barriers concerning physical activity in people living with dementia in care homes and to give recommendations for intervention development. Qualitative semi-structured interviews were conducted; transcripts were analyzed using qualitative content analysis. Following a tailored procedural model, inductive and deductive category development was applied. The value of Cohen's κ = .94 indicates the high intercoder reliability of the category system developed. Ten interviewees reported 24 different barriers and 12 motivators concerning physical activity in the context of the social-ecological model. The strong impact of intrapersonal factors and the living environment became apparent. Points of reference for how people living with dementia can overcome barriers and activate their motivators to achieve more physical activity are provided.
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Affiliation(s)
| | - Eva Mir
- Carinthia University of Applied
Sciences, Feldkirchen, Austria
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32
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Fernandez-Chirino L, Antonio-Villa NE, Bello-Chavolla OY. Pushing the boundaries of precision nutrition to tackle Alzheimer's disease: is there a role for DHA? Am J Clin Nutr 2021; 113:1396-1397. [PMID: 33851196 DOI: 10.1093/ajcn/nqab085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 02/24/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Luisa Fernandez-Chirino
- Faculty of Chemistry, National Autonomous University of Mexico, Mexico City, Mexico.,Division of Research, Instituto Nacional de Geriatría, Mexico City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Division of Research, Instituto Nacional de Geriatría, Mexico City, Mexico.,MD/PhD Plan de Estudios Combinados en Medicina (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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33
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Hansen TEA, Praestegaard J, Tjørnhøj-Thomsen T, Andresen M, Nørgaard B. Dementia-Friendliness in Danish and international contexts: A critical discourse analysis. THE GERONTOLOGIST 2021; 62:130-141. [PMID: 34000011 DOI: 10.1093/geront/gnab056] [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: 12/09/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Initiatives to create dementia-friendly environments are subject to political attention the world over. As the interpretation of dementia-friendliness is influenced by current cultural trends, the concept is highly ambiguous. The present study aims to explore how discourses concerning dementia-friendliness are manifested in Danish and international policy documents and how they interact internationally. RESEARCH DESIGN AND METHODS Inspired by Fairclough's critical discourse approach, 21 policy documents were analysed to reveal how power is exerted through language and the discursive construction. RESULTS We identified five types of discourse, viz., those concerning the domains of socioeconomy, rehabilitation, knowledge, responsibility and a good life, respectively. Dementia-friendliness was found to be embedded in an overall ideology aimed toward supporting the individual's autonomy in life and health choices and their participation in society. DISCUSSION AND IMPLICATIONS Our analysis furthermore suggests that dementia-friendly initiatives are used collectively as a lever to achieve these policy aims to ultimately compensate for and protect people with dementia against the consequences of the loss of competencies, identity and control. Thus, to develop and establish sustainable dementia-friendly environments and communities that meet the needs of people living with dementia, we need to be aware of and discuss the implications of the discourses constructing dementia-friendliness and their influence on the appearance of dementia-friendliness in society.
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Affiliation(s)
- Tania E A Hansen
- Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Research and Development, University College Absalon, Naestved, Denmark
| | - Jeanette Praestegaard
- Department of Research and Development, University College Absalon, Naestved, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Mette Andresen
- Department of Research and Development, University College Absalon, Naestved, Denmark
| | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Bray NW, Pieruccini-Faria F, Bartha R, Doherty TJ, Nagamatsu LS, Montero-Odasso M. The effect of physical exercise on functional brain network connectivity in older adults with and without cognitive impairment. A systematic review. Mech Ageing Dev 2021; 196:111493. [PMID: 33887281 DOI: 10.1016/j.mad.2021.111493] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Neurodegeneration is a biproduct of aging that results in concomitant cognitive decline. Physical exercise is an emerging intervention to improve brain health. The underlying neural mechanisms linking exercise to neurodegeneration, however, are unclear. Functional brain network connectivity (FBNC) refers to neural regions that are anatomically separate but temporally synched in functional signalling. FBNC can be measured using functional Magnetic Resonance Imaging (fMRI) and is affected by neurodegeneration. METHODS We conducted a systematic review using PubMed and EMBASE to assess the effect of physical exercise on FBNC in older adults with and without cognitive impairment. RESULTS Our search yielded 1474 articles; after exclusion, 13 were included in the final review, 8 of which focused on cognitively healthy older adults. 10 studies demonstrated an increase in FBNC post-exercise intervention, while 11 studies showed improvements in secondary outcomes (cognitive and/or physical performance). One study showed significant correlations between FBNC and cognitive performance measures that significantly improved post-intervention. DISCUSSION We found evidence that physical exercise increases FBNC. When assessing the association between FBNC with physical and cognitive functioning, careful consideration must be given to variability in exercise parameters, neural regions of interest and networks examined, and heterogeneity in methodological approaches.
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Affiliation(s)
- Nick W Bray
- Faculty of Health Sciences, School of Kinesiology, Western University, London, ON, Canada; Gait and Brain Lab, Lawson Health Research Institute, Parkwood Institute, London, ON, Canada.
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Lawson Health Research Institute, Parkwood Institute, London, ON, Canada; Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Robert Bartha
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Robarts Research Institute, Western University, London, ON, Canada.
| | - Timothy J Doherty
- Faculty of Health Sciences, School of Kinesiology, Western University, London, ON, Canada; Neuromuscular Function Lab, Lawson Health Research Institute, Parkwood Institute, London, ON, Canada; Department of Clinical Neurological Sciences, Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Lindsay S Nagamatsu
- Faculty of Health Sciences, School of Kinesiology, Western University, London, ON, Canada; Exercise, Mobility and Brain Health Lab, Western University, London, ON, Canada; Brain and Mind Institute, Western University, London, ON, Canada.
| | - Manuel Montero-Odasso
- Faculty of Health Sciences, School of Kinesiology, Western University, London, ON, Canada; Gait and Brain Lab, Lawson Health Research Institute, Parkwood Institute, London, ON, Canada; Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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35
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Ghassab-Abdollahi N, Mobasseri K, Dehghani Ahmadabad A, Nadrian H, Mirghafourvand M. The effects of Huperzine A on dementia and mild cognitive impairment: An overview of systematic reviews. Phytother Res 2021; 35:4971-4987. [PMID: 33851462 DOI: 10.1002/ptr.7126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/03/2021] [Accepted: 03/30/2021] [Indexed: 01/23/2023]
Abstract
Cognitive impairments are a part of the neurocognitive disorders which deteriorate the normal cognitive function. An overview of systematic reviews (SRs) was conducted to summarize the findings of SRs and meta-analyses on the effectiveness of Huperzine A (Hup A) in dementia and mild cognitive impairment (MCI). A literature search was conducted since inception to December 2020. We used the AMSTAR tool to assess the methodological quality of SRs. The quality of evidence of primary studies was evaluated according to the SRs authors' assessment. Six SRs met our inclusion criteria. The results showed that Hup A has beneficial effects on cognitive function and Activities of Daily Living (ADLs) in Alzheimer's disease, but in vascular dementia and MCI, there was little or no evidence to conclusion. There is insufficient evidence of the effectiveness of Hup A on the quality of life and global clinical assessment. None of the SRs reported any serious side effects. Despite the promising effects of Hup A on cognition and ADLs, there is insufficient evidence to support the effectiveness of Hup A in cognitive impairments due to the high heterogeneity of SRs and the low quality of primary studies. High-quality, large multicenter RCTs with long-term follow-up in different settings are warranted.
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Affiliation(s)
- Nafiseh Ghassab-Abdollahi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Health Education & Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khorshid Mobasseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Health Education & Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Dehghani Ahmadabad
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Health Education & Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haidar Nadrian
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Orgeta V, Palpatzis E, See Y, Tuijt R, Sole Verdaguer E, Leung P. Development of a Psychological Intervention to Promote Meaningful Activity in People Living With Mild Dementia: An Intervention Mapping Approach. THE GERONTOLOGIST 2021; 62:629-641. [PMID: 33822947 PMCID: PMC9019644 DOI: 10.1093/geront/gnab047] [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: 09/21/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the importance of meaningful activity in mild dementia, only limited data are available on the development of interventions supporting people with mild dementia to engage in meaningful activity. In this paper we describe the development of an intervention that responds to this need. RESEARCH DESIGN AND METHODS Intervention Mapping (IM), an evidence-based approach, was used to develop STAYING ACTIVE (STAYing well and active - schedulINg meaninGful and enjoyAble aCTIvities to promote Vitality and wEll-being in mild dementia). The first step, a needs assessment, comprised a literature review, focus groups and individual interviews with service-users. Performance objectives of the intervention were formulated in step two, followed by development of theory-based methods in step three. In step four the new intervention was developed based on data collected in previous steps, existing interventions, and pilot testing. Qualitative data were analyzed using framework analysis. RESULTS The needs assessment indicated that people with dementia and their carers view "staying active" as an important part of 'enjoying life'. Adapting to loss through compensation and receiving support were key facilitators of engaging in meaningful activity. Ecological, psycho-social, and activity-oriented theories guided the development of theory-based intervention strategies, which were based on awareness, skills and addressing barriers of meaningful activity. IMPLICATIONS STAYING ACTIVE is grounded on theory, and service-user experiences and aims at promoting meaningful activity in mild dementia. The IM framework may be useful in the development of future psychosocial interventions for people with dementia, facilitating transparency when efficacy is evaluated.
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Affiliation(s)
- Vasiliki Orgeta
- Division of Psychiatry, University College London, London, United Kingdom
| | - Eleni Palpatzis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Yina See
- Department of Rehabilitation, National University Hospital, Singapore
| | - Remco Tuijt
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | | | - Phuong Leung
- Division of Psychiatry, University College London, London, United Kingdom
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Marinho V, Bertrand E, Naylor R, Bomilcar I, Laks J, Spector A, Mograbi DC. Cognitive stimulation therapy for people with dementia in Brazil (CST-Brasil): Results from a single blind randomized controlled trial. Int J Geriatr Psychiatry 2021; 36:286-293. [PMID: 32881071 DOI: 10.1002/gps.5421] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/31/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The prevalence of dementia has been increasing particularly in developing countries but care provision is still limited in these regions. Psychosocial interventions are recognized as useful tools to improve cognitive and behavioral difficulties, as well as quality of life of people with dementia (PwD) and their caregivers. Cognitive stimulation therapy (CST) is an evidence-based psychosocial intervention, recommended and implemented in many countries. In Brazil, there is no validated psychosocial intervention for dementia care. The present study aims to explore feasibility and obtain preliminary data on the efficacy of CST-Brasil in a sample of 47 people with mild to moderate dementia attending an outpatient unit. METHODS A single-blind design was used, with participants being randomly allocated to either 14 sessions of CST + treatment as usual (TAU; n = 23) or TAU (n = 24) during 7 weeks. Changes in cognition, quality of life, depressive symptoms, caregiver burden and functionality were measured. RESULTS PwD receiving CST and their family caregivers expressed good acceptance of the intervention, with low attrition and high attendance. Participants receiving CST exhibited significant improvements in mood and in activities of daily living compared to TAU. There were no significant effects in cognition, quality of life and caregiver burden. CONCLUSIONS CST-Brasil proved to be a feasible and useful intervention to improve mood in PwD, with high acceptance between study participators. CST-Brasil is a promising psychosocial intervention for dementia and should be explored in other clinical settings to allow generalization to a wider Brazilian context.
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Affiliation(s)
- Valeska Marinho
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elodie Bertrand
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata Naylor
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Iris Bomilcar
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Translational Biomedicine Postgraduate Programme, Universidade do Grande Rio (Unigranrio), Duque de Caxias, Brazil
| | - Aimee Spector
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Daniel C Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Culph J, Clemson L, Jeon YH, Scanlan J, Laver K. Preparing for Implementation Within Therapy Services for People With Dementia: Exploring Expectations and Experiences Among Service Providers. J Appl Gerontol 2021; 40:1172-1179. [PMID: 33463396 DOI: 10.1177/0733464820986286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study examined how occupational therapists, nurses, and their managers within different organizational contexts in the Australian health and aged care system prepare for implementation. The program being implemented was the Care of People with dementia in their Environment (COPE) program, a community reablement program for people with dementia and their carers. METHODS Qualitative data from 29 in-depth interviews were collected from occupational therapists, nurses, and their managers. Recruitment ensured a variety of organizational contexts were included. Thematic analysis was used to capture key themes. RESULTS Themes include innovation in a time of instability and uncertainty, values that align with the innovation, shifting the day-to-day practice, and confidence in new specialized skills. CONCLUSION Organizations need to carefully consider internal and external contexts when planning implementation efforts. Study findings have informed plans for embedding delivery of the program within the health and aged care sector.
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Affiliation(s)
- Jennifer Culph
- The University of Sydney, Lidcombe, New South Wales, Australia
| | - Lindy Clemson
- The University of Sydney, Lidcombe, New South Wales, Australia
| | - Yun-Hee Jeon
- The University of Sydney, Lidcombe, New South Wales, Australia
| | - Justin Scanlan
- The University of Sydney, Lidcombe, New South Wales, Australia
| | - Kate Laver
- Flinders University, Adelaide, South Australia, Australia
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Murray AL, Vollmer M, Deary IJ, Muniz-Terrera G, Booth T. Assessing individual-level change in dementia research: a review of methodologies. ALZHEIMERS RESEARCH & THERAPY 2021; 13:26. [PMID: 33451358 PMCID: PMC7811223 DOI: 10.1186/s13195-021-00768-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 01/01/2021] [Indexed: 01/12/2023]
Abstract
Background Whether in the context of monitoring disease progression or in assessing the effects of interventions, a major challenge in dementia research is determining when an individual has undergone meaningful change in symptoms and other relevant outcomes such as cognitive test performance. The challenge lies in differentiating genuine improvement or deterioration from change in scores due to random and systematic error. Body In this review, we discuss the advantages and limitations of available methods for assessing individual-level change in the context of key challenges, including imperfect and differential reliability of scores, and practice effects. We discuss indices of reliable change and the use of composite and item response theory (IRT) scores. Conclusion We conclude that IRT-based approaches hold particular promise because they have the flexibility to accommodate solutions to a wide range of issues that influence the accuracy of judgements of meaningful change. We close by discussing the practical implications of adopting IRT-based approaches.
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Affiliation(s)
- Aja Louise Murray
- Department of Psychology, University of Edinburgh, F17, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Marlena Vollmer
- Department of Psychology, University of Edinburgh, F17, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, F17, 7 George Square, Edinburgh, EH8 9JZ, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Graciela Muniz-Terrera
- Centre for Clinical Brain Sciences, Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Tom Booth
- Department of Psychology, University of Edinburgh, F17, 7 George Square, Edinburgh, EH8 9JZ, UK.
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40
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Dyer S, Mordaunt DA, Adey-Wakeling Z. Interventions for Post-Stroke Shoulder Pain: An Overview of Systematic Reviews. Int J Gen Med 2020; 13:1411-1426. [PMID: 33324087 PMCID: PMC7732168 DOI: 10.2147/ijgm.s200929] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023] Open
Abstract
Background Shoulder pain following stroke leads to poorer quality of life and daily functioning. Whilst many treatment approaches exist, there is currently no systematic overview of the evidence base for these. This review addressed the question “What is the evidence for interventions for treating hemiplegic shoulder pain?” Methods An overview of systematic reviews was performed according to PROSPERO protocol (CRD42020140521). Five electronic databases including Cochrane, MEDLINE, Embase and EmCare were searched to June 2019. Included systematic reviews were those of comparative trials of interventions for hemiplegic shoulder pain in adults, reporting pain outcomes using a validated pain scale. Review quality was assessed with AMSTAR2 and those considered at high risk of bias for four or more items were excluded. The most recent, comprehensive review for each intervention category was included. Outcomes of function and quality of life were also extracted. Results Seven systematic reviews of 11 interventions were included, with varied quality. Reviews showed significant benefits in terms of pain reduction for many interventions including acupuncture (conventional 19 trials, electroacupuncture 5 trials, fire needle 2 trials, warm needle 1 trial and bee venom 3 trials), orthoses (1 trial), botulinum toxin injection (4 trials), electrical stimulation (6 trials) and aromatherapy (1 trial). However, the majority of trials were small, leading to imprecise estimates of effect. Findings were often inconsistent across outcome measures or follow-up times. Outcomes from trials of acupuncture were heterogenous with likely publication bias. Conclusion A number of systematic reviews indicate significant reductions in pain, with a wide range of treatments appearing promising. However, significant limitations mean the clinical importance of these findings are uncertain. Due to complex etiology, practitioners and health systems must consider the range of potential interventions and tailor their approach to individual presentation, guided by their local circumstances, expert opinion and the growing literature base.
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Affiliation(s)
- Suzanne Dyer
- Rehabilitation, Aged and Extended Care, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Dylan A Mordaunt
- Rehabilitation, Aged and Extended Care, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Department of Rehabilitation Medicine, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Zoe Adey-Wakeling
- Rehabilitation, Aged and Extended Care, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Department of Rehabilitation Medicine, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
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Laver KE, Crotty M, Low LF, Clemson L, Whitehead C, McLoughlin J, Swaffer K, Cations M. Rehabilitation for people with dementia: a multi-method study examining knowledge and attitudes. BMC Geriatr 2020; 20:531. [PMID: 33297973 PMCID: PMC7727118 DOI: 10.1186/s12877-020-01940-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/30/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND People with dementia are not routinely offered rehabilitation services despite experiencing disability associated with the condition and accumulating evidence for therapies such as exercise, occupational therapy, and cognitive or physical rehabilitation. It is important to understand the needs and preferences of people with dementia regarding rehabilitation services. The aim of this study was to explore thoughts and beliefs about rehabilitation amongst people with dementia and their families. METHODS Interviews with people with dementia and family members regarding their experience of care following diagnosis and their attitudes and beliefs about rehabilitation for dementia. Surveys with older people with cognitive impairment and/or a diagnosis of dementia to determine preferences for services and understanding of rehabilitation programs. RESULTS Interviews with 13 participants (n = 6 people living with dementia with mean age 60 and n = 7 care partners) revealed gaps in care post diagnosis. People reported having to seek out services and frequently sought out services which were rehabilitative in nature. Survey data (n = 91 participants, average age 82) showed that most people had heard of rehabilitation (92%) or had experience of rehabilitation (49%) at some point. There was a wide range of services identified as being beneficial. Rehabilitative interventions including case management, exercise and memory strategies were considered desirable. CONCLUSIONS People with dementia report having a wide variety of needs. There are gaps following diagnosis where people with dementia report having to seek out their own services. Some interview participants (who tended to be younger) clearly articulated the need for tailored interventions which maximised independence and quality of life. Survey participants, who were on average older, reported that they would participate in individually applicable rehabilitative therapies if they were available.
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Affiliation(s)
- Kate E Laver
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Lee-Fay Low
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lindy Clemson
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig Whitehead
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - James McLoughlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kate Swaffer
- Dementia Alliance International, Adelaide, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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Orgeta V, Tuijt R, Leung P, Verdaguer ES, Gould RL, Jones R, Livingston G. Behavioral Activation for Promoting Well-Being in Mild Dementia: Feasibility and Outcomes of a Pilot Randomized Controlled Trial. J Alzheimers Dis 2020; 72:563-574. [PMID: 31609689 DOI: 10.3233/jad-190696] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Engaging in meaningful and enjoyable activities is an important contributor to well-being and maintaining good quality of life. There is a paucity of randomized controlled trials of interventions supporting people with mild dementia to engage in meaningful and purposeful activity. The aim of this study was to assess whether Behavioral Activation (BA) is an acceptable psychological intervention for people with mild dementia and whether a large-scale trial is feasible. Participants were randomly assigned to BA (n = 42) or treatment as usual (TAU) (n = 21). BA aimed at increasing engagement in enjoyable and meaningful activity, and preventing low mood. Follow-up was at 3 and 6 months. Assessors were blind to treatment allocation (trial registration number: ISRCTN75503960). Retention rate was above 80% at both assessment time points. Treatment acceptability and credibility were high. Depressive symptoms remained unchanged in both groups. There was evidence of improvement associated with BA for every day function (-3.92, 95% Confidence Interval (CI) -6.87 to -0.97), and engagement in meaningful and enjoyable activity (5.08, 95% CI 0.99 to 9.16) post-treatment (3 months) in comparison to TAU. Both carer-rated patient health-related quality of life (0.16, 95% CI 0.04 to 0.28) and physical health (11.31, 95% CI 2.03 to 20.59) showed evidence of improvement at 3 months. Improvements in meaningful and enjoyable activity were maintained at 6 months.BA for people with mild dementia is feasible and acceptable and may be associated with clinically significant changes in function and quality of life. A full scale randomized controlled trial of clinical effectiveness is now needed.
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Cations M, May N, Crotty M, Low LF, Clemson L, Whitehead C, McLoughlin J, Swaffer K, Laver KE. Health Professional Perspectives on Rehabilitation for People With Dementia. THE GERONTOLOGIST 2020; 60:503-512. [PMID: 30759218 DOI: 10.1093/geront/gnz007] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Multidisciplinary rehabilitation is not incorporated into the usual care pathway for dementia despite increasing demand from key advocates. Clinician views regarding the relevance of rehabilitation in dementia care are not well known. This qualitative study explored the perspectives of health professionals regarding barriers to provision of multidisciplinary rehabilitation programs for people with dementia. RESEARCH DESIGN AND METHODS Sixteen health professionals from a variety of settings and professional backgrounds were purposively sampled using maximum variation sampling. Semi-structured interviews were conducted to explore attitudes toward the care of people with dementia and beliefs about the feasibility and value of multidisciplinary rehabilitation in this population. Thematic analysis was used to identify themes. RESULTS Participating clinicians acknowledged problems with existing dementia care pathways in Australia but rarely conceptualized rehabilitation as relevant to this pathway. Analyses yielded two main and related themes: (i) difficulty defining worthwhile outcomes of a rehabilitation program for people with dementia and (ii) perceived barriers to participation in this population. Clinicians felt that achievable outcomes for people with dementia were not sufficiently worthwhile for investment. DISCUSSION AND IMPLICATIONS Broader acceptance of multidisciplinary rehabilitation as relevant to dementia care will require a reframing of practice that both educates emerging health professionals regarding the outcomes that may be achievable for people with dementia and persuades staff to appreciate that the investment is worthwhile.
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Affiliation(s)
- Monica Cations
- College of Medicine and Public Health, Flinders University, South Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales
| | - Natalie May
- College of Medicine and Public Health, Flinders University, South Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, South Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales
| | - Lee-Fay Low
- Faculty of Health Sciences, The University of Sydney, New South Wales
| | - Lindy Clemson
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales.,Faculty of Health Sciences, The University of Sydney, New South Wales.,ARC Centre of Excellence in Population Ageing Research, The University of Sydney, New South Wales
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, South Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales
| | - James McLoughlin
- College of Nursing and Health Sciences, Flinders University, South Australia
| | - Kate Swaffer
- University of Wollongong, New South Wales, Australia.,Dementia Alliance International, Ankeny, Iowa
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, South Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales
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O'Connor CMC, Gresham M, Poulos RG, Hudson W, Jackman J, Clemson L, McGilton KS, Cameron ID, Radoslovich H, Poulos CJ. Translating reablement research for dementia practice: development of a handbook using implementation science. Disabil Rehabil 2020; 44:1524-1536. [PMID: 32772575 DOI: 10.1080/09638288.2020.1797910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Reablement is a strategy recommended in clinical practice guidelines that could maximise functioning and quality of life in people living with dementia. This project sought to develop a practical handbook for health professionals illustrating the best, currently available evidence via newly-developed composite reablement programs. MATERIALS AND METHODS Handbook development occurred over five phases, informed by Normalisation Process Theory: (1) literature review, (2) sector interviews to explore how handbook implementation may impact practice, (3) workshop to determine final handbook content, (4) reablement program synthesis and handbook development, and (5) dissemination and implementation planning to support optimal uptake and normalisation within the sector. RESULTS Interviews (n = 22) identified sector support for development of the reablement handbook. Workshop (n = 24 participants) outcomes informed the final eight reablement programs sorted by functional outcomes (everyday living activities; mobility and physical function; and cognition and communication). A technical guide and consumer information booklet were developed to support the handbook. A comprehensive handbook implementation plan involving dynamic assessment and monitoring was developed. CONCLUSIONS The reablement handbook provides a practical and accessible avenue to support function in people with dementia. Robust, coordinated dissemination, implementation and assessment of the new resource across a range of practice settings is now required.Implications for rehabilitationDementia leads to disability and dependence, impacting the person with dementia, their family and society.Reablement, an approach consistent with rehabilitation, is a strategy recommended in clinical practice guidelines that could maximise functional performance and quality of life in people living with dementia.This study describes development of a freely available evidence-informed reablement handbook designed to support delivery of high-quality reablement programs by allied health/nursing professionals for people living with dementia.Outcomes have potential to inform future implementation work and to ultimately improve the quality of services offered within the dementia sector.
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Affiliation(s)
- Claire M C O'Connor
- Centre for Positive Ageing, HammondCare, Sydney, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Roslyn G Poulos
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | | | - Lindy Clemson
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | | | - Ian D Cameron
- Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
| | | | - Christopher J Poulos
- Centre for Positive Ageing, HammondCare, Sydney, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Feneberg E, Otto M. [Gene-specific treatment approaches in Alzheimer's disease and other tauopathies]. DER NERVENARZT 2020; 91:312-317. [PMID: 32076757 DOI: 10.1007/s00115-020-00872-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The pathological hallmarks of Alzheimer's disease are aggregation and accumulation of amyloid-β and tau proteins. So far most interventional studies have focused on the removal of the toxic protein products, such as antibody-based immunotherapies targeted against amyloid-β and tau proteins; however, the development of gene therapies targeting gene products involved in the disease has opened up new therapeutic strategies to reduce the development of toxic protein aggregates by inhibiting the translation of pathological Alzheimer genes using antisense oligonucleotides (ASO). This has a timely influence on development of the disease. This article gives an overview of new advances in ASO-based treatment strategies for Alzheimer's disease.
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Affiliation(s)
- E Feneberg
- Abteilung für Neurologie, Universitäts- und Rehabilitationskliniken, Oberer Eselsberg 45, 89081, Ulm, Deutschland. .,Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, Oxford, Großbritannien.
| | - M Otto
- Abteilung für Neurologie, Universitäts- und Rehabilitationskliniken, Oberer Eselsberg 45, 89081, Ulm, Deutschland
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Rathnayake S, Moyle W, Jones C, Calleja P. Co-design of an mHealth application for family caregivers of people with dementia to address functional disability care needs. Inform Health Soc Care 2020; 46:1-17. [DOI: 10.1080/17538157.2020.1793347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sarath Rathnayake
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Department of Nursing, University of Peradeniya, Kandy, Sri Lanka
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Cindy Jones
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Pauline Calleja
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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Reiss AB, Glass AD, Wisniewski T, Wolozin B, Gomolin IH, Pinkhasov A, De Leon J, Stecker MM. Alzheimer's disease: many failed trials, so where do we go from here? J Investig Med 2020; 68:1135-1140. [PMID: 32699179 DOI: 10.1136/jim-2020-001297] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 12/21/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative brain disorder associated with relentlessly progressive cognitive impairment and memory loss. AD pathology proceeds for decades before cognitive deficits become clinically apparent, opening a window for preventative therapy. Imbalance of clearance and buildup of amyloid β and phosphorylated tau proteins in the central nervous system is believed to contribute to AD pathogenesis. However, multiple clinical trials of treatments aimed at averting accumulation of these proteins have yielded little success, and there is still no disease-modifying intervention. Here, we discuss current knowledge of AD pathology and treatment with an emphasis on emerging biomarkers and treatment strategies.
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Affiliation(s)
- Allison Bethanne Reiss
- Medicine, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, New York, USA
| | - Amy D Glass
- Medicine, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, New York, USA
| | - Thomas Wisniewski
- Departments of Neurology, Pathology and Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Benjamin Wolozin
- Departments of Pharmacology and Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Irving H Gomolin
- Medicine, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, New York, USA
| | - Aaron Pinkhasov
- Department of Psychiatry, NYU Winthrop Hospital, Mineola, New York, USA
| | - Joshua De Leon
- Medicine, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, New York, USA
| | - Mark M Stecker
- Neurology, UCSF San Francisco/Fresno, Fresno, California, USA
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Mullane K, Williams M. Alzheimer’s disease beyond amyloid: Can the repetitive failures of amyloid-targeted therapeutics inform future approaches to dementia drug discovery? Biochem Pharmacol 2020; 177:113945. [DOI: 10.1016/j.bcp.2020.113945] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/31/2020] [Indexed: 12/12/2022]
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Yap TL, Alderden J, Sabol VK, Horn SD, Kennerly SM. Real-time Positioning Among Nursing Home Residents Living With Dementia: A Case Study. Wound Manag Prev 2020; 66:16-22. [PMID: 32614327 PMCID: PMC10507611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dementia contributes to the development of pressure injuries (PrIs). PURPOSE This study describes the real-time body positions of 2 nursing home (NH) residents, residing in the United States and living with dementia, to inform development of PrI prevention strategies tailored to individual risk profiles. METHODS As part of a larger study, eligible residents were fitted with a triaxial accelerometer sensor placed on the anterior chest to monitor body positions 24-hours daily through a 4-week monitoring period. The current study used an observational, prospective design during routine repositioning events for 2 residents. A convenience sample of 2 residents from a single NH wing who were considered moderately at risk for PrI development (Braden Scale score 13-14) with a Brief Interview for Mental Status score in the severely impaired range were selected based on nursing staff recommendation. RESULTS Sensor data showed that both residents, although "chairfast" according to the Braden Scale, spent <5% in an upright position and the great majority of time reclining at an angle <50%. One (1) resident demonstrated a persistent side preference. CONCLUSIONS Wearable sensors are not a long-term solution for protecting those with dementia from PrI formation but do provide a crude picture of overall body positions throughout the 24-hour day that may inform individualized PrI prevention strategies. Studies including large samples of NH residents living with dementia are warranted.
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Affiliation(s)
- Tracey L Yap
- Duke University School of Nursing, Durham, North Carolina
| | - Jenny Alderden
- University of Utah College of Nursing, Salt Lake City, Utah
| | | | - Susan D Horn
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Susan M Kennerly
- East Carolina University College of Nursing, Greenville, North Carolina
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Rathnayake S, Moyle W, Jones C, Calleja P. Family carers’ needs related to management of functional disability in dementia care and use of mHealth applications in health information seeking: An online survey. Collegian 2020. [DOI: 10.1016/j.colegn.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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