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Lee MMS, Yeoh EK, Wang K, Wong ELY. Caregiver Employees' Mental Well-Being in Hong Kong. Healthcare (Basel) 2024; 12:1013. [PMID: 38786422 PMCID: PMC11121220 DOI: 10.3390/healthcare12101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/01/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The rapidly aging global population has increased the demand for caregivers. Many caregivers simultaneously engage in paid employment, and the dual role makes the needs of caregiver employees conceivably more remarkable. However, there is a gap in the literature about the specific needs of caregiver employees. METHOD Caregiver employees (n = 1205) across Hong Kong caring for those ≥65 years were recruited for a cross-sectional face-to-face survey from December 2021 to January 2022, to evaluate mental well-being measured by the Short Warwick -Edinburgh Mental Well-being Scale. Univariate and multivariate analyses were conducted; significant variables (p < 0.05) were included in multiple linear regression, along with caregiver-friendly workplace policies' availability, to understand their association with their mental well-being. FINDINGS The mean score of the Short Warwick-Edinburgh Mental Well-being Scale among caregiver employees in this study was 24.9, with 7.2% indicative of probable clinical depression and 10.0% possible mild depression. In addition, the current study showed that 30.2% of the caregiver employees felt distressed about the caregiving role. Among external factors, family support (measured by the Lubben Social Network Scale) and workplace culture (measured by the Marshall Supervision Subscale) positively correlated with mental well-being with regression coefficients of 0.252 (p < 0.001) and 0.482 (p < 0.001), respectively. In the fully adjusted model, a negative regression coefficient was observed for overall spillover (-0.050, p < 0.001) and Short Warwick-Edinburgh Mental Well-being Scale scores, while positive regression coefficients were observed for overall self-rate (0.041, p < 0.001), Lubben (0.124, p < 0.001), and corporate culture (0.365, p < 0.001). Better Short Warwick-Edinburgh Mental Well-being Scale scores were observed when caregiver-friendly workplace policies were clearly stated than when they were made on a case-by-case discretionary basis. CONCLUSIONS Caregiver-friendly workplace policies may be critical to Hong Kong's sustainable future, both economically and socially, as they ensure a healthy and productive workforce to support an aging population.
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Affiliation(s)
| | | | | | - Eliza Lai-Yi Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Central Avenue, Hong Kong, China; (M.M.-S.L.); (E.-K.Y.); (K.W.)
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Kleiner G, Ismail F, Khan O, Pilieci C, Truong L, Boulias C. Survey of Canadian Physician Use of Botulinum Toxin A (BoNT-A) for Paratonia: Real World Insights. Can J Neurol Sci 2024:1-4. [PMID: 38555970 DOI: 10.1017/cjn.2024.46] [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: 04/02/2024]
Abstract
Paratonia is a form of hypertonia characterized by an inability to relax muscles in the setting of cognitive impairment. Paratonia results in pain, refusal of care, and caregiver burden. We sent surveys to 67 Canadian physiatrists and neurologists regarding their experience treating paratonia with botulinum toxin A (BoNT-A). Twenty-seven survey respondents were included in the analysis. Thirteen percent of survey respondents treating paratonia with BoNT-A reported a significant clinically relevant improvement; 74% endorsed a moderately clinically relevant improvement; 13% endorsed a slight clinically relevant improvement. Ninety percent of survey respondents endorsed significant barriers in treating paratonia with BoNT-A.
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Affiliation(s)
- Galit Kleiner
- Austin Centre for Neurology and Behavioral Supports, Baycrest Health Sciences, Katz Interprofessional Research Program in Geriatric Dementia Care, Rotman Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Farooq Ismail
- West Park Health Care Center, Toronto, ON, Canada
- Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Omar Khan
- Hotel Dieu Shaver Health and Rehabilitation Centre, St. Catherine's, ON, Canada
- Division of Physiatry, Dept of Medicine, McMaster University, St. Catherine's, ON, Canada
| | - Christopher Pilieci
- Kunin-Lunenfeld Centre for Applied Research and Evaluation, Baycrest Academy for Research and Education, Rotman Research Institute, Toronto, ON, Canada
| | - Linda Truong
- Kunin-Lunenfeld Centre for Applied Research and Evaluation, Baycrest Academy for Research and Education, Rotman Research Institute, Toronto, ON, Canada
| | - Chris Boulias
- West Park Health Care Center, Toronto, ON, Canada
- Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Lagerlund H, Thunborg C, Sandborgh M. Behaviour-directed interventions for problematic person transfer situations in two dementia care dyads: a single-case design study. BMC Geriatr 2022; 22:261. [PMID: 35351026 PMCID: PMC8966167 DOI: 10.1186/s12877-022-02952-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Persons with dementia living in nursing homes need assistance with moving and transfers; however, caregivers assisting persons with dementia in their daily person transfers report strain-related and complicated transfer-related behavioural problems. The reciprocity of complex dyadic transfer-related behaviours is affected by environmental factors, the health status of the person with dementia and the caregiver’s skills and knowledge. The aim of this study was to explore tailored interventions guided by a functional behaviour analysis for problematic person transfer situations in two dementia care dyads. Methods This study was a quasi-experimental single-case study with an A-B design. Tailored interventions were developed in a five-step model for functional behavioural analysis. The study was conducted in a dementia special care unit at a nursing home, and the inclusion criteria were caregivers’ experiences of physical strain and/or resistiveness to care, which led to complex transfer-related behaviour. Two care dyads were included. Transfer situations were video-recorded and evaluated with the Dyadic Interaction in Dementia Transfer Assessment Scale, Pain Assessment in Advanced Dementia Scale, and Resistiveness to Care Scale for Dementia of the Alzheimer’s Type. The caregiver experience was evaluated with study-specific items addressing caregiver self-efficacy, catastrophizing thoughts, perceived control, and perceived physical strain. Scorings were graphically displayed. The graphs were inspected visually to identify changes in trend, level, latency, and variability. Nonoverlap of all pairs (NAP), including 90% confidence intervals (CIs), was calculated to complement the visual inspection. Results Verbal and nonverbal discomfort decreased in care dyad 1, which mirrored the caregiver changes in adapting their actions to the needs of the person with dementia. High variability was seen in both the intervention and the baseline phases in care dyad 2. In both care dyads, caregiver transfer-related behaviour improved. Conclusions The results indicate that the transfer-related behaviours of the care dyad might be improved through a behaviour-directed intervention tailored to meet the care dyad´s needs. The small number of cases and observations limits the generalizability, and the results should be interpreted in consideration of the piloting approach of the study. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02952-5.
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Affiliation(s)
- Hanna Lagerlund
- Rehabilitation Unit, Nyköping Municipality, 611 83, Nyköping, Sweden
| | - Charlotta Thunborg
- Department of Neurobiology, Care Sciences and Society Division of Clinical Geriatrics, Karolinska Institute, Karolinska vägen 37A, 171 76, Stockholm, SE, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
| | - Maria Sandborgh
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden.
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Drenth H, Zuidema S, Bautmans I, Marinelli L, Kleiner G, Hobbelen H. Paratonia in Dementia: A Systematic Review. J Alzheimers Dis 2021; 78:1615-1637. [PMID: 33185600 PMCID: PMC7836054 DOI: 10.3233/jad-200691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Paratonia is a dementia-induced motor abnormality. Although paratonia affects virtually all people with dementia, it is not well known among clinicians and researchers. Objective: The aim of this study was to perform a systematic review of the literature on the definition, pathogenesis, diagnosis, and intervention of paratonia as well as to propose a research agenda for paratonia. Methods: In this systematic review, the Embase, PubMed, CINAHL, and Cochrane CENTRAL databases were searched for articles published prior to December 2019. Two independent reviewers performed data extraction and assessed the risk of bias of the studies. The following data were extracted: first author, year of publication, study design, study population, diagnosis, assessment, pathogenesis, therapy and interventions. Results: Thirty-five studies met the inclusion criteria and were included. Most studies included in the review mention clinical criteria for paratonia. Additionally, pathogenesis, method of assessment, diagnosis, and paratonia severity as are interventions to address paratonia are also discussed. Conclusion: This systematic review outlines what is currently known about paratonia, as well as discusses the preliminary research on the underlying mechanisms of paratonia. Although paratonia has obvious devastating impacts on health and quality of life, the amount of research to date has been limited. In the last decade, there appears to have been increased research on paratonia, which hopefully will increase the momentum to further advance the field.
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Affiliation(s)
- Hans Drenth
- Research group Healthy Ageing, Allied Health Care and Nursing, University of Applied Sciences Groningen, Groningen, the Netherlands.,ZuidOostZorg, center for Elderly Care, Drachten, the Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ivan Bautmans
- Frailty in Ageing Research Group and Gerontology Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Galit Kleiner
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Jeff and Diane Ross Movement Disorders Clinic, Baycrest Center for Geriatric Health, Toronto, ON, Canada
| | - Hans Hobbelen
- Research group Healthy Ageing, Allied Health Care and Nursing, University of Applied Sciences Groningen, Groningen, the Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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5
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Drenth H, Zuidema S, Bautmans I, Hobbelen H. The role of inflammaging and advanced glycation end products on paratonia in patients with dementia. Exp Gerontol 2020; 142:111125. [PMID: 33132147 DOI: 10.1016/j.exger.2020.111125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 01/20/2023]
Abstract
Impaired motor function is a prominent characteristic of aging. Inflammatory processes and oxidative stress from advanced glycation end-products are related to impaired motor function and could plausibly be a contributing factor to the pathogenesis of paratonia, a specific motor disorder in people with dementia. Severe paratonia results in a substantial increase of a caretaker's burden and a decrease in the quality of life. The pathogenesis of paratonia is not well understood, and no effective interventions are available to combat it. Intensive glycaemic control, reducing oxidative stress, possibly combined with a low AGE diet and AGE targeting medication may be the key method for preventing advanced glycation end-product accumulation and reducing the inflammatory burden as well as possibly postponing or preventing paratonia.
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Affiliation(s)
- Hans Drenth
- Research Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences, PO Box 3109, 9701 DC Groningen, the Netherlands; ZuidOostZorg, Organisation for Elderly Care, Burg. Wuiteweg 140, 9203 KP Drachten, the Netherlands.
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD Groningen, HPC FA21, the Netherlands.
| | - Ivan Bautmans
- Frailty in Ageing Research Group and Gerontology Department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium.
| | - Hans Hobbelen
- Research Group Healthy Ageing, Allied Healthcare and Nursing, Hanze University of Applied Sciences, PO Box 3109, 9701 DC Groningen, the Netherlands; Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD Groningen, HPC FA21, the Netherlands.
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van Engelen MPE, Gossink FT, de Vijlder LS, Meursing JR, Scheltens P, Dols A, Pijnenburg YA. End Stage Clinical Features and Cause of Death of Behavioral Variant Frontotemporal Dementia and Young-Onset Alzheimer's Disease. J Alzheimers Dis 2020; 77:1169-1180. [PMID: 32925036 PMCID: PMC7683069 DOI: 10.3233/jad-200337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Limited literature exists regarding the clinical features of end stage behavioral variant frontotemporal dementia (bvFTD). This data is indispensable to inform and prepare family members as well as professional caregivers for the expected disease course and to anticipate with drug-based and non-pharmacological treatment strategies. OBJECTIVE The aim of the present study was to describe end stage bvFTD in a broad explorative manner and to subsequently evaluate similarities and dissimilarities with the end stage of the most prevalent form of young-onset dementia, Alzheimer's disease (yoAD). METHODS We analyzed medical files on patients, using a mixed model of qualitative and quantitative approaches. Included were previously deceased patients with probable bvFTD and probable yoAD. End stage was defined as the last 6 months prior to death. Primary outcome measures comprised somatic, neurological, and psychiatric symptoms and the secondary outcome measure was cause of death. RESULTS Out of 89 patients, a total of 30 patients were included (bvFTD; n = 12, yoAD; n = 18). Overall, the end stages of bvFTD and yoAD were characterized by a broad spectrum of clinical symptoms including severe autonomic dysfunction and an increased muscle tone. Patients with bvFTD displayed more mutism compared with yoAD while compulsiveness was only present in bvFTD. CONCLUSION Our study describes the full clinical spectrum of end stage bvFTD and yoAD. In this study, symptoms extend far beyond the initial behavioral and cognitive features. By taking both somatic, psychiatric, and neurological features into account, family members and professional caregivers may anticipate (non) pharmacological treatment.
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Affiliation(s)
- Marie-Paule E. van Engelen
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Flora T. Gossink
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Lieke S. de Vijlder
- Lisidunahof, nursing home specialized in (young-onset) dementia, Beweging 3.0, Leusden, The Netherlands
| | - Jan R.A. Meursing
- Lisidunahof, nursing home specialized in (young-onset) dementia, Beweging 3.0, Leusden, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZinGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Yolande A.L. Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Dehail P, Gaudreault N, Zhou H, Cressot V, Martineau A, Kirouac-Laplante J, Trudel G. Joint contractures and acquired deforming hypertonia in older people: Which determinants? Ann Phys Rehabil Med 2019; 62:435-441. [DOI: 10.1016/j.rehab.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 01/05/2023]
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Van Deun B, Hobbelen JSM, Cagnie B, Van Eetvelde B, Van Den Noortgate N, Cambier D. Reproducible Measurements of Muscle Characteristics Using the MyotonPRO Device: Comparison Between Individuals With and Without Paratonia. J Geriatr Phys Ther 2019; 41:194-203. [PMID: 28005829 DOI: 10.1519/jpt.0000000000000119] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The MyotonPRO is a portable device that measures muscle tone and biomechanical muscle properties objectively. MyotonPRO has already proven to be effective in measuring muscle properties in healthy and diseased populations. However, to the best of our knowledge, it has never been tested in individuals suffering from paratonia, a form of hypertonia frequently accompanying dementia. The aims of the present study were to (1) compare muscle tone, elasticity, and stiffness between 3 different subpopulations of young and old healthy adults and individuals with paratonia, and (2) investigate the intra- and interrater reproducibility of MyotonPRO measurements of the biceps brachii (BB) muscle in each subpopulation. METHODS MyotonPRO measurements of muscle tone, elasticity, and dynamic stiffness were carried out by 2 investigators on 2 different days over the BB muscles of 54 participants (18 healthy young adults, 20 healthy older adults, and 16 older individuals with paratonia). Muscle properties were compared between subpopulations using ANOVA/Welch and post hoc tests. Reliability (intraclass correlation coefficient) and agreement parameters (standard error of measurement and the minimal detectable change) were calculated. RESULTS Statistically significant differences between subpopulations were found in all parameters, except for stiffness between healthy elderly and individuals with paratonia. In the healthy subpopulations, (a) intrarater reliability was very high and intrarater agreement was good between 2 consecutive series, (b) between days intrarater reliability was low to high and intrarater agreement was variable, (c) interrater reliability was high to very high and interrater agreement was good. In individuals with paratonia, (a) intrarater reliability was moderate to high and agreement was variable between series, (b) between days intrarater reliability was poor to moderate and agreement was poor, (c) interrater reliability ranged from low to high with poor agreement. CONCLUSIONS MyotonPRO measurements of the BB muscle showed good reproducibility in both healthy subpopulations, particularly for measurements performed within the same day. In individuals with paratonia, reliability and agreement were substantially lower. MyotonPRO can be used in clinical assessment and research. However, in individuals with paratonia, careful interpretation of results is required. Research in a larger sample of persons with paratonia at different stages of disease severity is recommended.
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Affiliation(s)
- Bieke Van Deun
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Johannes S M Hobbelen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Birgit Van Eetvelde
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | | | - Dirk Cambier
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Van Deun B, Van Den Noortgate N, Van Bladel A, De Weerdt K, Cambier D. Managing Paratonia in Persons With Dementia: Short-term Effects of Supporting Cushions and Harmonic Techniques. J Am Med Dir Assoc 2019; 20:1521-1528. [PMID: 31227470 DOI: 10.1016/j.jamda.2019.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/29/2019] [Accepted: 04/30/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Paratonia, a form of hypertonia typically seen in dementia, is often associated with difficulties in positioning and daily care. No evidence-based therapy or clinical guideline for management is available. In this study, the short-term effect of harmonic techniques (HT) and supporting cushions (SC) on paratonia was explored. DESIGN This was a multicenter interventional clinical trial with AB/BA crossover design. Each intervention (SC or HT) was subsequently implemented over 1 week in each of the participants. SETTING AND PARTICIPANTS The study included 22 participants with moderate to severe paratonia from 9 different nursing homes in Flanders, Belgium. METHODS Measurements of biceps brachii and rectus femoris muscle tone (MyotonPRO), maximal elbow and knee extension (goniometer), and pain (Pain Assessment Checklist for Seniors With Limited Ability to Communicate) were performed on 3 different days within 1 week. The effect of HT on nursing care was evaluated with the Pain Assessment Checklist for Seniors With Limited Ability to Communicate and visual analog scale ratings of discomfort items. RESULTS After 30 minutes of positioning with SC, participants had lower biceps brachii muscle tone (P = .041) and higher maximal elbow extension (P = .006) than without SC. After a 30-minute session of HT, a significant increase in biceps brachii muscle tone (P = .032) and maximal extension of elbow (P < .001) and knee (P = .028) was found. Pain (P = .003) and discomfort (P = .001 to P = .019) during morning care were significantly lower when care was preceded by 30 minutes of HT. CONCLUSIONS/IMPLICATIONS This explorative study revealed beneficial short-term effects on range of motion for both SC and HT and a positive effect of SC on upper limb muscle tone. Beneficial effects of HT were found on resident's pain and caregiver's discomfort during care. The results of the present study are encouraging and can contribute to the development of evidence-based interventions for paratonia.
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Affiliation(s)
- Bieke Van Deun
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | | | - Anke Van Bladel
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Koen De Weerdt
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Dirk Cambier
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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10
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The Impact of Paratonia on Fine and Gross Motor Function in Older Adults With Mild and Moderate Dementia. Alzheimer Dis Assoc Disord 2018; 33:54-61. [PMID: 30371515 DOI: 10.1097/wad.0000000000000278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dementia is associated with impairment in gait, balance, and fine motor function. Paratonia, a form of hypertonia, is often present in severe dementia. However, little is known about muscle tone in early dementia, and the eventual relation between muscle tone abnormalities and changes in fine and gross motor function. METHODS Three groups of participants were included in the study: healthy controls (n=60), participants with mild dementia (MiD) (n=31), and participants with moderate dementia (n=31). Measurements of fine motricity (Purdue pegboard test), balance and gait (Dynaport Hybrid), the presence of paratonia (PAI), and muscle tone measurements (MyotonPRO) were performed. RESULTS Paratonia was present in 42% of participants with MiD and in 58% of participants with moderate dementia. Participants with paratonia had lower Purdue Pegboard scores (P<0.001), lower balance coordination in semitandem stance (P<0.001), lower walking speed at a fast pace (P=0.001), and lower step regularity at normal (P=0.025) and fast (P<0.001) pace. CONCLUSIONS Paratonia is already present in participants with MiD and is associated with a decline in both fine and gross motor performance. Early detection of paratonia might be helpful to detect persons at higher risk of motor deterioration and falls.
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11
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Kojović M, Bhatia KP. Bringing order to higher order motor disorders. J Neurol 2018; 266:797-805. [PMID: 30027322 DOI: 10.1007/s00415-018-8974-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 11/26/2022]
Abstract
Majority of movements in everyday situations are complex and involve volition, planning of the movement and selection of the motor programme, all occurring before movement execution. Higher order motor disorders may be defined as abnormal motor behaviours resulting from disruption of any of the cortical processes that precede execution of the motor act. They are common in patients with neurodegenerative disorders, psychiatric diseases and structural brain lesions. These abnormal behaviours may be overlooked in the clinic, unless specifically evoked by the examiner. We discuss clinical and pathophysiological aspects of higher order motor disorders including: (1) disorders of disinhibition, such as grasp reflex and grasping behaviour, utilisation and imitation behaviour, motor preservations and paratonia; (2) disorders of motor intention such as motor neglect and motor impersistence; (3) alien limb syndrome; and (4) motor overflow phenomena, such as mirror movements and synkinesias. A video illustration of each phenomenon is provided. We place the findings from recent neurophysiological studies within the framework of theories of motor control to provide better insight into pathophysiology of different disorders.
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Affiliation(s)
- Maja Kojović
- Department of Neurology, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.
| | - Kailash P Bhatia
- Institute of Neurology, University College London, 7 Queen Square, London, WC1N 3BG, UK
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12
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Van Deun B, Van den Noortgate N, Cinthia S, Van Bladel A, Dirk C. Paratonia in Flemish Nursing Homes: Current State of Practice. Am J Alzheimers Dis Other Demen 2018; 33:205-214. [PMID: 29468898 PMCID: PMC10852473 DOI: 10.1177/1533317518760594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paratonia is a major underlying motor problem impeding functionality and locomotion in dementia. Despite its undeniable impact on patient's quality of life and daily care, there is a lack of evidence-based therapy on patients with this condition. METHODS We surveyed physiotherapists working in nursing homes in Flanders (Belgium) concerning the use and perceived effect of therapeutic strategies and positioning methods/aids. RESULTS Positioning and soft passive mobilization were the most applied and positively appraised therapeutic interventions. Highest ratings for positioning were found for C-shaped positioning cushions and multi-position wheelchair. According to the respondents, key points for paratonia approach were relaxation, positioning, active movement stimulation, and-to some extent-passive mobilization. Indispensable for any success however is multidisciplinary cooperation. CONCLUSION These findings might provide an inspirational path for research to verify possible (evidence based) beneficial treatments that could be applied to improve current and future treatment of patients with paratonia.
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Affiliation(s)
- Bieke Van Deun
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | | | - Saucedo Cinthia
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Anke Van Bladel
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Cambier Dirk
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Peralta V, Cuesta MJ. Motor Abnormalities: From Neurodevelopmental to Neurodegenerative Through "Functional" (Neuro)Psychiatric Disorders. Schizophr Bull 2017; 43:956-971. [PMID: 28911050 PMCID: PMC5581892 DOI: 10.1093/schbul/sbx089] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Motor abnormalities (MAs) of severe mental disorders have been traditionally neglected both in clinical practice and research, although they are an increasing focus of attention because of their clinical and neurobiological relevance. For historical reasons, most of the literature on MAs has been focused to a great extent on schizophrenia, and as a consequence their prevalence and featural properties in other psychiatric or neuropsychiatric disorders are poorly known. In this article, we evaluated the extent to which catatonic, extrapyramidal and neurological soft signs, and their associated clinical features, are present transdiagnostically. Methods We examined motor-related features in neurodevelopmental (schizophrenia, obsessive compulsive disorder, autism spectrum disorders), "functional" (nonschizophrenic nonaffective psychoses, mood disorders) and neurodegenerative (Alzheimer's disease) disorders. Examination of the literature revealed that there have been very few comparisons of motor-related features across diagnoses and we had to rely mainly in disorder-specific studies to compare it transdiagnostically. Results One or more motor domains had a substantial prevalence in all the diagnoses examined. In "functional" disorders, MAs, and particularly catatonic signs, appear to be markers of episode severity; in chronic disorders, although with different degree of strength or evidence, all motor domains are indicators of both disorder severity and poor outcome; lastly, in Alzheimer's disease they are also indicators of disorder progression. Conclusions MAs appear to represent a true transdiagnostic domain putatively sharing neurobiological mechanisms of neurodevelopmental, functional or neurodegenerative origin.
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Affiliation(s)
- Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Manuel J Cuesta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Psychiatry Service, Complejo Hospitalario de Navarra, Pamplona, Spain
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Drenth H, Zuidema SU, Krijnen WP, Bautmans I, van der Schans C, Hobbelen H. Advanced Glycation End-Products Are Associated With the Presence and Severity of Paratonia in Early Stage Alzheimer Disease. J Am Med Dir Assoc 2017; 18:636.e7-636.e12. [DOI: 10.1016/j.jamda.2017.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 12/01/2022]
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A randomized, placebo controlled pilot trial of botulinum toxin for paratonic rigidity in people with advanced cognitive impairment. PLoS One 2014; 9:e114733. [PMID: 25536218 PMCID: PMC4275182 DOI: 10.1371/journal.pone.0114733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Evaluate safety and efficacy of Incobotulinumtoxin A in elderly patients with dementia and paratonia. SETTING University-affiliated hospital, spasticity management Clinic. PARTICIPANTS Ten subjects were enrolled. INCLUSION CRITERIA 1) severe cognitive impairment 2) diagnosis of Alzheimer's disease, vascular dementia, or frontotemporal dementia, and 3) score >3 on the paratonic assessment instrument, with posture in an arm(s) interfering with provision of care. EXCLUSION CRITERIA 1) alternate etiologies for increased tone and 2) injection with botulinum toxin within the 6 months preceding the study. DESIGN Single center, randomized, double blind, placebo-controlled, crossover trial with two treatment cycles of 16 weeks. Assessments occurred at 2, 6, 12 and16 weeks following injections. Subjects received up to 300 U of Incobotulinumtoxin A in arm(s). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measure was the modified caregiver burden scale (mCBS); exploratory secondary outcome measures were also performed. Analysis of variance and mixed modeling techniques were used to evaluate treatment effects. RESULTS Incobotulinumtoxin A treatment produced significant improvement in mCBS total score -1.11 (-2.04 to -0.18) (Treatment effect and 95% CI), dressing sub-score -0.36 (-0.59 to 0.12), and cleaning under the left and right armpits sub-score -0.5 (-0.96 to -0.04), -0.41 (-0.79 to -0.04) respectively. PROM in the left and right elbow increased by 27.67 degrees (13.32-42.02) and 22.07 degrees (9.76-34.39) respectively. PROM in the left and right shoulder increased by 11.92 degrees (5.46-18.38) and 8.58 degrees (3.73-13.43) respectively. No significant treatment effect was found for GAS, VAS and PAINAD scales or change in time to perform care. No adverse drug reactions occurred. CONCLUSIONS Administration of Incobotulinumtoxin A in elderly people with advanced dementia and paratonia may be an efficacious and safe treatment to increase range of motion and reduce functional burden. Further studies are needed to confirm results. TRIAL REGISTRATION ClinicalTrials.Gov NCT02212119.
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Abstract
BACKGROUND Paratonia causes severe movement dysfunction in late stage dementia. Passive Movement Therapy (PMT) is often used to decrease high muscle tone, but the efficacy has never been shown. The objective of this study is to investigate the effect of PMT on muscle tone after two and four weeks of treatment. METHODS This study comprised a multicenter single-blinded RCT. Nursing home residents with dementia (according to the DSM-IV-TR criteria) and moderate to severe paratonia were randomly assigned to either a PMT or control group. The PMT group received PMT three times a week over four weeks. The control group received no PMT. The primary outcome was the severity of paratonia as measured by the Modified Ashworth scale (MAS). Secondary outcomes were clinical change (Clinical Global Impression; CGI), caregiver's burden (modified patient specific complaints; PSC), and level of pain during morning care (Pain Assessment Checklist for Elderly with Limited Ability to Communicate, Dutch version; PACSLAC-D). All outcomes were assessed at baseline and after two and four weeks. The MAS, PACSLAC-D, and PSC data were subjected to multilevel mixed linear analysis, and the CGI data to cross-tabulation χ2 analysis. RESULTS One-hundred-and-one patients from 12 Dutch nursing homes participated in the study; data from 47 patients in the PME group and 54 controls were analyzed. Patients receiving PMT performed no better in paratonia assessments, nor on CGI, PSC, or PACSLAC-D, than controls in two and four week's time. CONCLUSION PMT has no beneficial effects and should therefore not be recommended as an intervention in severe paratonia. TRIAL REGISTRATION Current Controlled Trials ISRCTN43069940.
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Prevalence, incidence and risk factors of paratonia in patients with dementia: a one-year follow-up study. Int Psychogeriatr 2011; 23:1051-60. [PMID: 21269542 DOI: 10.1017/s1041610210002449] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Paratonia is a progressive motor problem that is observed in individuals with dementia and is not a well-known phenomenon. This study explores the development and risk factors of paratonia in moderate stage dementia patients. METHODS A multi-center, longitudinal, one-year follow-up cohort study was performed. Patients with an established diagnosis of dementia, with a score of 6 or lower on the Global Deterioration Scale (GDS) were included. The participants were assessed using the Paratonia Assessment Instrument (PAI), the Timed Up and GO test, the Qualidem, the Global Deterioration Scale (Reisberg et al., 1982) and the Mini-mental State Examination. Information about each patient's diagnosis of dementia, comorbidities and use of medication were obtained from the participant's medical file. The PAI was assessed every three months, the other variables at baseline and after 12 months. Cross-tabulation χ2 and logistic regression tests were used for the statistical analyses. RESULTS Baseline measures were assessed in the 204 participants - 111 (54%) female and 93 (46%) male, with a mean age of 79.8 years (56-97). Seventy-one patients (34.8%) were diagnosed with paratonia at baseline, and 51 patients developed paratonia over one year. The highest hazard ratio (3.1) for developing paratonia within one year was observed in the vascular dementia group. The logistic regression analysis revealed that the presence of diabetes mellitus (OR = 10.7) was significantly related to the development of paratonia (Wald χ2 p-value < 0.01). CONCLUSIONS Diabetes mellitus and likely vascular damage are risk factors for the development of paratonia.
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Lalonde R, Strazielle C. Brain regions and genes affecting limb-clasping responses. ACTA ACUST UNITED AC 2011; 67:252-9. [DOI: 10.1016/j.brainresrev.2011.02.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 02/14/2011] [Accepted: 02/20/2011] [Indexed: 10/18/2022]
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Wångblad C, Ekblad M, Wijk H, Ivanoff SD. Experiences of physical strain during person transfer situations in dementia care units. Scand J Caring Sci 2009; 23:644-50. [DOI: 10.1111/j.1471-6712.2008.00655.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Test-retest reliability and minimal detectable change scores for the timed "up & go" test, the six-minute walk test, and gait speed in people with Alzheimer disease. Phys Ther 2009; 89:569-79. [PMID: 19389792 DOI: 10.2522/ptj.20080258] [Citation(s) in RCA: 296] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the increasing incidence of Alzheimer disease (AD), determining the validity and reliability of outcome measures for people with this disease is necessary. OBJECTIVE The goals of this study were to assess test-retest reliability of data for the Timed "Up & Go" Test (TUG), the Six-Minute Walk Test (6MWT), and gait speed and to calculate minimal detectable change (MDC) scores for each outcome measure. Performance differences between groups with mild to moderate AD and moderately severe to severe AD (as determined by the Functional Assessment Staging [FAST] scale) were studied. DESIGN This was a prospective, nonexperimental, descriptive methodological study. METHODS Background data collected for 51 people with AD included: use of an assistive device, Mini-Mental Status Examination scores, and FAST scale scores. Each participant engaged in 2 test sessions, separated by a 30- to 60-minute rest period, which included 2 TUG trials, 1 6MWT trial, and 2 gait speed trials using a computerized gait assessment system. A specific cuing protocol was followed to achieve optimal performance during test sessions. RESULTS Test-retest reliability values for the TUG, the 6MWT, and gait speed were high for all participants together and for the mild to moderate AD and moderately severe to severe AD groups separately (intraclass correlation coefficients > or = .973); however, individual variability of performance also was high. Calculated MDC scores at the 90% confidence interval were: TUG=4.09 seconds, 6MWT=33.5 m (110 ft), and gait speed=9.4 cm/s. The 2 groups were significantly different in performance of clinical tests, with the participants who were more cognitively impaired being more physically and functionally impaired. LIMITATIONS A single researcher for data collection limited sample numbers and prohibited blinding to dementia level. CONCLUSIONS The TUG, the 6MWT, and gait speed are reliable outcome measures for use with people with AD, recognizing that individual variability of performance is high. Minimal detectable change scores at the 90% confidence interval can be used to assess change in performance over time and the impact of treatment.
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Diagnosing paratonia in the demented elderly: reliability and validity of the Paratonia Assessment Instrument (PAI). Int Psychogeriatr 2008; 20:840-52. [PMID: 18177542 DOI: 10.1017/s1041610207006424] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Paratonia is one of the associated movement disorders characteristic of dementia. The aim of this study was to develop an assessment tool (the Paratonia Assessment Instrument, PAI), based on the new consensus definition of paratonia. An additional aim was to investigate the reliability and validity of the PAI. METHODS A three-phase cross-sectional survey was conducted. In the first two phases, the PAI was developed and validated. In the third phase, the inter-observer reliability and feasibility of the instrument was tested. RESULTS The original PAI consisted of five criteria that all needed to be met in order to make the diagnosis. On the basis of a qualitative analysis, one criterion was reformulated and another was removed. Following this, inter-observer reliability between the two assessors resulted in an improvement of Cohen's kappa from 0.532 in the initial phase to 0.677 in the second phase. This improvement was substantiated in the third phase by two independent assessors with Cohen's kappa ranging from 0.625 to 1. CONCLUSION The PAI is a reliable and valid assessment tool for diagnosing paratonia in elderly people with dementia that can be applied easily in daily practice.
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Song JA, Lim YM, Hong GRS. Wandering behaviour of persons with dementia in Korea: investigation of related factors. Aging Ment Health 2008; 12:366-73. [PMID: 18728950 DOI: 10.1080/13607860802120821] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Despite being identified as a significant clinical phenomenon, wandering of persons with dementia (PWDs) has not been studied in Korea. As an initial trial, various factors chosen from the literature for their predictive relationships to wandering of Korean PWDs were evaluated in this study. METHOD A total of 160 PWDs residing in 14 long-term care facilities participated in this study. The Mini-Mental State Exam (MMSE), Physical Activities of Daily Living (PADL) and Korean-translated Revised Algase Wandering Scale (Nursing Home version) (KRAWS-NH) were used to assess participants' degree of cognitive impairment, functional ability and wandering behaviour on six dimensions: persistent walking (PW), specific patterns (SP), spatial disorientation (SD), escape behaviour (EB), attention shift (AS) and negative outcomes (NO). Demographic, personal and environmental data were also collected. RESULTS The MMSE score was a significant negative predictor for KRAWS-NH overall and subscales except for EB; while age, PADL and history of falls were positive predictors for SD and NO. Total number of residents in a room was a significant negative predictor for EB and AS. CONCLUSION Different factors found in PWDs may contribute to different aspects of wandering behaviour. Further studies on factors influencing multiple facets of wandering in various cultural settings are warranted.
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Affiliation(s)
- Jun-Ah Song
- Korea University College of Nursing, Seoul, Korea.
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Hobbelen JSM, Verhey FRJ, Bor JHJ, de Bie RA, Koopmans RTCM. Passive movement therapy in patients with moderate to severe paratonia; study protocol of a randomised clinical trial (ISRCTN43069940). BMC Geriatr 2007; 7:30. [PMID: 18093298 PMCID: PMC2257947 DOI: 10.1186/1471-2318-7-30] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 12/19/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paratonia, a form of hypertonia, is associated with loss of mobility and with the development of contractures especially in the late stages of the dementia. Passive movement therapy (PMT) currently is the main physiotherapeutic intervention. General doubt about the beneficial effects of this widely used therapy necessitates a randomised clinical trial (RCT) to study the efficacy of PMT on the severity of paratonia and on the improvement of daily care. METHODS/DESIGN A RCT with a 4-week follow-up period. Patients with dementia (according to the DSM-IV-TR Criteria) and moderate to severe paratonia are included in the study after proxy consent. By means of computerised and concealed block randomisation (block-size of 4) patients are included in one of two groups. The first group receives PMT, the second group receives usual care without PMT. PMT is given according to a protocol by physical therapist three times a week for four weeks in a row. The severity of paratonia (Modified Ashworth scale), the severity of the dementia (Global Deterioration Scale), the clinical improvement (Clinical Global Impressions), the difficulty in daily care (Patient Specific Complaints) and the experienced pain in daily care of the participant (PACSLAC-D) is assessed by assessors blind to treatment allocation at baseline, after 6 and 12 treatments. Success of the intervention is defined as a significant increase of decline on the modified Ashworth scale. The 'proportion of change' in two and four weeks time on this scale will be analysed. Also a multiple logistic regression analysis using declined/not declined criteria as dependent variable with correction for relevant confounders (e.g. stage of dementia, medication, co-morbidity) will be used. DISCUSSION This study is the first RCT of this size to gain further insight on the effect of passive movement therapy on the severity of paratonia. TRIAL REGISTRATION Current Controlled Trials ISRCTN43069940.
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Affiliation(s)
- Johannes SM Hobbelen
- Physiotherapy Research Vitalis WoonZorg groep Eindhoven, The Netherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Frans RJ Verhey
- University Hospital of Maastricht/Alzheimer Centre Limburg PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Jacobus HJ Bor
- Department of Nursing Home Medicine Radboud University Nijmegen Medical Centre P.O. Box 9101, 229 VPG 6500 HB Nijmegen, The Netherlands
| | - Rob A de Bie
- School for Public Health and Primary Care (CAPHRI), Maastricht University PO Box 616, 6200 MD Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Raymond TCM Koopmans
- Department of Nursing Home Medicine Radboud University Nijmegen Medical Centre P.O. Box 9101, 229 VPG 6500 HB Nijmegen, The Netherlands
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Meyers E. Medicare coverage for the cognitively impaired resident. Part A. Am J Alzheimers Dis Other Demen 2004; 19:149-52. [PMID: 15214200 PMCID: PMC10833855 DOI: 10.1177/153331750401900308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Reisberg B, Franssen EH, Souren LEM, Auer SR, Akram I, Kenowsky S. Evidence and mechanisms of retrogenesis in Alzheimer's and other dementias: management and treatment import. Am J Alzheimers Dis Other Demen 2002; 17:202-12. [PMID: 12184509 PMCID: PMC10833976 DOI: 10.1177/153331750201700411] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Retrogenesis is the process by which degenerative mechanisms reverse the order of acquisition in normal development. Alzheimer's disease (AD) and related conditions in the senium have long been noted to resemble "a return to childhood" Previously, we noted that the functional stages of AD precisely and remarkably recapitulated the acquisition of the same functional landmarks in normal human development. Subsequent work indicated that this developmental recapitulation also applied to the cognitive and related symptoms in AD. Remarkably, further investigations revealed that the same neurologic "infantile" reflexes, which mark the emergence from infancy in normal development, are equally robust indicators of corresponding stages in AD. Neuropathologic and biomolecular mechanisms for these retrogenic processes are now evident. For example, the pattern of myelin loss in AD appears to mirror the pattern of myelin acquisition in normal development. Also, recent findings indicate that mitogenic factors become reactivated in AD, and, consequently, the most actively "growing" brain regions are the most vulnerable. Because of this robust retrogenic process, the stages of AD can be translated into corresponding developmental ages (DAs). These DAs can account for the overall management and care needs of AD patients. A science of AD management can be formulated on the basis of the DA of the Alzheimer's patient, taking into consideration differences of AD from normal development as well as homologies.
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Affiliation(s)
- Barry Reisberg
- Alzheimer's Disease Education and Resources Program, New York University School of Medicine, New York, USA
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