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Massimo L, Hirschman KB, Aryal S, Quinn R, Fisher L, Sharkey M, Thomas G, Bowles KH, Riegel B. iCare4Me for FTD: A pilot randomized study to improve self-care in caregivers of persons with frontotemporal degeneration. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12381. [PMID: 37143583 PMCID: PMC10152138 DOI: 10.1002/trc2.12381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/03/2023] [Accepted: 03/06/2023] [Indexed: 05/06/2023]
Abstract
Introduction A tremendous burden is placed on frontotemporal degeneration (FTD) caregivers who sacrifice their own self-care to manage the functional impairments of their loved one, contributing to high levels of stress and depression. Health coaching provides support for coping with stress while fostering self-care behaviors. We report on preliminary evidence for efficacy of a virtual health coach intervention aimed at increasing self-care. Methods Thirty-one caregivers of persons with behavioral variant FTD (bvFTD) were assigned randomly to an intervention group, which included 10 coaching sessions over 6 months plus targeted health information or the control group receiving standard care augmented with the health information. Caregiver self-care (primary outcome), stress, depression, coping, and patient behavioral symptoms were collected at enrollment and 3 and 6 months. Change over time was evaluated between the intervention and control groups using linear mixed-effects models. Results There was a significant group-by-time interaction for self-care monitoring (t58 = 2.37, p = 0.02 and self-care confidence (t58 = 2.32, p = 0.02) on the Self-Care Inventory, demonstrating that caregivers who received the intervention improved their self-care over time. Behavioral symptoms were reduced in bvFTD patients whose caregivers received the intervention (t54 = -2.15, p = 0.03). Discussion This randomized controlled trial (RCT) shows promise for health coaching as a way to increase support that is urgently needed to reduce poor outcomes in FTD caregivers.
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Affiliation(s)
- Lauren Massimo
- Frontotemporal Degeneration Center, Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Subhash Aryal
- School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ryan Quinn
- School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Lauren Fisher
- School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Michelle Sharkey
- School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Gladys Thomas
- School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kathryn H. Bowles
- School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Barbara Riegel
- School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Dinand C, Nover SU, Holle D, Zischka M, Halek M. What is known about the subjective needs of people with behavioural variant frontotemporal dementia? A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:375-385. [PMID: 25827780 DOI: 10.1111/hsc.12225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 06/04/2023]
Abstract
Behavioural variant frontotemporal dementia (bvFTD) is an early-onset and progressive neurodegenerative disease associated with strong changes in judgement, behaviour, personality and emotions. These changes can cause significant problems in everyday life for people with bvFTD and their families, and have implications for health and society. Currently, there are no suitable evidence-based specific interventions for people with bvFTD. This scoping review aims to identify the self-expressed needs, demands and coping strategies of people with bvFTD. Identifying these issues is the first step towards the development of need-based psycho-social interventions for people with bvFTD. A comprehensive literature research was conducted of German and English scientific articles published between January 2000 and October 2014 using the databases MEDLINE, CINAHL, PsycINFO, PSYNDEX, SocINDEX, GeroLit, the Cochrane Library, ProQuest, the German National Library and additional search strategies in terms of a scoping review. Articles were identified by combining search terms related to 'frontotemporal dementia' with terms related to 'self-expressions', 'needs/demands' and 'coping'. After excluding duplicates, two independent reviewers screened the titles and abstracts of 2317 records for eligibility. Because eligibility could not be assessed from the titles or abstracts of 28 articles, those articles were assessed using the full text. One poster abstract met our research question and a few articles were related, but no article met all of the inclusion criteria. This lack of scientifically based knowledge concerning the perspective of people with bvFTD is discussed with reference to the search strategy and the research questions, disease-related aspects such as changes in behaviour or language and emotions and the difficulties in researching this topic. Recommendations are formulated for future research considering the perspective of people with bvFTD and that will involve the development of appropriate data collection methods. Subsequently, specialised interventions must be developed.
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Affiliation(s)
- Claudia Dinand
- Witten, Research Group: Care Interventions, German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Sabine Ursula Nover
- Witten, Research Group: Care Interventions, German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Daniela Holle
- Witten, Research Group: Care Interventions, German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Matthias Zischka
- Witten, Research Group: Care Interventions, German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
| | - Margareta Halek
- Witten, Research Group: Care Interventions, German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
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Massimo L, Powers JP, Evans LK, McMillan CT, Rascovsky K, Eslinger P, Ersek M, Irwin DJ, Grossman M. Apathy in Frontotemporal Degeneration: Neuroanatomical Evidence of Impaired Goal-directed Behavior. Front Hum Neurosci 2015; 9:611. [PMID: 26617508 PMCID: PMC4639601 DOI: 10.3389/fnhum.2015.00611] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/23/2015] [Indexed: 12/12/2022] Open
Abstract
Background: Apathy, the major manifestation of impaired goal-directed behavior (GDB), is the most common neuropsychiatric syndrome associated with behavioral variant frontotemporal degeneration (bvFTD). The behavioral and biological mechanisms of apathy, however, are not well understood. We hypothesized that GDB has multiple components—including at least initiation, planning and motivation—and that GDB is supported by a network of multiple frontal brain regions. In this study, we examined this hypothesis by evaluating the selective breakdown of GDB in bvFTD, and relating these deficits to gray matter (GM) atrophy and white matter (WM) integrity. Methods: Eighteen apathetic bvFTD participants and 17 healthy controls completed the Philadelphia Apathy Computerized Test (PACT). This test quantifies each of three components of GDB hypothesized to contribute to apathy. We then used regression analyses to relate PACT scores to GM atrophy and reduced white matter (WM) fractional anisotropy (FA) in bvFTD. Results: Compared to controls, bvFTD participants demonstrated significant impairments in each of the three hypothesized components of GDB that contribute to apathy. Regression analyses related each component to disease in specific GM structures and associated WM tracts. Poor initiation thus was related to GM atrophy in anterior cingulate and reduced FA in the cingulum. Planning impairment was related to GM atrophy in dorsolateral prefrontal cortex and reduced FA in superior longitudinal fasciculus. Poor motivation was related to GM atrophy in orbitofrontal cortex (OFC) and reduced FA in uncinate fasciculus (UNC). Conclusions: bvFTD patients have difficulty with initiation, planning and motivation components of GDB. These findings are consistent with the hypotheses that GDB encompasses at least three processes, that these are supported by a large-scale neural network within specific portions of the frontal lobe, and that degradation of any one of these prefrontal regions in bvFTD may contribute to apathy.
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Affiliation(s)
- Lauren Massimo
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA ; School of Nursing, University of Pennsylvania Philadelphia, PA, USA
| | - John P Powers
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Lois K Evans
- School of Nursing, University of Pennsylvania Philadelphia, PA, USA
| | - Corey T McMillan
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Katya Rascovsky
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Paul Eslinger
- Department of Neurology, Penn State Hershey Milton S. Hershey Medical Center Hershey, PA, USA
| | - Mary Ersek
- School of Nursing, University of Pennsylvania Philadelphia, PA, USA
| | - David J Irwin
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Murray Grossman
- Department of Neurology, Frontotemporal Degeneration Center, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
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Massimo L, Evans LK. Differentiating subtypes of apathy to improve person-centered care in frontotemporal degeneration. J Gerontol Nurs 2015; 40:58-65. [PMID: 25199154 DOI: 10.3928/00989134-20140827-01] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/05/2014] [Indexed: 12/13/2022]
Abstract
Apathy, a reduction in goal-directed behavior (GDB), affects 90% of individuals with behavioral variant frontotemporal degeneration, which is a common cause of early onset neurodegenerative disease. The cognitive and neural impairments associated with apathy make it difficult to initiate, plan, and self-motivate activities toward a specific goal, such as dressing or bathing. These impairments are associated with significant decline in functional ability, caregiver burden, and increased cost of care due to early institutionalization. The current article reviews the evidence suggesting that apathy arises from the interruption of one or any combination of three GDB processes: initiation, planning, and motivation. From this perspective, three subtypes of apathy related to dysfunction at the level of GDB and the corresponding neuroanatomy are explored. Further research is required to confirm and measure these subtypes of apathy for use in clinical and research settings. A more precise classification of apathy by subtype will allow implementation of the most appropriate person-centered, individualized therapy.
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O'Connor CM, Clemson L, da Silva TBL, Piguet O, Hodges JR, Mioshi E. Enhancement of carer skills and patient function in the non-pharmacological management of frontotemporal dementia (FTD): A call for randomised controlled studies. Dement Neuropsychol 2013; 7:143-150. [PMID: 29213832 PMCID: PMC5619510 DOI: 10.1590/s1980-57642013dn70200002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
FTD is a unique condition which manifests with a range of behavioural symptoms,
marked dysfunction in activities of daily living (ADL) and increased levels of
carer burden as compared to carers of other dementias. No efficacious
pharmacological interventions to treat FTD currently exist, and research on
pharmacological symptom management is variable. The few studies on
non-pharmacological interventions in FTD focus on either the carer or the
patients' symptoms, and lack methodological rigour. This paper reviews and
discusses current studies utilising non-pharmacological approaches, exposing the
clear need for more rigorous methodologies to be applied in this field. Finally,
a successful randomised controlled trial helped reduce behaviours of concern in
dementia, and through implementing participation in tailored activities, the
FTD-specific Tailored Activities Program (TAP) is presented. Crucially, this
protocol has scope to target both the person with FTD and their carer. This
paper highlights that studies in this area would help to elucidate the potential
for using activities to reduce characteristic behaviours in FTD, improving
quality of life and the caregiving experience in FTD.
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Affiliation(s)
- Claire M O'Connor
- Ageing, Work & Health Research Unit, Faculty of Health Sciences, University of Sydney.,Neuroscience Research Australia, Sydney, Australia
| | - Lindy Clemson
- Ageing, Work & Health Research Unit, Faculty of Health Sciences, University of Sydney
| | - Thaís Bento Lima da Silva
- Behavioural and Cognitive Neurology Unit, Neurology Department, University of São Paulo, São Paulo SP, Brazil
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Science, University of New South Wales, Sydney, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Science, University of New South Wales, Sydney, Australia
| | - Eneida Mioshi
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Science, University of New South Wales, Sydney, Australia
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Lippa CF, Rosso AL. Loss of synaptophysin immunoexpression in primary progressive aphasia. Am J Alzheimers Dis Other Demen 2012; 27:250-3. [PMID: 22586262 PMCID: PMC10697334 DOI: 10.1177/1533317512446187] [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] [Indexed: 11/15/2022]
Abstract
Primary progressive aphasia (PPA) is characterized by progressive loss of language, unassociated with generalized cognitive loss and with no uniform pathological abnormality. To address whether the issue of PPA is associated with synaptic loss, we compared immunoreactivity in Broca's area with that in the adjacent gyrus from a case of progressive, nonfluent PPA using antibodies against synaptophysin. Using semiautomated methods, we assessed serial 0.10 mm(2) diameter areas from the cortical surface to the white matter in both the case and the control. In PPA, synaptophysin immunoreactivity was significantly less in Broca's area than in the adjacent area (optical densities of 0.16 and 0.24). The reduced synaptophysin immunoreactivity was significantly greater in the upper cortex than in the regions of cortex adjacent to the white matter (mean optical densities of 0.14 and 0.18). These data suggest that synaptic loss may be a factor underlying the language deficits in PPA.
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Affiliation(s)
- Carol F Lippa
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA 19102, USA.
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Flaherty-Craig C, Brothers A, McFalls A, Yang C, Simmons Z. VALUES†: a national multicenter study of regional and gender differences in frontotemporal disease in amyotrophic lateral sclerosis. Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.12.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
SUMMARY Aims: To investigate regional and gender differences in prevalence rates and the pattern of cognitive and behavioral impairment in amyotrophic lateral sclerosis. Materials & methods: One hundred and ten subjects (55 male) from 14 amyotrophic lateral sclerosis clinics were cross-sectionally evaluated with the Penn State Brief Exam of frontal and temporal dysfunction syndromes. Results: Prevalence rates of cognitive impairment and behavioral impairment were statistically equivalent among rural, suburban and urban subgroups. Females evidenced significant strengths in fluency and limitations in configurational processing. Patterns of regional findings suggested greater frontal cortical involvement in the rural sample. Females demonstrated more bihemispheric involvement in comparison to more left hemispheric involvement for males. Conclusions: Regional prevalence differences in frontotemporal disease prodrome appear insignificant and multifactorial, while being consistent with the toxicity model implicating pesticides in frontal lobe change. Female gender potentially masks the frontotemporal disease prodrome due to a bilateral distribution of language processing, which requires an assessment of right hemisphere-mediated capacities to detect.
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Affiliation(s)
| | - Allyson Brothers
- Colorado State University, Department of Human Development & Family Studies, Fort Collins, CO 80523, USA
| | - Ashley McFalls
- Penn State University, Department of Psychology, Middletown, PA 17057, USA
| | - Chengwu Yang
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA 17033, USA
| | - Zachary Simmons
- Penn State College of Medicine, Department of Neurology, Hershey, PA 17033, USA
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Irwin D, Lippa CF, Rosso A. Effects of prescribed medications on cognition and behavior in frontotemporal lobar degeneration. Am J Alzheimers Dis Other Demen 2010; 25:566-71. [PMID: 20930186 PMCID: PMC10845326 DOI: 10.1177/1533317510382285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
A retrospective chart review of 21 patients meeting core clinical criteria for behavioral or aphasic variants of frontotemporal lobar degeneration (FTLD) was conducted. Data recorded included Folstein Mini-Mental State Examination (MMSE) scores, medications prescribed, and subjective reports of behavioral symptoms from each visit. Behaviors were graded on a scale from 1 to 3 and totaled for each visit. Changes in MMSE and behavior scores between visits 1 month and 6 months apart where a new medication was started were analyzed using a paired t test and were compared between medication classes using an unpaired t test. Acetylcholinesterase inhibitors (AChEIs) were associated with a decrease in MMSE scores by 1.6 (P = .02) and an increase in total behavior scores by 1.0 (P = .03). Mean MMSE and behavior scores were statistically more improved by selective serotonin reuptake inhibitors than AChEIs (P = .04). This data suggest a potential worsening of objective measures of cognitive and behavioral symptoms in FTLD with AChEI treatment.
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Affiliation(s)
- David Irwin
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA 19102, USA
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