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Shigihara S, Shirakabe A, Matsushita M, Nishigoori S, Sawatani T, Tani K, Kiuchi K, Toguchi R, Kawakami S, Michiura Y, Sawahata M, Kobayashi N, Asai K. Ten-year trends in non-surgical patients requiring intensive care: Long-term prognostic differences by year of admission. J Cardiol 2024:S0914-5087(24)00109-6. [PMID: 38901474 DOI: 10.1016/j.jjcc.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/17/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The aim of the present study is to elucidate prognostic impact of temporal trends of non-surgical patients requiring intensive care over a 10-year period. METHODS AND RESULTS A total of 4276 non-surgical patients requiring intensive care from 2012 to 2021 were enrolled. Patients' backgrounds, in-hospital management, and prognoses were compared between five groups [2012-2013 (n = 825), 2014-2015 (n = 784), 2016-2017 (n = 864), 2018-2019 (n = 939), and 2020-2021 (n = 867)]. During the study period, mean age significantly increased from 69 years in 2012-2013 to 72 years in 2020-2021. Mean Acute Physiology and Chronic Health Evaluation scores significantly increased from 10 points in 2012-2013 to 12 points in 2020-2021. The median duration of intensive care unit stays increased from 3 to 4 days. Kaplan-Meier survival curve analysis showed that survival rates during 30- and 365-days were significantly lower in 2020-2021 than in 2012-2013, but it was not significantly different by a Cox proportional hazards regression model in 30 days. A Cox proportional hazards regression model revealed that the risks of 365-day all-cause death were significantly higher in patients enrolled in 2016-2017 (HR: 1.324, 95 % CI: 1.042-1.680, p = 0.021), in 2018-2019 (HR: 1.329, 95 % CI: 1.044-1.691, p = 0.021), and in 2020-2021 (HR: 1.409, 95 % CI: 1.115-1.779, p = 0.004). CONCLUSION The condition of patients requiring intensive care is becoming more critical year by year, leading to poorer long-term prognoses despite improvements in treatment strategies. These findings emphasize the importance of additional care management after admission into non-surgical intensive care units, particularly for the aging society of Japan.
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Affiliation(s)
- Shota Shigihara
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Tomofumi Sawatani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kenichi Tani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kazutaka Kiuchi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Riku Toguchi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Shohei Kawakami
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yu Michiura
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Mana Sawahata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Yuan Y, Yang Y, Hu X, Zhang L, Xiong Z, Bai Y, Zeng J, Xu F. Effective dosage and mode of exercise for enhancing cognitive function in Alzheimer's disease and dementia: a systematic review and Bayesian Model-Based Network Meta-analysis of RCTs. BMC Geriatr 2024; 24:480. [PMID: 38824515 PMCID: PMC11143595 DOI: 10.1186/s12877-024-05060-8] [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: 01/19/2024] [Accepted: 05/08/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVE Research the dose-response relationship between overall and certain types of exercise and cognitive function in older adults with Alzheimer's disease and dementia. DESIGN Systemic and Bayesian Model-Based Network Meta-Analysis. METHODS In our study, we analyzed data from randomized controlled trials investigating the effects of different exercises on cognitive outcomes in older adults with AD. We searched the Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and Embase up to November 2023. Using the Cochrane Risk of Bias tool (Rob2) for quality assessment and R software with the MBNMA package for data analysis, we determined standard mean differences (SMDs) and 95% confidence intervals (95%CrI) to evaluate exercise's impact on cognitive function in AD. RESULTS Twenty-seven studies with 2,242 AD patients revealed a nonlinear relationship between exercise and cognitive improvement in AD patients. We observed significant cognitive enhancements at an effective exercise dose of up to 1000 METs-min/week (SMDs: 0.535, SD: 0.269, 95% CrI: 0.023 to 1.092). The optimal dose was found to be 650 METs-min/week (SMDs: 0.691, SD: 0.169, 95% CrI: 0.373 to 1.039), with AE (Aerobic exercise) being particularly effective. For AE, the optimal cognitive enhancement dose was determined to be 660 METs-min/week (SMDs: 0.909, SD: 0.219, 95% CrI: 0.495 to 1.362). CONCLUSION Nonlinear dose-response relationship between exercise and cognitive improvement in Alzheimer's disease, with the optimal AE dose identified at 660 METs-min/week for enhancing cognitive function in AD.
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Affiliation(s)
- Yuan Yuan
- Department of Physical Education, Kunsan National University, Daehak-RoJeollabuk-Do, Gunsan-Si, 541150, Korea
| | - Yong Yang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, Hefei, 238000, China
| | - XiaoFei Hu
- The School of Physical Education, Handan University, Handan, 056005, China
| | - Lin Zhang
- Department of Rehabilitation, West China Hospital Sichuan University Jintang Hospital, Chengdu, 610499, China.
| | - Zhiyu Xiong
- The School of Physical Education and Health, East China Jiaotong University, Nanchang, 330013, China
| | - Ying Bai
- Department of Physical Education, Kunsan National University, Daehak-RoJeollabuk-Do, Gunsan-Si, 541150, Korea
| | - JiaLe Zeng
- The School of Physical Education, Jiangxi Normal University, Nanchang, 330224, China
| | - Feng Xu
- College of Physical Education, Fujian Normal University, FuZhou, 350007, China
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McCartney A, Crosswell J, Rafnsson SB, Hoe J. The effectiveness of structured physical activity on agitation in people with dementia: a rapid review. Aging Ment Health 2024:1-11. [PMID: 38683159 DOI: 10.1080/13607863.2024.2345129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/13/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Managing agitation and other behaviours that challenge is a significant dementia care challenge. The priority is to find effective non-pharmacological interventions as drug treatments can have significant side effects. This review evaluates the effectiveness of structured physical activity on agitation in dementia. METHOD Our rapid review searched four electronic databases, Cochrane CENTRAL, MEDLINE, CINAHL and Embase, for interventional studies using a structured physical activity programme in people with dementia and studied the effect of this activity on behaviours that challenge. Study quality was assessed using CASP criteria and data was narratively synthesised. RESULTS We included 13 studies in this review (four rated as high quality), involving a total of 1546 participants. Results were analysed according to exercise type, frequency and intensity of the intervention. Exercise is effective in reducing agitation and studies with higher adherence to exercise demonstrated more positive effects on agitation and behaviours that challenge. CONCLUSION Physical activity can be effective in reducing agitation in older adults with dementia. Further research is needed to clarify the type of intervention that is most beneficial. Strategies to make physical activity more acceptable and available to people with dementia need to be established.
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Affiliation(s)
- A McCartney
- Estuary View Medical Centre, Whitstable Medical Practice, Kent, United Kingdom
| | - J Crosswell
- Estuary View Medical Centre, Whitstable Medical Practice, Kent, United Kingdom
| | - S B Rafnsson
- Geller Institute of Ageing and Memory, School of Biomedical Sciences, University of West London, London, United Kingdom
| | - J Hoe
- Geller Institute of Ageing and Memory, School of Biomedical Sciences, University of West London, London, United Kingdom
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Khan SA, Khan S, Kausar H, Shah R, Luitel A, Gautam S, Parajuli SB, Rauniyar VK, Khan MA. Insights into the management of Lewy body dementia: a scoping review. Ann Med Surg (Lond) 2024; 86:930-942. [PMID: 38333295 PMCID: PMC10849442 DOI: 10.1097/ms9.0000000000001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024] Open
Abstract
Lewy body dementia (LBD) is situated at the convergence of neurodegenerative disorders, posing an intricate and diverse clinical dilemma. The accumulation of abnormal protein in the brain, namely, the Lewy body causes disturbances in typical neural functioning, leading to a range of cognitive, motor, and mental symptoms that have a substantial influence on the overall well-being and quality of life of affected individuals. There is no definitive cure for the disease; however, several nonpharmacological and pharmacological modalities have been tried with questionable efficacies. The aim of this study is to figure out the role of different interventional strategies in the disease. Donepezil, rivastigmine, memantine, and galantamine were the commonly used drugs for LBD. Together with that, levodopa, antipsychotics, armodafinil, piracetam, and traditional medications like yokukansan were also used, when indicated. Talking about nonpharmacological measures, exercise, physical therapy, multicomponent therapy, occupational therapy, psychobehavioral modification, transcranial stimulation, and deep brain stimulation have been used with variable efficacies. Talking about recent advances in the treatment of LBD, various disease-modifying therapies like ambroxol, neflamapimod, irsenontrine, nilotinib, bosutinib, vodobatinib, clenbuterol, terazosin, elayta, fosgonimeton, and anle138b are emerging out. However, there drugs are still in the different phases of clinical trials and are not commonly used in clinical practice. With the different pharmacological and nonpharmacological modalities we have for treatment of LBD, all of them offer symptomatic relief only. Being a degenerative disease, definite cure of the disease can only be possible with regenerative measures.
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Affiliation(s)
- Sajjad Ahmed Khan
- Department of Community Medicine, Birat Medical College Teaching Hospital, Morang
| | - Sadab Khan
- Karnali Academy of Health Sciences, Karnali, Nepal
| | - Huma Kausar
- Karnali Academy of Health Sciences, Karnali, Nepal
| | - Rajat Shah
- Department of Community Medicine, Birat Medical College Teaching Hospital, Morang
| | - Anish Luitel
- Department of Community Medicine, Birat Medical College Teaching Hospital, Morang
| | - Sakshyam Gautam
- Department of Community Medicine, Birat Medical College Teaching Hospital, Morang
| | | | - Vivek K. Rauniyar
- Department of Clinical Neurology, Birat Medical College Teaching Hospital, Morang
| | - Moien A.B. Khan
- Department of Family Medicine, College of Medicine and Health sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates
- Primary Care, NHS North West London, United Kingdom
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Bynum JPW, Montoya A, Lawton EJ, Gibbons JB, Banerjee M, Meddings J, Norton EC. Accountable Care Organization Attribution and Post-Acute Skilled Nursing Facility Outcomes for People Living With Dementia. J Am Med Dir Assoc 2024; 25:53-57.e2. [PMID: 38081322 DOI: 10.1016/j.jamda.2023.10.031] [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: 07/10/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES Under the Accountable Care Organization (ACO) model, reductions in healthcare spending have been achieved by targeting post-acute care, particularly in skilled nursing facilities (SNFs). People with Alzheimer disease and related dementias (ADRD) are frequently discharged to SNF for post-acute care and may be at particular risk for unintended consequences of SNF cost reduction efforts. We examined SNF length of stay (LOS) and outcomes among ACO-attributed and non-ACO-attributed ADRD patients. DESIGN Observational serial cross-sectional study. SETTING AND PARTICIPANTS Twenty percent national random sample of fee-for-service Medicare beneficiaries (2013-2017) to identify beneficiaries with a diagnosis of ADRD and with a hospitalization followed by SNF admission (n = 263,676). METHODS Our primary covariate of interest was ACO (n = 66,842) and non-ACO (n = 196,834) attribution. Hospital readmission and death were measured for 3 time periods (<30, 31-90, and 91-180 days) following hospital discharge. We used 2-stage least squares regression to predict LOS as a function of ACO attribution, and patient and facility characteristics. RESULTS ACO-attributed ADRD patients have shorter SNF LOS than their non-ACO counterparts (31.7 vs 32.8 days; P < .001). Hospital readmission rates for ACO vs non-ACO differed at ≤30 days (13.9% vs 14.6%; P < .001) but were similar at 31-90 days and 91-180 days. No significant difference was observed in mortality post-hospital discharge for ACO vs non-ACO at ≤30 days; however, slightly higher mortality was observed at 31-90 days (8.4% vs 8.8%; P = .002) and 91-180 days (7.6% vs 7.9%; P = .011). No significant association was found between LOS and readmission, with small effects on mortality favoring ACOs in fully adjusted models. CONCLUSIONS AND IMPLICATIONS Being an ACO-attributed patient is associated with shorter SNF LOS but is not associated with changes in readmission or mortality after controlling for other factors. Policies that shorten LOS may not have adverse effects on outcomes for people living with dementia.
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Affiliation(s)
- Julie P W Bynum
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Ana Montoya
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Emily J Lawton
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jason B Gibbons
- Department of Health Policy and Managing, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mousumi Banerjee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jennifer Meddings
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, MI, USA; Geriatrics Research Education and Clinical Center (GRECC), Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Edward C Norton
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Bardopoulou MS, Patsaki I, Chondronikola C, Chryssanthopoulos C, Cherouveim ED, Lakoniti KO, Maridaki M, Papageorgiou SG, Koutsilieris M, Philippou A. Effect of a 36-Week Supervised Exercise Training Program on Physical and Cognitive Function in Older Patients With Dementia. In Vivo 2024; 38:286-294. [PMID: 38148092 PMCID: PMC10756456 DOI: 10.21873/invivo.13437] [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: 07/15/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND/AIM To investigate the effects of an exercise training program on physical and cognitive function in older patients with dementia. PATIENTS AND METHODS Thirty-eight patients with early-middle dementia (31 females and seven males), aged 80.6±6.9 years, residents in an Elderly Care Unit, either completed a 36-week structured exercise program (Intervention Group, IG; n=19), or received the usual medical care (Control Group, CG; n=19). Before and after the 36-week intervention, cognitive function was evaluated in both groups by Mini-Mental State Examination (MMSE) and depression by Geriatric Depression Scale (GDS); physical function was assessed using handgrip test, Timed Up to Go (TUG), Berg Balance Scale (BBS) and Chair-Stand Test (CST), and daily living functionality by Functional Rating Scale for Symptoms of Dementia (FRSSD). RESULTS As a result of exercise intervention, participants scored better in all functional and cognitive test assessments compared to the control group, as reflected by absolute and relative (%) differences in all metrics after the 36-week exercise program (p<0.001). CONCLUSION A 36-week supervised exercise training program was found to result in significant improvements in physical and cognitive function of elderly patients in early to middle stages of dementia at an Elderly Care Unit. The promising results of this study shed more light on the adaptability of elderly patients with early and mild dementia to long-term exercise training and verified the feasibility of applying such programs in this clinical population.
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Affiliation(s)
- Mari S Bardopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Irini Patsaki
- Physiotherapy Department, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | | | - Costas Chryssanthopoulos
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evgenia D Cherouveim
- School of Physical Education and Sports Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Klaountia-Olympia Lakoniti
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Maridaki
- School of Physical Education and Sports Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Sokratis G Papageorgiou
- First Department of Neurology, Aeginiteio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastassios Philippou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece;
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Lenox ER, Jones MW. Balance-based exercise programs on balance in older adults with mild to moderate dementia: A critically appraised topic. Ageing Res Rev 2023; 91:102073. [PMID: 37709056 DOI: 10.1016/j.arr.2023.102073] [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: 07/10/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE It is well established that exercise programs including balanced-based exercises are practical and beneficial for cognitively healthy older adults. However, there is limited evidence to determine if these types of training regimens are effective for individuals with dementia. We conducted a critical appraisal to determine if the addition of balance-based exercise programs, compared with usual care at residential homes, improved balance in adults diagnosed with mild to moderate dementia. MATERIALS AND METHODS Four databases were searched for randomized control trials implementing balanced-based exercise programs with individuals diagnosed with mild to moderate dementia. The articles were evaluated based on the Centre for Evidence Based Medicine level of evidence criteria and appraised using the PEDro scale. RESULTS A comprehensive literature search revealed four studies relevant to the clinical question that fit the inclusion and exclusion criteria. All four studies indicated an improvement in balance following a weekly physical therapy program implementing balance-based exercises. CONCLUSIONS There is sufficient evidence to suggest that the use of physical therapy programs that include balance-based exercises, performed 1-2 times a week over the course of 12-25 weeks, improves balance in elderly adults with mild to moderate dementia.
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Affiliation(s)
- Ella R Lenox
- Biological Sciences Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407, USA.
| | - Michael W Jones
- Biological Sciences Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407, USA.
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Liu Y, Zhang H, Xu R. The impact of technology on promoting physical activities and mental health: a gender-based study. BMC Psychol 2023; 11:298. [PMID: 37775753 PMCID: PMC10542252 DOI: 10.1186/s40359-023-01348-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Physical inactivity is a significant public health concern globally, associated with an increased risk of chronic diseases and detrimental effects on both physical and mental health. Technologically based interventions have emerged as a potential solution to promote physical activity engagement and improve mental health outcomes. However, understanding the effectiveness of these interventions and the role of gender in their outcomes is essential for developing tailored strategies. OBJECTIVE This study aims to examine the effectiveness of technologically based interventions in promoting physical activity and improving mental health outcomes, with a specific focus on gender differences. METHODOLOGY This study employed a three-phase mixed methods research design. Phase one was an experimental phase where 300 participants were randomly assigned to intervention or control groups. The intervention group received a technologically based physical activity intervention, while the control group did not. Physical activity levels and mental health outcomes were assessed before and after the intervention. Phase two involved qualitative interviews with a subset of participants (n = 20) from the intervention group. These interviews explored motivations and barriers to physical activity, aiming to uncover personal factors influencing engagement. Thematic analysis was used to identify recurring themes. Phase three utilized a quantitative survey to compare motivations and barriers between males and females. The survey, administered to a larger sample, included participants from both intervention and control groups. It assessed various factors and allowed for a quantitative comparison of gender differences. FINDINGS findings indicated that the intervention improved the mental health and physical activities level of the intervention groups. Findings also there are 8 motivations for and barriers to using technology in physical activities. Male and females' scores on some of the motivations and barriers were statistically significant. CONCLUSION technology plays an important role in improving the mental health and physical activities of adults. Findings can be used by health care centers, digital psychologists, and physical trainers.
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Affiliation(s)
- Yangyang Liu
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, 450001, China
| | - Hongxue Zhang
- School of Physical Education, Zhengzhou University, Zhengzhou, 450044, Henan Province, China
| | - Ruilin Xu
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou, 450001, China.
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Quasdorf T, Manietta C, Rommerskirch-Manietta M, Braunwarth JI, Roßmann C, Roes M. Implementation of interventions to maintain and promote the functional mobility of nursing home residents - a scoping review. BMC Geriatr 2023; 23:600. [PMID: 37752436 PMCID: PMC10523713 DOI: 10.1186/s12877-023-04213-5] [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: 02/07/2023] [Accepted: 08/02/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND To provide an overview of the available evidence on the implementation of direct and capacity-building interventions to promote and maintain the functional mobility of nursing home residents. METHODS We conducted a scoping review following the methodological guidance for the conduct of scoping reviews as described by the Joanna Briggs Institute. We searched for studies in MEDLINE (via PubMed) and CINAHL (via EBSCO). We conducted a qualitative content analysis of the included studies with deductive categories based on the Consolidated Framework for Implementation Research (CFIR). RESULTS Ultimately, we included 8 studies on direct interventions, 6 studies on capacity-building interventions, and 2 studies on both types of interventions in our review. Seven studies provided evidence on implementation strategies comprising discrete as well as multifaceted, multilevel strategies. Most of the studies did not systematically evaluate the strategies but remained at a descriptive level. All 16 studies provided evidence of influencing factors. We identified 32 of the 37 influencing factors of the CFIR. The five most frequent influencing factors were available resources (n = 14), access to knowledge and information (n = 12), patient needs and resources (n = 10), knowledge and beliefs about the intervention (n = 10) and compatibility (n = 9). CONCLUSIONS The available evidence on the implementation of functional mobility interventions in nursing homes is rather limited. This emphasizes the need for further research. Regarding implementation strategies, the systematic evaluation and further development of the reported promising approaches might be a starting point.
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Affiliation(s)
- Tina Quasdorf
- School of Health Science, Institute of Nursing, ZHAW Zürich University of Applied Science, Winterthur, Switzerland.
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Jana Isabelle Braunwarth
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Christin Roßmann
- Bundeszentrale für gesundheitliche Aufklärung (BZgA), Köln, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Standort Witten, Witten, Germany
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
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Rivas-Campo Y, Aibar-Almazán A, Afanador-Restrepo DF, García-Garro PA, Vega-Ávila GC, Rodríguez-López C, Castellote-Caballero Y, Carcelén-Fraile MDC, Lavilla-Lerma ML. Effects of High-Intensity Functional Training (HIFT) on the Functional Capacity, Frailty, and Physical Condition of Older Adults with Mild Cognitive Impairment: A Blind Randomized Controlled Clinical Trial. Life (Basel) 2023; 13:life13051224. [PMID: 37240869 DOI: 10.3390/life13051224] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
Physical exercise has been established as an intervention in the integral approach for the physical, functional, and social health of older adults. The objective of this study was to determine the effects of a high-intensity functional training (HIFT) program on the physical condition and functional capacity of an elderly Colombian population with mild cognitive impairment. This research corresponds to a blind randomized controlled clinical trial. A total of 169 men and women aged over 65 years were evaluated and distributed in two groups: the experimental group that received a 12-week HIFT intervention (n = 82) and the control group (n = 87) that received general recommendations on the benefits of physical exercise. The outcome variables included physical condition, assessed using the Senior Fitness battery (SNB); Fried's frailty phenotype was applied, and gait and balance were assessed using the Tinetti scale. For the functional variables, activities of daily living, instrumental activities of daily living, and advanced activities of daily living were evaluated. All variables were measured pre- and post-intervention. Statistically significant improvements were observed in the IG for gait stability and balance (p < 0.001), as well as for independence in activities of daily living (p = 0.003), and instrumental and advanced activities (p < 0.001). Likewise, greater functionality was found when assessed with the SNB (p < 0.001), except for upper limb strength. The frailty classification did not show changes post-intervention (p = 0.170) nor in the group x time interaction. MANCOVA analysis showed that regardless of gender, health level, age, BMI, cognition, and health level, the HIFT intervention produced better results in functional capacity, balance, and gait (F = 0.173, p < 0.001, Wilks' λ = 88.231).
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Affiliation(s)
- Yulieth Rivas-Campo
- Faculty of Human and Social Sciences, University of San Buenaventura-Cali, Santiago de Cali 760016, Colombia
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | | | - Gloria Cecilia Vega-Ávila
- Faculty of Distance and Virtual Education, Antonio José Camacho University Institution, Santiago de Cali 760016, Colombia
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Chen CH, Lin CY, Chen CL, Chen KT, Lee C, Yu YH, Shih CY. Long-Term Effectiveness of Physical Exercise-Based Swallowing Interventions for Older Adults with Dementia in a Day-Care Center. Healthcare (Basel) 2023; 11:healthcare11091262. [PMID: 37174804 PMCID: PMC10178008 DOI: 10.3390/healthcare11091262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Swallowing safety is one of the top health concerns of dementia. Coughing and choking (coughing/choking) are signs of impaired swallowing safety. This study aimed to investigate the effectiveness of regular physical exercise-based swallowing intervention for reducing coughing-choking at the dementia day-care center. This was a retrospective analysis with data from medical records, including age, the clinical dementia rating (CDR), and the frequencies of coughing/choking in ten days (10-day coughing/choking). Those who complied with the exercise programs were assigned to the exercise-based group (n = 22), and those who could not comply were assigned to the non-exercised-based group (n = 7). The non-exercised-based group showed more advanced age and higher CDR than the exercise-based group (p < 0.05). The 10-day coughing/choking showed significant decreases at the 5-month and 19-month in the exercise-based group and at the 5-month in the non-exercise-based group (p < 0.05). Our findings suggested that regular physical exercise-based swallowing intervention effectively alleviated coughing/choking problems of older adults with dementia and its effectiveness was long-lasting. For those who could not comply with exercise programs, noticeably with more advanced age and dementia, the effective swallowing intervention period was short-term.
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Affiliation(s)
- Chia-Hui Chen
- Department of Rehabilitation Medicine, Hualien Tzu Chi Medical Center, Hualien 970, Taiwan
| | - Chia-Yu Lin
- Department of Rehabilitation Medicine, Hualien Tzu Chi Medical Center, Hualien 970, Taiwan
| | - Chiao-Ling Chen
- Department of Psychiatric, Hualien Tzu Chi Medical Center, Hualien 970, Taiwan
| | - Kuan-Ting Chen
- Department of Psychiatric, Hualien Tzu Chi Medical Center, Hualien 970, Taiwan
| | - Cho Lee
- Department of Psychiatric, Hualien Tzu Chi Medical Center, Hualien 970, Taiwan
| | - Ya-Hsin Yu
- Department of Psychiatric, Hualien Tzu Chi Medical Center, Hualien 970, Taiwan
| | - Chiao-Yu Shih
- Department of Physical Therapy, Tzu Chi University, Hualien 970, Taiwan
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Behrendt D, Spieker S, Sumngern C, Wendschuh V. Integrating social support into interventions among the elderly in nursing homes: a scoping review. BMJ Open 2023; 13:e071962. [PMID: 37085297 PMCID: PMC10124279 DOI: 10.1136/bmjopen-2023-071962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES This study aimed to understand the evidence related to integration of social support into interventions, to identify literature gaps related to social support interventions, and to clarify dimensions of supportive functions, outcomes, and providers among the elderly in nursing homes. DESIGN This scoping review followed the approach by Arksey and O'Malley. The Mixed Methods Appraisal Tool V.2018 was used for quality assessment of the studies. DATA SOURCES Searches were conducted of the PubMed, ScienceDirect, Public Library of Science, SocioHub, Wiley Online Library and PsycINFO databases for publications from 2010 to 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We searched for primary studies and heterogeneous study designs published in English. Eligible studies took place in nursing and care homes and had study populations of elderly adults (older adults, geriatrics, ageing, seniors, older people and those aged 60 years and older). DATA EXTRACTION AND SYNTHESIS A data extraction form based on Joanna Briggs Institute's recommendations for scoping reviews was used. Two reviewers independently extracted data and performed quality assessment of the studies. Then, extracted data and quality assessment reports were discussed by all authors. RESULTS Thirty-one eligible studies were included in this review. 54.8% of the studies provided interventions for cognitively impaired residents. The top-three outcomes were neuropsychiatric symptoms, physical function and quality of life, respectively. The interventions were performed by nursing home staff (83.9%), other persons with specific qualifications (58.1%) and health volunteers (6.5%). Most studies (90.3%) depicted the integration of emotional and instrumental supportive functions into interventions. CONCLUSION The appropriate dimensions of supportive function, mainly emotional and instrumental support, are important to integrate into the social care of elderly people living in nursing homes.
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Affiliation(s)
- Daniel Behrendt
- Nursing Department, Städtisches Klinikum Dessau, Dessau, Germany
| | - Sybille Spieker
- Departments of Neurology and Geriatrics, Städtisches Klinikum Dessau, Dessau, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin and Brandenburg, Germany
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13
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Luo G, Zhang J, Song Z, Wang Y, Wang X, Qu H, Wang F, Liu C, Gao F. Effectiveness of non-pharmacological therapies on cognitive function in patients with dementia-A network meta-analysis of randomized controlled trials. Front Aging Neurosci 2023; 15:1131744. [PMID: 36967820 PMCID: PMC10035791 DOI: 10.3389/fnagi.2023.1131744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Objective Non-pharmacological therapies (NPTs) have received increasing attention from researchers as a category of treatment to improve cognitive impairment in patients with dementia because of their fewer side effects. In this study, photobiomodulation (PBM), enriched environment (EE), exercise therapy (ET), computerized cognitive training (CCT), and cognitive stimulation therapy (CST) were selected to compare the effects of NPTs that improve dementia by quantifying information from randomized controlled trials (RCTs). Methods We did a systematic review and network meta-analysis. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure Database, Wan Fang Database, Chinese Biomedical Literature Database, Web of Science, and VIP Database from the time of database creation to 1 August 2022. Two investigators independently screened the literature, extracted information, and assessed the RCTs' quality with the Cochrane Collaboration Network Risk of Bias 2.0. Network meta-analysis was performed using R language (X64 version 4.1.3) and STATA 17.0. Results We identified 1,268 citations and of these included 38 trials comprising 3,412 participants. For improving dementia, the results of the network meta-analysis showed that compared with the control group (CON), PBM (SMD = 0.90, 95% CI: 0.43-1.37), EE (SMD = 0.71, 95% CI: 0.02-1.41), ET (SMD = 0.42, 95% CI: 0.16-0.68), and CST (SMD = 0.36, 95% CI: 0.11-0.62) were significantly different (P < 0.05); There was no significant difference in CCT (SMD = 0.41, 95% CI: -0.07-0.88) (P > 0.05). The ranked results showed that PBM has more potential to be the best intervention (P = 0.90). In addition, there was a significant difference between PBM and CST in improving cognitive function (SMD = 0.54, 95% CI: 0.00; 1.08, P < 0.05). Conclusion In this study, NPTs have excellent potential to improve cognition in people with dementia, and PBM may have more significant benefits in improving cognition than the other four NPTs. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022363746.
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Affiliation(s)
- Guangxin Luo
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Junqiu Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Zeyi Song
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Ying Wang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Xiaojing Wang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Haifeng Qu
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Fang Wang
- Department of Psychology, The Fourth People’s Hospital of Wuhu, Wuhu, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical University, Anqing, China
| | - Fujia Gao
- School of Public Health, North China University of Science and Technology, Tangshan, China
- Hebei Province Key Laboratory of Occupational Health and Safety for Coal Industry, School of Public Health, North China University of Science and Technology, Tangshan, China
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Abbas RL, Saab IM, Al-Sharif HK, Naja N, El-Khatib A. Effect of Adding Motorized Cycle Ergometer Over Exercise Training on Balance in Older Adults with Dementia: A Randomized Controlled Trial. Exp Aging Res 2023; 49:100-111. [PMID: 35301911 DOI: 10.1080/0361073x.2022.2046947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Falls secondary to balance disturbances have been considered as a burden on health systems in people with dementia aged above 65. Exercise has been increasingly recommended to address such problem and the main challenges being the commitment and supervision of training. The study's aim was to investigate the effect of adding motorized cycle ergometer (MCE) on high intensity functional exercise (HIFE) training on balance and cognition in older adults with dementia. METHODS Sixty participants over the age of 65 were randomly allocated into 3 groups, Mo, Ex, and MoEx undergoing, respectively, 50 minutes MCE, HIFE, or combination of both. Sessions were done 3 times per week for 12 weeks. Outcome measures taken before and after study period were Berg Balance Scale (BBS), timed up and go test (TUG), and Mini Mental State Exam (MMSE). RESULTS All groups showed significant improvement in BBS scores but not on TUG or MMSE scores. Between group analysis showed no privilege of any used training methods over the other for all measures taken. CONCLUSIONS Training with HIFE, MCE, or combination of both is effective in improving balance but not cognition. However, MCE can be an alternative to supervised exercise training in addressing balance.
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Affiliation(s)
- Rami L Abbas
- Physical Therapy Department, Faculty of Health Sciences, Beirut Arab University, Lebanon
| | - Ibtissam M Saab
- Physical Therapy Department, Faculty of Health Sciences, Beirut Arab University, Lebanon
| | | | - Nabil Naja
- Dar Al Ajaza Al Islamiah Hospital, Lebanon
| | - Ayman El-Khatib
- Physical Therapy Department, Faculty of Health Sciences, Beirut Arab University, Lebanon
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15
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Naito T, Suzuki Y, Yamasue K, Saito K, Umemura M, Kojima N, Kim H, Osuka Y, Ishikawa Y, Tochikubo O. Relationship between Cognitive Function and Sway of Body in Standing Posture: A Cross-Sectional Study. Geriatrics (Basel) 2023; 8:geriatrics8020029. [PMID: 36960984 PMCID: PMC10037616 DOI: 10.3390/geriatrics8020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/02/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND The influence of neurological or balance dysfunction on cognitive impairment has not been well studied. We compared the results of the balance test, measured by either head or foot sway to consider whole body sway, with those of the cognitive impairment test. METHODS Individuals of either gender, aged over 60 years, underwent a 30 s balance test. We measured sway while standing on one-leg or two-legs. Sway was evaluated by the distance or area of movement of the head or foot pressure. We also evaluated the effect of visual condition: eyes-open (EO) or -closed (EC). The Mini-Mental State Examination (MMSE) was used to evaluate the degree of cognitive impairment. RESULTS The head sway area standing on one leg was significantly correlated to MMSE score with EO (correlation r = -0.462). In standing on two legs, no sway test results showed a significant correlation to MMSE scores with EO. With EC, the magnitude of sway became greater, and was significantly correlated to MMSE scores in the head distance. CONCLUSION Although the correlation between head sway and MMSE was not strong, head sway showed a stronger correlation than did foot pressure sway. Standing on one leg, as measured by head sway area, may thus predict cognitive impairment.
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Affiliation(s)
- Takao Naito
- Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Yume Suzuki
- Department of General Internal Medicine, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Kotaro Yamasue
- Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Kyoko Saito
- Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Masanari Umemura
- Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Narumi Kojima
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Hunkyung Kim
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Yosuke Osuka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Yoshihiro Ishikawa
- Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Osamu Tochikubo
- Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
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Cowley A, Booth V, Di Lorito C, Chandria P, Chadwick O, Stanislas C, Dunlop M, Howe L, Harwood RH, Logan PA. A Qualitative Study on the Experiences of Therapists Delivering the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) Intervention During the COVID-19 Pandemic. J Alzheimers Dis 2023; 91:203-214. [PMID: 36404541 PMCID: PMC9881024 DOI: 10.3233/jad-220424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) intervention is a programme of physical activity and exercise designed to maintain participation in activities of daily living, mobility, and quality of life for people living with dementia. During the COVID-19 pandemic first national lockdown in England, the PrAISED physiotherapists, occupational therapists, and rehabilitation support workers adapted to delivering the intervention remotely via telephone or video conferencing. OBJECTIVE The aim of this study was to explore therapists' experience of delivering the PrAISED intervention during the COVID-19 pandemic and derive implications for clinical practice. METHODS Qualitative semi-structured interviews were conducted with 16 therapists using purposive sampling. Thematic analysis was used to analyze the transcripts. RESULTS Therapists reported a change in the relationship between themselves, the person with dementia and the caregiver, with an increased reliance on the caregiver and a loss of autonomy for the person living with dementia. There was concern that this would increase the burden on the caregiver. The therapists reported using creativity to adapt to different modes of delivery. They felt their sessions were mostly focused on providing social and emotional support, and that assessing, progressing, and tailoring the intervention was difficult. CONCLUSION It is possible to deliver some elements of a physical intervention using remote delivery, but a dual modal approach including remote and face-to-face delivery would optimize treatment efficacy. Educational support would be required to enable people living with dementia and their caregivers to overcome barriers relating to digital literacy.
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Affiliation(s)
- Alison Cowley
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom,Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom,Correspondence to: Alison Cowley, Research & Innovation, Nottingham University Hospitals NHS Trust, QMC Campus, Derby Road, Nottingham NG2 7UH, UK. Tel.: +0115 9691169 Ext. 77148; E-mail:
| | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom,Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Claudio Di Lorito
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Pooja Chandria
- School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Olivia Chadwick
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | | | - Marianne Dunlop
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Louise Howe
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom,
School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Rowan H. Harwood
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Pip A. Logan
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, United Kingdom,Nottingham CityCare Partnership CIC, Nottingham, United Kingdom
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Hsiao CC, Lin CC, Cheng CG, Chang YH, Lin HC, Wu HC, Cheng CA. Self-Reported Beneficial Effects of Chinese Calligraphy Handwriting Training for Individuals with Mild Cognitive Impairment: An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1031. [PMID: 36673790 PMCID: PMC9859373 DOI: 10.3390/ijerph20021031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Dementia is a common disease in aging populations. The treatment has mainly focused on memory decline prevention and behavior control. Nonpharmacological treatments, such as cognition training, physical exercise, and music therapy have been effective in slowing memory decline. Chinese calligraphy handwriting (CCH) through breath regulation and fine hand control involves high concentration levels, emotion regulation, and self-awareness. CCH is a mind and body activity that is culturally relevant to older Chinese adults. This study evaluated the beneficial effects of CCH on mild cognitive impairment. METHODS In 2018, we conducted 8 weeks of CCH training at the Tri-Service General Hospital. The participants were asked to copy a regular script. At the end of the course, they gave oral presentations and showed their work. Self-report questionnaires on emotion, memory, upper limb coordination, attention, and language were collected before and after training. RESULTS The five questionnaires showed significantly positive feelings after CCH training. The conditions of emotional stability, concentration, hand movement, memory, and speech improved. CONCLUSIONS CCH training stimulated the brain and improved cognition, psychological symptoms, and hand stability. It is inexpensive and worthwhile for elderly Chinese individuals with mild cognitive impairment to take time daily to practice calligraphy.
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Affiliation(s)
- Chih-Chun Hsiao
- Department of Nursing, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
| | - Chun-Chieh Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chun-Gu Cheng
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, National Defense Medical Center, Taoyuan 32549, Taiwan
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Yin-Han Chang
- Department of Psychology, National Taiwan University, Taipei 10621, Taiwan
| | - Hui-Chen Lin
- School of Nursing, Taipei Medical University, Taipei 11031, Taiwan
| | - Hsing-Chen Wu
- Graduate Institute of Vocational and Technological Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
| | - Chun-An Cheng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
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Boulares A, Fabre C, Cherni A, Jdidi H, Gaied Chortane S, Trompetto C, Puce L, Bragazzi NL. Effects of a Physical Activity Program that Incorporates Exercises Targeting Balance, Strength, and Proprioception on Cognitive Functions and Physical Performance in Old Adults with Mild Cognitive Impairment. J Alzheimers Dis 2023; 96:245-260. [PMID: 37742641 DOI: 10.3233/jad-230305] [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: 09/26/2023]
Abstract
BACKGROUND Aging often leads to cognitive function decline, sensory structure deterioration, and musculoskeletal system weakening. This impacts postural control during static and dynamic activities like walking, increasing the fall risk among the elderly. Older adults with mild cognitive impairment (MCI) face an elevated fall risk and cognitive decline, magnifying the public health concern. OBJECTIVE This study aimed to explore solutions by investigating the effects of a multi-component physical activity program on cognitive and motor functions in MCI patients. METHODS Twenty-three participants were enrolled in the study and assigned into two groups: an intervention group (n = 13; age = 85.7±5.5 years) and a control group (n = 9; age = 85±6.7 years). The study spanned two months, with participants engaging in three 60-minute weekly physical exercise sessions. The intervention focused on improving proprioception, muscle strength, and balance. RESULTS Results demonstrated significant enhancements in physical performance, fall risk reduction, and balance (p < 0.05). Various tests, including the timed up and go test, Unipedal Stance test, Tinetti test, Short Physical Performance Battery, and 6-minute walking test, indicated these improvements. Cognitive function was evaluated with the Mini-Mental State Examination, revealing non-significant progress (p > 0.05). Predictive models for outcomes were developed using linear regression analysis during the follow-up stage. CONCLUSIONS This study underscores the effectiveness of a multi-component physical activity program encompassing balance, proprioception, and muscle-strengthening exercises as a non-pharmaceutical approach in improving balance skills and playing a key role in mitigating the risk of falls among old adults with MCI.
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Affiliation(s)
- Ayoub Boulares
- Research Laboratory (LR23JS01) "Sport Performance, Health & Society" Higher Institute of Sport and Physical Education of Ksar Said, University of "La Manouba", Manouba, Tunisia
| | - Claudine Fabre
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Ala Cherni
- Research Unit: Sports Science, Health and Movement, UR22JS01, High Institute of Sport and Physical Education of Kef, University of Jendouba, Jendouba, Tunisia
| | - Hela Jdidi
- University of Poitiers, Laboratory Move-UR 20296, Faculty of Sports Sciences, Poitiers, France
| | - Sabri Gaied Chortane
- Research Laboratory (LR23JS01) "Sport Performance, Health & Society" Higher Institute of Sport and Physical Education of Ksar Said, University of "La Manouba", Manouba, Tunisia
- Laboratory of Cardio-Circulatory, Respiratory, Metabolic and Hormonal Adaptations to Muscular Exercise, Faculty of Medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Nicola Luigi Bragazzi
- Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, ON, Canada
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Jehu DA, Davis JC, Gill J, Oke O, Liu-Ambrose T. The Effect of Exercise on Falls in People Living with Dementia: A Systematic Review. J Alzheimers Dis 2023; 92:1199-1217. [PMID: 36872779 DOI: 10.3233/jad-221038] [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: 03/05/2023]
Abstract
BACKGROUND People living with dementia (PWD) are at a heightened risk for falls. However, the effects of exercise on falls in PWD are unclear. OBJECTIVE To conduct a systematic review of randomized controlled trials (RCTs) examining the efficacy of exercise to reduce falls, recurrent falls, and injurious falls relative to usual care among PWD. METHODS We included peer-reviewed RCTs evaluating any exercise mode on falls and related injuries among medically diagnosed PWD aged ≥55years (international prospective register of systematic reviews (PROSPERO) ID:CRD42021254637). We excluded studies that did not solely involve PWD and were not the primary publication examining falls. We searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register and grey literature on 08/19/2020 and 04/11/2022; topical categories included dementia, exercise, RCTs, and falls. We evaluated the risk of bias (ROB) using the Cochrane ROB Tool-2 and study quality using the Consolidated Standards of Reporting Trials. RESULTS Twelve studies were included (n = 1,827; age = 81.3±7.0 years; female = 59.3%; Mini-Mental State Examination = 20.1±4.3 points; intervention duration = 27.8±18.5 weeks; adherence = 75.5±16.2%; attrition = 21.0±12.4%). Exercise reduced falls in two studies [Incidence Rate Ratio (IRR) range = 0.16 to 0.66; fall rate range: intervention = 1.35-3.76 falls/year, control = 3.07-12.21 falls/year]; all other studies (n = 10) reported null findings. Exercise did not reduce recurrent falls (n = 0/2) or injurious falls (n = 0/5). The RoB assessment ranged from some concerns (n = 9) to high RoB (n = 3); no studies were powered for falls. The quality of reporting was good (78.8±11.4%). CONCLUSION There was insufficient evidence to suggest that exercise reduces falls, recurrent falls, or injurious falls among PWD. Well-designed studies powered for falls are needed.
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Affiliation(s)
- Deborah A Jehu
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer C Davis
- Applied Health Economics Laboratory, The University of British Columbia -Okanagan, Kelowna, BC, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, BC, Canada
| | - Jessica Gill
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Olabamibo Oke
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Teresa Liu-Ambrose
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Park HJ, Oh DW, Kang TW. Music-Based Sling Exercise for Cognition and Function of Older Adults with Dementia. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2091722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Hyun-Ju Park
- Dr Ara Pilaes Lab, Seo-gu, Daejeon, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Tae-Woo Kang
- Department of Physical Therapy, College of Health and Welfare, Woosuk University, Wanju_Gun, Jeollabuk-do, Republic of Korea
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Telenius EW, Tangen GG, Eriksen S, Rokstad AMM. Fun and a meaningful routine: the experience of physical activity in people with dementia. BMC Geriatr 2022; 22:500. [PMID: 35689197 PMCID: PMC9188090 DOI: 10.1186/s12877-022-03149-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Physical activity is important to health and wellbeing. People with dementia are less physically active than their cognitively healthy counterparts. Reasons for this are multifaceted, and are thought to be social, psychological, and physiological. People with dementia often use services such as home care, day care centres and nursing home, and according to the stage of disease they are less or more dependent on other people to take part in activities. To develop appropriate services to this patient group, their needs and preferences regarding physical activity must be recognized. The aim of the study was therefore to provide insight into experiences with physical activity in people with dementia. Methods The current study is part of a larger research project on needs in people with dementia. The main project included qualitative semi-structured interviews with 35 persons with dementia. 27 of the participants talked about their experience with physical activity. In the current study, the relevant findings on this theme were analysed separately. A phenomenological hermeneutic research design was applied. Results The analysis revealed three main categories regarding experiences with physical activity. To be physically active provided positive experiences such as feelings of mastering and post-exercise euphoria. To be physically active was meaningful. The daily walk was an important routine to many, and it gave meaningful content to the day. Keeping up with activities confirmed identity. Lastly, to be active was perceived as challenging. Participants described different barriers to being physically active such as a decline of physical function, lack of motivation and being dependent on others to go out. Conclusions Many of the participants expressed that being physically active was important to them. It is essential that informal and formal carers are aware of the role physical activity plays in the lives of many people with dementia, so that appropriate measures can be taken to assure continued active living in order to preserve health and quality of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03149-6.
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Affiliation(s)
- Elisabeth Wiken Telenius
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, PO Box 2136, 3103, Tønsberg, Norway. .,Faculty of Health Studies, VID Specialized University, Oslo, Norway.
| | - Gro Gujord Tangen
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, PO Box 2136, 3103, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Siren Eriksen
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, PO Box 2136, 3103, Tønsberg, Norway.,Lovisenberg Diaconal University College, Oslo, Norway
| | - Anne Marie Mork Rokstad
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, PO Box 2136, 3103, Tønsberg, Norway.,Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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22
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Da Silva JL, Agbangla NF, Le Page C, Ghernout W, Andrieu B. Effects of Chronic Physical Exercise or Multicomponent Exercise Programs on the Mental Health and Cognition of Older Adults Living in a Nursing Home: A Systematic Review of Studies From the Past 10 Years. Front Psychol 2022; 13:888851. [PMID: 35645927 PMCID: PMC9136454 DOI: 10.3389/fpsyg.2022.888851] [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: 03/03/2022] [Accepted: 04/25/2022] [Indexed: 12/12/2022] Open
Abstract
Some nursing homes for the elderly provide holistic care that integrates several interventions, including physical exercise. The aim of this systematic review is to summarize the effects of physical exercise or multicomponent exercise programs on the mental health (wellbeing, anxiety and depression) and cognitive functions of older adults with/without dementia who live in a nursing home and do/do not require wheelchair assistance. To this end, PubMed, PsycInfo and Web of Science are using to identify clinical trials and randomized controlled studies conducted during the period January 2011 to December 2021 to examine the progression of research in this field over the past ten years. In total, 2597 articles are identifying and 21 are including in the systematic review. After selecting articles according to the PRISMA standards, the data extraction and methodological quality assessment of the eligible studies are performing individually by two reviewers and then pooled together. The synthesis of the studies shows that physical exercise or multicomponent exercise programs have a beneficial effect on mental health and cognitive functions. However, this effect is more common among older adults without dementia, compared to their counterparts who have dementia or use wheelchairs. The explanatory mechanisms, lack of benefits from physical exercise and the need to standardize methods are discussing in this regard. Finally, future studies must examine the effects of an innovative and adaptive physical activity program on the mental health and cognitive functions of older adults living in nursing homes.
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Affiliation(s)
- Jason Leonardo Da Silva
- Institut des Sciences du Sport-Santé de Paris (URP 3625), Université Paris Cité, Paris, France
- Maison de Retraite Villa Jules Janin, Paris, France
- *Correspondence: Jason Leonardo Da Silva
| | - Nounagnon Frutueux Agbangla
- Institut des Sciences du Sport-Santé de Paris (URP 3625), Université Paris Cité, Paris, France
- Laboratory URePSSS – SHERPAS (ULR 7369), Univ. Artois, Univ. Littoral Côte d'Opale, Univ. Lille, UFR STAPS, Liévin, France
- Nounagnon Frutueux Agbangla
| | - Christine Le Page
- Institut des Sciences du Sport-Santé de Paris (URP 3625), Université Paris Cité, Paris, France
| | | | - Bernard Andrieu
- Institut des Sciences du Sport-Santé de Paris (URP 3625), Université Paris Cité, Paris, France
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Chen PJ, Chen KM, Hsu HF, Belcastro F. Types of exercise and training duration on depressive symptoms among older adults in long-term care facilities. Ageing Res Rev 2022; 77:101613. [PMID: 35339704 DOI: 10.1016/j.arr.2022.101613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Depression is associated with a greater risk of disability, cognitive impairment, and suicide. Older adults in long-term care facilities (LTCFs) are more likely to develop depression due to changes in family roles and separation from family members. The aim of this study was to synthesize and analyze the effects of different types of exercise and training duration on depressive symptoms of older adults in LTCFs. METHODS Relevant peer-reviewed journal articles published in English were identified through a search of six electronic databases up to June 2021. RESULTS A total of 25 studies were included in the systematic review and 22 in the meta-analysis. The results of meta-analysis showed that exercise interventions reduced depression in cognitively intact older adults and in cognitively impaired older adults. Both exercising less than 150 min per week or more than 150 min per week, reduced depressive symptoms of older adults. In terms of exercise types, mind-body exercises, exergames, and strength training reduced depressive symptoms. CONCLUSION Exercise has a positive effect on reducing depressive symptoms with mind-body exercises, exergames, and strength training producing the best effect. Regardless of cognitive impairment, older adults in LTCFs benefited from exercise in reducing depressive symptoms.
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Affiliation(s)
- Po-Jung Chen
- Center for Long-Term Care Research, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung, 80708 Taiwan.
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan; Center for Long-Term Care Research, Kaohsiung Medical University, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Taiwan.
| | - Hui-Fen Hsu
- Center for Long-Term Care Research, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung, 80708 Taiwan.
| | - Frank Belcastro
- Department of Education and Psychology, University of Dubuque, 2000 University Ave., Dubuque, IA 52001, USA.
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Galhardas L, Raimundo A, Del Pozo-Cruz J, Marmeleira J. Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5058. [PMID: 35564453 PMCID: PMC9105463 DOI: 10.3390/ijerph19095058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023]
Abstract
This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.
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Affiliation(s)
- Luis Galhardas
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais, 7000-727 Évora, Portugal; (A.R.); (J.M.)
- Comprehensive Health Research Centre (CHRC), Palácio do Vimioso, Gabinete 256, Largo Marquês de Marialva, Apart. 94, 7002-554 Évora, Portugal
| | - Armando Raimundo
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais, 7000-727 Évora, Portugal; (A.R.); (J.M.)
- Comprehensive Health Research Centre (CHRC), Palácio do Vimioso, Gabinete 256, Largo Marquês de Marialva, Apart. 94, 7002-554 Évora, Portugal
| | - Jesús Del Pozo-Cruz
- Department of Physical Education and Sports, University of Seville, 41013 Sevilla, Spain;
- Epidemiology of Physical Activity and Fitness across Lifespan Research Group (EPAFit), University of Seville, 41013 Sevilla, Spain
| | - José Marmeleira
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais, 7000-727 Évora, Portugal; (A.R.); (J.M.)
- Comprehensive Health Research Centre (CHRC), Palácio do Vimioso, Gabinete 256, Largo Marquês de Marialva, Apart. 94, 7002-554 Évora, Portugal
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Rivas-Campo Y, García-Garro PA, Aibar-Almazán A, Martínez-Amat A, Vega-Ávila GC, Afanador-Restrepo DF, León-Morillas F, Hita-Contreras F. The Effects of High-Intensity Functional Training on Cognition in Older Adults with Cognitive Impairment: A Systematic Review. Healthcare (Basel) 2022; 10:670. [PMID: 35455847 PMCID: PMC9025277 DOI: 10.3390/healthcare10040670] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: High-Intensity Functional Training (HIFT) is a new exercise modality that emphasizes multi-joint functional movements adaptable to any fitness level and promotes greater muscle recruitment. Previous studies have evaluated the positive effects of HIFT on mental and cognitive health but have not evaluated it in older people. This study aims to conduct a systematic review of randomized controlled trials assessing the effects of HIFT on general cognition in older adults with cognitive impairment. (2) Methods: Following the PRISMA 2020 guideline, articles that did a high-intensity functional physical exercise intervention on cognitive performance in older adults with mild to moderate cognitive impairment (MMSE > 10) or dementia, aged 55 years or older, published between 2011 and 2021 in five different electronic databases: PubMed, Web of Science, Scopus, CINAHL, and Cochrane plus were included. (3) Results: 7 articles were included, all having general cognition as their primary outcome. All assessed general cognition using the Mini-Mental State Examination, the ADAS-Cog, or both. All studies had at least one HIFT experimental group with a frequency of 2 sessions per week and a variable duration between protocols of 12, 13, 16, and 26 weeks. Two articles showed that a progressive HIFT program improves general cognition, four articles showed no significant changes within or between groups and one article concluded that a HIFT intervention does not slow cognitive decline. (4) Conclusions: Evidence exists of the benefits of HIFT on general cognition in older adults with cognitive impairment, assessed using the MMSE, the ADAS-cog, or both. Two articles that showed improvement in cognitive function used progressive HIFT with 80% RM at 6, 12, and 1 weeks; however, in the other articles, due to the heterogeneity of intervention protocols, measurement time points, and control group activities, mixed results were evidenced
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Affiliation(s)
- Yulieth Rivas-Campo
- Faculty of Human and Social Sciences, University of San Buenaventura—Cali, Santiago de Cali 760016, Colombia;
| | - Patricia Alexandra García-Garro
- School by Faculty of Distance Learning and Virtual Education, Antonio José Camacho University Institution, Santiago de Cali 760016, Colombia; (P.A.G.-G.); (G.C.V.-Á.)
| | - Agustín Aibar-Almazán
- Department of Health Sciences, School of Health Sciences, University of Jaén, 23071 Jaén, Spain; (A.M.-A.); (F.H.-C.)
| | - Antonio Martínez-Amat
- Department of Health Sciences, School of Health Sciences, University of Jaén, 23071 Jaén, Spain; (A.M.-A.); (F.H.-C.)
| | - Gloria Cecilia Vega-Ávila
- School by Faculty of Distance Learning and Virtual Education, Antonio José Camacho University Institution, Santiago de Cali 760016, Colombia; (P.A.G.-G.); (G.C.V.-Á.)
| | | | - Felipe León-Morillas
- Department of Physiotherapy, Catholic University of Murcia UCAM, 30107 Murcia, Spain;
| | - Fidel Hita-Contreras
- Department of Health Sciences, School of Health Sciences, University of Jaén, 23071 Jaén, Spain; (A.M.-A.); (F.H.-C.)
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26
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The perceptions, needs and preferences of informal caregivers of nursing home residents with dementia regarding physical therapy: A qualitative study. Geriatr Nurs 2022; 44:167-175. [PMID: 35182805 DOI: 10.1016/j.gerinurse.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Informal caregivers often support nursing home residents with dementia in making therapeutic decisions. We explored the perceptions, needs and preferences of informal caregivers of nursing home residents with dementia regarding physical therapy. METHOD We conducted eleven semi-structured interviews. Thematic analysis was used. RESULTS Five themes emerged: 1) visibility and familiarity; 2) communication; 3) aim and content; 4) dosage and location; 5) level of expertise and the role of the physical therapist within the interdisciplinary team. Informal caregivers' perceptions of physical therapy included a lack of visibility and familiarity. They needed more communication, and empathic communication skills of the physical therapists. Preferences included physical therapy to be enjoyable, accessible and tailored to the needs of the resident. CONCLUSION Physical therapists need to involve informal caregivers in physical therapy care. Implementing shared decision-making will help to get informal caregivers more involved, but has yet to be studied in this setting.
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Apathy as a Treatment Target in Alzheimer's Disease: Implications for Clinical Trials. Am J Geriatr Psychiatry 2022; 30:119-147. [PMID: 34315645 DOI: 10.1016/j.jagp.2021.06.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022]
Abstract
Apathy is one of the most prevalent, stable and persistent neuropsychiatric symptom across the neurocognitive disorders spectrum. Recent advances in understanding of phenomenology, neurobiology and intervention trials highlight apathy as an important target for clinical intervention. We conducted a comprehensive review and critical evaluation of recent advances to determine the evidence-based suggestions for future trial designs. This review focused on 4 key areas: 1) pre-dementia states; 2) assessment; 3) mechanisms/biomarkers and 4) treatment/intervention efficacy. Considerable progress has been made in understanding apathy as a treatment target and appreciating pharmacological and non-pharmacological apathy treatment interventions. Areas requiring greater investigation include: diagnostic procedures, symptom measurement, understanding the biological mechanisms/biomarkers of apathy, and a well-formed approach to the development of treatment strategies. A better understanding of the subdomains and biological mechanisms of apathy will advance apathy as a treatment target for clinical trials.
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28
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Wang S, Liu HY, Cheng YC, Su CH. Exercise Dosage in Reducing the Risk of Dementia Development: Mode, Duration, and Intensity-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413331. [PMID: 34948942 PMCID: PMC8703896 DOI: 10.3390/ijerph182413331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 12/02/2022]
Abstract
Senile dementia, also known as dementia, is the mental deterioration which is associated with aging. It is characterized by a decrease in cognitive abilities, inability to concentrate, and especially the loss of higher cerebral cortex function, including memory, judgment, abstract thinking, and other loss of personality, even behavior changes. As a matter of fact, dementia is the deterioration of mental and intellectual functions caused by brain diseases in adults when they are mature, which affects the comprehensive performance of life and work ability. Most dementia cases are caused by Alzheimer’s disease (AD) and multiple infarct dementia (vascular dementia, multi-infarct dementia). Alzheimer’s disease is characterized by atrophy, shedding, and degenerative alterations in brain cells, and its occurrence is linked to age. The fraction of the population with dementia is smaller before the age of 65, and it increases after the age of 65. Since women live longer than men, the proportion of women with Alzheimer’s disease is higher. Multiple infarct dementia is caused by a cerebral infarction, which disrupts blood supply in multiple locations and impairs cerebral cortex function. Researchers worldwide are investigating ways to prevent Alzheimer’s disease; however, currently, there are no definitive answers for Alzheimer’s prevention. Even so, research has shown that we can take steps to reduce the risk of developing it. Prospective studies have found that even light to moderate physical activity can lower the risk of dementia and Alzheimer’s disease. Exercise has been proposed as a potential lifestyle intervention to help reduce the occurrence of dementia and Alzheimer’s disease. Various workout modes will be introduced based on various physical conditions. In general, frequent exercise for 6–8 weeks lessens the risk of dementia development.
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Affiliation(s)
- Sukai Wang
- College of Physical Education, Huaqiao University, Quanzhou 362021, China;
| | - Hong-Yu Liu
- Department of Exercise and Health Promotion, Chinese Culture University, Taipei 111369, Taiwan; (H.-Y.L.); (Y.-C.C.)
| | - Yi-Chen Cheng
- Department of Exercise and Health Promotion, Chinese Culture University, Taipei 111369, Taiwan; (H.-Y.L.); (Y.-C.C.)
| | - Chun-Hsien Su
- College of Kinesiology and Health, Chinese Culture University, Taipei 111369, Taiwan
- Correspondence: ; Tel.: +886-975159678
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Kiuchi K, Shirakabe A, Okazaki H, Matsushita M, Shibata Y, Shigihara S, Nishigoori S, Sawatani T, Otsuka Y, Kokubun H, Miyakuni T, Kobayashi N, Asai K, Shimizu W. The Prognostic Impact of Hospital Transfer after Admission due to Acute Heart Failure. Int Heart J 2021; 62:1310-1319. [PMID: 34853224 DOI: 10.1536/ihj.21-126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The prognostic impact of transfer to another hospital among acute heart failure (AHF) patients has not been well elucidated.Of the 800 AHF patients analyzed, 682 patients were enrolled in this study for analysis. The subjects were divided into two groups according to their discharge location: discharge home (Group-H, n = 589) or transfer to another hospital for rehabilitation (Group-T, n = 93). The Kaplan-Meier curves revealed a poorer prognosis, including all-cause death and heart failure (HF) events (death, readmission-HF), in Group-T than that in Group-H (P < 0.001, respectively). A multivariate Cox regression model showed that Group-T was an independent predictor of 365-day all-cause death (hazard ratio: 2.618, 95% confidence interval [CI]: 1.510-4.538, P = 0.001). The multivariate logistic regression analysis showed that aging (per 1-year-old increase, odds ratio [OR]: 1.056, 95% CI: 1.028-1.085, P < 0.001), female gender (OR: 2.128, 95% CI: 1.287-3.521, P = 0.003), endotracheal intubation during hospitalization (OR: 2.074, 95% CI: 1.093-3.936, P = 0.026), and increased Controlling Nutritional Status score on admission (per 1.0-point increase, OR: 1.247, 95% CI: 1.131-1.475, P < 0.001) were associated with transfer to another hospital after AHF admission. The prognosis, including all-cause death, was determined to be significantly poorer in patients who were transferred to another hospital, as their activities of daily living were noted to lessen before discharge (n = 11) compared to others (n = 82).Elderly AHF patients suffering from malnutrition were difficult to discharge home after AHF admission, and transfer to another hospital only led to adverse outcomes. Appropriate rehabilitation during definitive hospitalization appears necessary for managing elderly patients in the HF pandemic era.
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Affiliation(s)
- Kazutaka Kiuchi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Shota Shigihara
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Tomofumi Sawatani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Yusuke Otsuka
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Hiroto Kokubun
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Tomoyo Miyakuni
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Hospital
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30
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Rodrigues SLDS, Silva JMD, Oliveira MCCD, Santana CMFD, Carvalho KM, Barbosa BJAP. Physical exercise as a non-pharmacological strategy for reducing behavioral and psychological symptoms in elderly with mild cognitive impairment and dementia: a systematic review of randomized clinical trials. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:1129-1137. [PMID: 34877985 DOI: 10.1590/0004-282x-anp-2020-0539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/30/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Elderly people with dementia may exhibit behavioral and psychological symptoms throughout the course of disease. Non-pharmacological therapies, such as regular physical activity, are considered strategies for managing these symptoms. OBJECTIVE The aim of this study was to investigate whether participation in physical exercise programs is effective in reducing behavioral and neuropsychiatric symptoms in elderly people with Mild Cognitive Impairment (MCI) and dementia. METHODS A literature review was carried out in MEDLINE (PubMed), SciELO, Web of Science, Scopus and SPORTDiscus databases from 2010 to 2020. The eligible studies were randomized clinical trials involving elderly people with mild cognitive impairment or dementia and assessing changes in neuropsychiatric and psychological symptoms as primary or secondary outcomes. The studies had a group with only physical exercise as an intervention compared to a control group. RESULTS Of 175 publications identified in the initial survey, only 7 studies met the eligibility criteria. Four out of 7 studies demonstrated positive effects in reducing behavioral symptoms, while the others did not report differences between gains according to the type of protocol. CONCLUSIONS Moderate to intense aerobic and muscle strengthening exercises may have a potential benefit in the management of behavioral and psychological symptoms in dementia, but studies varied in their conclusions. This review indicates the need for further intervention studies to investigate, as a primary outcome, the absolute effect of physical exercise and its impact on behavioral and psychological symptoms in elderly people with MCI dementia, especially in the early stages of the disease.
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Affiliation(s)
| | | | | | | | | | - Breno José Alencar Pires Barbosa
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife PE, Brazil
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Área Acadêmica de Neuropsiquiatria, Recife PE, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil
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31
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Lewis LK, Henwood T, Boylan J, Hunter S, Lange B, Lawless M, Milte R, Petersen J. Re-thinking reablement strategies for older adults in residential aged care: a scoping review. BMC Geriatr 2021; 21:667. [PMID: 34847860 PMCID: PMC8638477 DOI: 10.1186/s12877-021-02627-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness). METHOD This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored. RESULTS Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness. CONCLUSIONS There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted. TRIAL REGISTRATION Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).
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Affiliation(s)
- Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Tim Henwood
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Jo Boylan
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Belinda Lange
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jasmine Petersen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Lu S, Zhang AY, Liu T, Choy JCP, Ma MSL, Wong G, Lum T. Degree of personalisation in tailored activities and its effect on behavioural and psychological symptoms and quality of life among people with dementia: a systematic review and meta-analysis. BMJ Open 2021; 11:e048917. [PMID: 34845067 PMCID: PMC8634002 DOI: 10.1136/bmjopen-2021-048917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To understand and assess the degree of personalisation of tailored activities for people with dementia (PWD); and to estimate the magnitude of the effects of levels of personalisation on reducing behavioural and psychological symptoms of dementia (BPSD), improving quality of life (QoL) and level of engagement. DESIGN Systematic review with meta-analysis. DATA SOURCES ProQuest, PubMed, Ovid, Cochrane Library, Web of Science and CINAHL were searched from the start of indexing to May 2020. ELIGIBILITY CRITERIA We included randomised controlled trials and quasi-experimental studies assessing the effects of tailored activities for people aged 60 years or older with dementia or cognitive impairment on the outcomes of BPSD, QoL, depression and level of engagement with control groups. DATA EXTRACTION AND SYNTHESIS Two researchers screened studies, extracted data and assessed risks of bias. A rating scheme to assess the degree of personalisation of tailored activities was developed to classify tailored activities into high/medium/low groups. Effect sizes were expressed using standardised mean differences at 95% Confidence Interval (CI). Subgroup analyses were conducted to assess whether the degree of personalisation of tailored activities affected outcomes of interest. RESULTS Thirty-five studies covering 2390 participants from 16 countries/regions were identified. Studies with a high-level of personalisation interventions (n=8) had a significant and moderate effect on reducing BPSD (standardised mean differences, SMD=-0.52, p<0.05), followed by medium (n=6; SMD=-0.38, p=0.071) and low-level personalisation interventions (n=6; SMD=-0.15, p=0.076). Tailored activities with a high-level of personalisation had a moderate effect size on improving QoL (n=5; SMD=0.52, p<0.05), followed by a medium level (n=3; SMD=0.41, p<0.05) of personalisation. CONCLUSIONS To develop high-level tailored activities to reduce BPSD and improve QoL among PWD, we recommend applying comprehensive assessments to identify and address two or more PWD characteristics in designed tailored activities and allow modification of interventions to respond to changing PWD needs/circumstances. PROSPERO REGISTRATION NUMBER CRD42020168556.
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Affiliation(s)
- Shiyu Lu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, Hong Kong, Hong Kong
| | - Anna Y Zhang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Tianyin Liu
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Jacky C P Choy
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Maggie S L Ma
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Gloria Wong
- Department of Social Work and Social Administration, Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, Hong Kong
| | - Terry Lum
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
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Fossati C, Torre G, Vasta S, Giombini A, Quaranta F, Papalia R, Pigozzi F. Physical Exercise and Mental Health: The Routes of a Reciprocal Relation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312364. [PMID: 34886090 PMCID: PMC8656946 DOI: 10.3390/ijerph182312364] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 01/18/2023]
Abstract
Sport participation and exercise practice are considered to be beneficial for mental status, yielding an improved mood and better quality of life. On the other hand, good mental fitness is thought to lead to better physical status and sport performance. The key aim of this narrative review is to provide an unstructured overview on the topic with special considerations on the role of mental and physical health to summarize the evidence on their reciprocal influence. While very few papers describe the role of mental health measures in affecting physical performance, more evidence is available concerning the effect of exercise and sport in improving mental health outcomes. Furthermore, there is a consistent role of depressive and anxiety symptoms in influencing the risk of sport injury in either recreational or elite athletes. Moreover, the importance of investigating mental health issues in elite and retired athletes is highlighted. On the basis of the available literature, several biases were found to affect the provided evidence mainly because of the complexity of a proper study design in this field.
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Affiliation(s)
- Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (C.F.); (A.G.); (F.Q.); (F.P.)
| | - Guglielmo Torre
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (S.V.); (R.P.)
- Correspondence:
| | - Sebastiano Vasta
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (S.V.); (R.P.)
| | - Arrigo Giombini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (C.F.); (A.G.); (F.Q.); (F.P.)
| | - Federico Quaranta
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (C.F.); (A.G.); (F.Q.); (F.P.)
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (S.V.); (R.P.)
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (C.F.); (A.G.); (F.Q.); (F.P.)
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Rydja J, Kollén L, Hellström P, Owen K, Lundgren Nilsson Å, Wikkelsø C, Tullberg M, Lundin F. Physical exercise and goal attainment after shunt surgery in idiopathic normal pressure hydrocephalus: a randomised clinical trial. Fluids Barriers CNS 2021; 18:51. [PMID: 34809666 PMCID: PMC8607575 DOI: 10.1186/s12987-021-00287-8] [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] [Received: 09/23/2021] [Accepted: 11/11/2021] [Indexed: 02/06/2023] Open
Abstract
Background Rehabilitation in iNPH is suggested to be an important factor to improve patients’ functions but there are lack of clinical trials evaluating the effect of rehabilitation interventions after shunt surgery in iNPH. The objective of this study was to evaluate the effect of a physical exercise programme and goal attainment for patients with idiopathic normal pressure hydrocephalus (iNPH) after surgery compared to a control group. Methods This was a dual centre randomised controlled trial with assessor blinding, intention-to-treat (ITT) and per protocol (PP) analysis. Individuals diagnosed with iNPH scheduled to undergo shunt surgery at the Linköping University Hospital in Linköping and Sahlgrenska University Hospital in Gothenburg, Sweden were consecutively eligible for inclusion. Inclusion was conducted between January 2016 and June 2018. The patients were randomised 1:1 using sequentially numbered sealed envelopes to receive either written exercise information (control group) or written information and an additional supervised high-intensity, functional exercise programme (HIFE) executed twice weekly over 12 weeks (exercise group). Preoperatively, the patients set individual goals. The primary outcome was change from baseline in the total iNPH scale score at the post-intervention follow-up. Secondary outcomes were goal attainment, and change in the separate scores of gait, balance, neuropsychology and continence and in the total score after 6 months. Results In total, 127 participants were randomised to the exercise group (n = 62) and to the control group (n = 65). In the ITT population (exercise group, n = 50; control group, n = 59), there were no between-group differences in the primary outcome, but the attrition rate in the exercise group was high. The exercise group improved more than the control group in the balance domain scores after 6 months. Post-intervention, the PP exercise population achieved their set goals to a greater extent than the controls. Conclusions An additional effect of the 12-week HIFE-programme on the overall improvement according to the iNPH-scale after shunt surgery in iNPH was not shown. This could be due to high attrition rate. However, the long-term effect on balance and higher goal achievement indicate beneficial influences of supervised physical exercise. Trial registration clinicaltrials.gov, NCT02659111. Registered 20 January 2016, https://clinicaltrials.gov/ct2/show/NCT02659111 Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00287-8.
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Affiliation(s)
- Johanna Rydja
- Department of Activity and Health, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping University Hospital, 581 85, Linköping, Sweden.
| | - Lena Kollén
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Hellström
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Owen
- Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Åsa Lundgren Nilsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carsten Wikkelsø
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Tullberg
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Lundin
- Department of Neurology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Skov SS, Nielsen MBD, Krølner RF, Øksnebjerg L, Rønbøl Lauridsen SM. A multicomponent psychosocial intervention among people with early-stage dementia involving physical exercise, cognitive stimulation therapy, psychoeducation and counselling: Results from a mixed-methods study. DEMENTIA 2021; 21:316-334. [PMID: 34416131 DOI: 10.1177/14713012211040683] [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: 12/25/2022]
Abstract
BACKGROUND There is increasing awareness of the benefits of both physical and psychosocial interventions to empower and benefit people with dementia and their caregivers. However, the potential additional benefits of combining physical and psychosocial interventions have only been sparsely explored. The aim of this pilot study was to investigate the acceptability and potential impact of a multicomponent intervention comprising physical exercise, cognitive stimulation therapy (CST), psychoeducation and counselling for people with early-stage dementia. DESIGN A 15-week multicomponent group-based intervention was offered to people with early-stage dementia in Denmark (N = 44). A mixed-methods design combining interviews, observations, tests of cognitive and physical functioning and an interviewer-assisted questionnaire on quality of life was applied to (1) investigate acceptability of the intervention, including whether people with dementia and their caregivers found the intervention meaningful and (2) to explore and assess changes in participants' physical and cognitive functioning and quality of life. The study was conducted between June 2018 and August 2019. RESULTS The pilot study demonstrated that the multicomponent intervention was acceptable for people with early-stage dementia and their caregivers. Test results did not show significant changes in measures of participants' physical and cognitive functioning or quality of life. However, qualitative data revealed that participants perceived the intervention as meaningful and found that it had a positive influence on their physical and social well-being. In addition, interaction and support from peers and staff members was considered important and rewarding. CONCLUSION This multicomponent intervention constitutes a meaningful and beneficial activity for people with early-stage dementia and their caregivers. It provides an opportunity to engage in social interactions with peers and experience professional support. The study also underlines the importance of providing prolonged and sustainable interventions for people with dementia to maintain personal and social benefits.
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Saho K, Sugano K, Uemura K, Matsumoto M. Screening of apathetic elderly adults using kinematic information in gait and sit-to-stand/stand-to-sit movements measured with Doppler radar. Health Informatics J 2021; 27:1460458221990051. [PMID: 33509024 DOI: 10.1177/1460458221990051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper presents a Doppler radar apathy-screening technique applied to elderly people based on their basic daily activities of walking and movements of sit-to-stand and stand-to-sit (STS). Our Doppler radar system remotely measured the kinematic parameters of the movements of 78 community-dwelling elderly adults (27 apathetic participants and 51 non-apathetic ones). Subsequently, logistic regression models using the measured kinematic parameters of gait and sit-to-stand/stand-to-sit movements were constructed for screening. The experimental results verified that, although the model using gait parameters could screen an apathetic group with a sensitivity of 85.2% and a specificity of 58.8%, the model using the STS parameters achieved better screening accuracies with a sensitivity of 88.9% and a specificity of 76.5%. These results reveal that the kinematic information of STS movements is significantly more effective at detecting apathy than is the gait information, which is otherwise regarded to be effective in conventional epidemiological studies.
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Gunning FM, Oberlin LE, Schier M, Victoria LW. Brain-based mechanisms of late-life depression: Implications for novel interventions. Semin Cell Dev Biol 2021; 116:169-179. [PMID: 33992530 PMCID: PMC8548387 DOI: 10.1016/j.semcdb.2021.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022]
Abstract
Late-life depression (LLD) is a particularly debilitating illness. Older adults suffering from depression commonly experience poor outcomes in response to antidepressant treatments, medical comorbidities, and declines in daily functioning. This review aims to further our understanding of the brain network dysfunctions underlying LLD that contribute to disrupted cognitive and affective processes and corresponding clinical manifestations. We provide an overview of a network model of LLD that integrates the salience network, the default mode network (DMN) and the executive control network (ECN). We discuss the brain-based structural and functional mechanisms of LLD with an emphasis on their link to clinical subtypes that often fail to respond to available treatments. Understanding the brain networks that underlie these disrupted processes can inform the development of targeted interventions for LLD. We propose behavioral, cognitive, or computational approaches to identifying novel, personalized interventions that may more effectively target the key cognitive and affective symptoms of LLD.
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Affiliation(s)
- Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Lauren E Oberlin
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA
| | - Maddy Schier
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA
| | - Lindsay W Victoria
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA.
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Jenkins E, Koirala B, Rodney T, Lee JW, Cotter VT, Szanton SL, Taylor JL. Home/community-based interventions to improve function in persons with mild cognitive impairment/early dementia. Geriatr Nurs 2021; 42:1109-1124. [PMID: 34280736 DOI: 10.1016/j.gerinurse.2021.06.023] [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: 04/20/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/18/2022]
Abstract
Persons with mild cognitive impairment/early dementia have a possible 20-year trajectory of disability and dependence with little information on the effectiveness of interventions to improve function. This review investigates the literature of home/community-based interventions for physical and executive function in persons with mild cognitive impairment/early dementia. A 2007-2020 systematic literature search was conducted through PubMed, CINAHL Plus with Full Text and PsycINFO. Of the 1749 articles retrieved, 18 eligible studies were identified and consisted of three types of interventions: cognitive training-only (n = 7), multicomponent (n = 9), and physical activity-only (n = 2). Results showed that the interventions impacting function in persons with cognitive impairment incorporated a visual/written element, technology-based training, caregiver support, and modified duration/increased frequency of interventions. In studies improving function, participants simulated Instrumental Activities of Daily Living. They addressed cognitive function using both objective and subjective cognitive measures. We found gaps in the literature in incorporating race/ethnicity and appropriate socioeconomic status measures.
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Affiliation(s)
- Emerald Jenkins
- Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205 USA.
| | - Binu Koirala
- Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205 USA
| | - Tamar Rodney
- Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205 USA
| | - Ji Won Lee
- Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205 USA
| | - Valerie T Cotter
- Johns Hopkins University School of Nursing, 929 N Wolfe St. Room 403, Baltimore, MD 21205 USA
| | - Sarah L Szanton
- Health Equity and Social Justice Endowed Professor, Director, Center on Innovative Care in Aging, Johns Hopkins School of Nursing, Joint Appointment with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, 525 North Wolfe Street #424, Baltimore, MD 21205 USA
| | - Janiece L Taylor
- Johns Hopkins University School of Nursing, 525 N. Wolfe St. Room 422, Baltimore, MD 21205 USA
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Hamel C, Garritty C, Hersi M, Butler C, Esmaeilisaraji L, Rice D, Straus S, Skidmore B, Hutton B. Models of provider care in long-term care: A rapid scoping review. PLoS One 2021; 16:e0254527. [PMID: 34270578 PMCID: PMC8284811 DOI: 10.1371/journal.pone.0254527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION One of the current challenges in long-term care homes (LTCH) is to identify the optimal model of care, which may include specialty physicians, nursing staff, person support workers, among others. There is currently no consensus on the complement or scope of care delivered by these providers, nor is there a repository of studies that evaluate the various models of care. We conducted a rapid scoping review to identify and map what care provider models and interventions in LTCH have been evaluated to improve quality of life, quality of care, and health outcomes of residents. METHODS We conducted this review over 10-weeks of English language, peer-reviewed studies published from 2010 onward. Search strategies for databases (e.g., MEDLINE) were run on July 9, 2020. Studies that evaluated models of provider care (e.g., direct patient care), or interventions delivered to facility, staff, and residents of LTCH were included. Study selection was performed independently, in duplicate. Mapping was performed by two reviewers, and data were extracted by one reviewer, with partial verification by a second reviewer. RESULTS A total of 7,574 citations were screened based on the title/abstract, 836 were reviewed at full text, and 366 studies were included. Studies were classified according to two main categories: healthcare service delivery (n = 92) and implementation strategies (n = 274). The condition/ focus of the intervention was used to further classify the interventions into subcategories. The complex nature of the interventions may have led to a study being classified in more than one category/subcategory. CONCLUSION Many healthcare service interventions have been evaluated in the literature in the last decade. Well represented interventions (e.g., dementia care, exercise/mobility, optimal/appropriate medication) may present opportunities for future systematic reviews. Areas with less research (e.g., hearing care, vision care, foot care) have the potential to have an impact on balance, falls, subsequent acute care hospitalization.
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Affiliation(s)
- Candyce Hamel
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chantelle Garritty
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mona Hersi
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Claire Butler
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Leila Esmaeilisaraji
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danielle Rice
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto and St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Sverdrup K, Bergh S, Selbæk G, Benth JŠ, Husebø B, Røen IM, Thingstad P, Tangen GG. Exploring life-space in the nursing home. An observational longitudinal study. BMC Geriatr 2021; 21:396. [PMID: 34187380 PMCID: PMC8243900 DOI: 10.1186/s12877-021-02345-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traditional performance-based measurements of mobility fail to recognize the interaction between the individual and their environment. Life-space (LS) forms a central element in the broader context of mobility and has received growing attention in gerontology. Still, knowledge on LS in the nursing home (NH) remains sparse. The aim of this study was to identify LS trajectories in people with dementia from time of NH admission, and explore characteristics associated with LS over time. METHODS In total, 583 people with dementia were included at NH admission and assessed biannually for 3 years. LS was assessed using the Nursing Home Life-Space Diameter. Association with individual (age, sex, general medical health, number of medications, pain, physical performance, dementia severity, and neuropsychiatric symptoms) and environmental (staff-to-resident ratio, unit size, and quality of the physical environment) characterises was assessed. We used a growth mixture model to identify LS trajectories and linear mixed model was used to explore characteristics associated with LS over time. RESULTS We identified four groups of residents with distinct LS trajectories, labelled Group 1 (n = 19, 3.5%), Group 2 (n = 390, 72.1%), Group 3 (n = 56, 10.4%), Group 4 (n = 76, 14.0%). Being younger, having good compared to poor general medical health, less severe dementia, more agitation, less apathy, better physical performance and living in a smaller unit were associated with a wider LS throughout the study period. CONCLUSION From NH admission most NH residents' LS trajectory remained stable (Group 2), and their daily lives unfolded within their unit. Better physical performance and less apathy emerged as potentially modifiable characteristics associated with wider LS over time. Future studies are encouraged to determine whether LS trajectories in NH residents are modifiable, and we suggest that future research further explore the impact of environmental characteristics.
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Affiliation(s)
- Karen Sverdrup
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway. .,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. .,Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway.,Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Brumunddal, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Bettina Husebø
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Nursing Home Medicine, Bergen, Norway
| | - Irene Mari Røen
- Centre for Development of Institutional and Home Care Services, Innlandet (Hedmark), Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Gro Gujord Tangen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Aldring og Helse, Postboks 2136, 3103, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Suicide among Older Adults with Dementia: Effects of Korea's Long-Term Care Insurance System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126582. [PMID: 34207323 PMCID: PMC8296317 DOI: 10.3390/ijerph18126582] [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: 05/10/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
South Korea recently expanded its coverage rate of long-term care insurance (LTCI) by adding a “dementia special grade” in 2014 to improve care service accessibility and extend health life for older adults with dementia. In this study, we propose a multifaceted policy to reduce the suicide risk among older adults with dementia by evaluating the effectiveness of using the long-term care services (LTCS). A sample of 62,282 older adults was selected from the “Older Adults Cohort DB” of the National Health Insurance Service. We conducted Kaplan–Meier and Cox regression to represent the yearly survival curve from 2002 to 2015 according to the individual characteristics. Difference-in-difference estimation was conducted to identify the effect of LTCS on suicide rates by using LTCS before and after 2014. The suicide risk of older adults using LTCS was about 0.256-times lower than those who did not use it (OR = 0.296, 95% CI = 0.183–0.478), whereas it increased after the expansion of the dementia grading (OR = 2.131, 95% CI = 1.061–4.280). To prevent the risk of suicide among older adults with dementia, not only did the mortality rate vary depending on the sex, activities of daily living (ADL), and type of caregiver at the individual level but appropriate national intervention and management, such as improving the accessibility of LTCS, are also needed.
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Miller DS, Robert P, Ereshefsky L, Adler L, Bateman D, Cummings J, DeKosky ST, Fischer CE, Husain M, Ismail Z, Jaeger J, Lerner AJ, Li A, Lyketsos CG, Manera V, Mintzer J, Moebius HJ, Mortby M, Meulien D, Pollentier S, Porsteinsson A, Rasmussen J, Rosenberg PB, Ruthirakuhan MT, Sano M, Zucchero Sarracini C, Lanctôt KL. Diagnostic criteria for apathy in neurocognitive disorders. Alzheimers Dement 2021; 17:1892-1904. [PMID: 33949763 PMCID: PMC8835377 DOI: 10.1002/alz.12358] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 03/26/2021] [Accepted: 04/05/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Apathy is common in neurocognitive disorders (NCD) but NCD-specific diagnostic criteria are needed. METHODS The International Society for CNS Clinical Trials Methodology Apathy Work Group convened an expert group and sought input from academia, health-care, industry, and regulatory bodies. A modified Delphi methodology was followed, and included an extensive literature review, two surveys, and two meetings at international conferences, culminating in a consensus meeting in 2019. RESULTS The final criteria reached consensus with more than 80% agreement on all parts and included: limited to people with NCD; symptoms persistent or frequently recurrent over at least 4 weeks, a change from the patient's usual behavior, and including one of the following: diminished initiative, diminished interest, or diminished emotional expression/responsiveness; causing significant functional impairment and not exclusively explained by other etiologies. DISCUSSION These criteria provide a framework for defining apathy as a unique clinical construct in NCD for diagnosis and further research.
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Affiliation(s)
| | - Philippe Robert
- Cognition Behaviour Technology Lab, Université Côte d'Azur, Nice, France.,Association Innovation Alzheimer, Nice, France.,Centre Memoire, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Lawrence Adler
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Daniel Bateman
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeff Cummings
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, USA.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Steven T DeKosky
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - Corinne E Fischer
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Alan J Lerner
- University Hospitals - Case Western Reserve University, Cleveland, Ohio, USA
| | - Abby Li
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Valeria Manera
- Cognition Behaviour Technology Lab, Université Côte d'Azur, Nice, France.,Association Innovation Alzheimer, Nice, France
| | - Jacobo Mintzer
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
| | | | - Moyra Mortby
- UNSW Ageing Futures Institute, The University of New South Wales, Sydney, Australia
| | - Didier Meulien
- Clinical Research and Development, H. Lundbeck A/S, Valby, Denmark
| | - Stephane Pollentier
- Boehringer Ingelheim Pharma GmbH & Co KG, CNS Diseases Research, Biberach an der Riss, Germany
| | | | | | | | | | - Mary Sano
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Krista L Lanctôt
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Departments of Psychiatry and Pharmacology/Toxicology, University of Toronto, Toronto, Ontario, Canada
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Exercise effects on backward walking speed in people with dementia: A randomized controlled trial. Gait Posture 2021; 85:65-70. [PMID: 33517038 DOI: 10.1016/j.gaitpost.2020.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Multidirectional walking, including backward walking, is integral to daily activities, and seems particularly challenging in older age, and in people with pathology affecting postural control such as dementia. RESEARCH QUESTION Does exercise influence backward walking speed in people with dementia, when tested using habitual walking aids and without, and do effects differ according to walking aid use? METHODS This study included 141 women and 45 men (mean age 85 years) with dementia from the Umeå Dementia and Exercise (UMDEX), a cluster-randomized controlled trial study set in 16 nursing homes in Umeå, Sweden. Participants were randomized to a High-Intensity Functional Exercise (HIFE) program targeting lower limb strength-, balance and mobility exercise or to a seated attention control activity. Blinded assessors measured 2.4-meter usual backward walking speed, at baseline, 4 - (intervention completion) and 7-month follow-up; tested 1) with habitual walking aids allowed, and 2) without walking aids. RESULTS Linear mixed models showed no between-group effect in either backward walking speed test at 4 or 7 months; test 1) 0.005 m/s, P = .788 and -0.006 m/s, P = .754 and test 2) 0.030 m/s, P = .231 and 0.015 m/s, P = .569, respectively. In interaction analyses, exercise effects differed significantly between participants who habitually walked unaided compared with those that used a walking aid at 7 months (0.094 m/s, P = .027). SIGNIFICANCE In this study of older people with dementia living in nursing homes, the effects of exercise had no overall effects on backwards walking speed. Nevertheless, some benefit was indicated in participants who habitually walked unaided, which is promising and merits further investigation in future studies.
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[Physical activity and activities of daily living of nursing homes residents: A systematic review and meta-analysis]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 161:66-76. [PMID: 33563560 DOI: 10.1016/j.zefq.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/28/2020] [Accepted: 12/19/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Interventions to promote physical activity in nursing homes are among the priorities of German long-term care insurance funds. We summarized the evidence on the effectiveness of such interventions. METHODS We conducted a systematic literature search in five electronic databases in November 2019, which was complemented by searching reference lists and trials registries. Eligible studies included individually (RCTs) or cluster randomized trials or non-randomized comparative studies that investigated the effectiveness of interventions to promote physical activity in nursing home residents and their impact on the ability to perform activities of daily living. Results were synthesized using random effects meta-analysis. RESULTS Meta-analysis of 19 included studies with high risk of bias showed a small yet statistically significant effect on activities of daily living (SMD = 0.40, 95 % CI 0.08-0.72); heterogeneity was substantial (I2 = 77 %, p < 0.0001). Sensitivity analysis excluding two non-randomized comparative studies did not alter the results (SMD = 0.40, 95 % CI 0.03-0.76). The effect attenuated but was still statistically significant in a meta-analysis which excluded five studies that were largely responsible for the heterogeneity (SMD = 0.27, 95 % CI 0.12-0.43, I2=34 %, p = 0.10). Subgroup analyses did not demonstrate any statistically significant results in favour of physical activity. DISCUSSION We found evidence for a beneficial effect on activities of daily living in favour of interventions that aim to promote physical activity. Due to the high overall risk of bias and substantial heterogeneity of the included studies the results should be interpreted with caution, though. CONCLUSION Methodologically sound studies are needed to strengthen the evidence base on the topic.
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Di Lorito C, Duff C, Rogers C, Tuxworth J, Bell J, Fothergill R, Wilkinson L, Bosco A, Howe L, O’Brien R, Godfrey M, Dunlop M, van der Wardt V, Booth V, Logan P, Cowley A, Harwood RH. Tele-Rehabilitation for People with Dementia during the COVID-19 Pandemic: A Case-Study from England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041717. [PMID: 33578949 PMCID: PMC7916656 DOI: 10.3390/ijerph18041717] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/10/2023]
Abstract
Introduction: The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) is delivering an exercise programme for people with dementia. The Lincolnshire partnership National Health Service (NHS) foundation Trust successfully delivered PrAISED through a video-calling platform during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: This qualitative case-study aimed to identify participants that video delivery worked for, to highlight its benefits and its challenges. Interviews were conducted between May and August 2020 with five participants with dementia and their caregivers (n = 10), as well as five therapists from the Lincolnshire partnership NHS foundation Trust. The interviews were analysed through thematic analysis. Results: Video delivery worked best when participants had a supporting caregiver and when therapists showed enthusiasm and had an established rapport with the client. Benefits included time efficiency of sessions, enhancing participants’ motivation, caregivers’ dementia awareness, and therapists’ creativity. Limitations included users’ poor IT skills and resources. Discussion: The COVID-19 pandemic required innovative ways of delivering rehabilitation. This study supports that people with dementia can use tele-rehabilitation, but success is reliant on having a caregiver and an enthusiastic and known therapist.
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Affiliation(s)
- Claudio Di Lorito
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (L.H.); (R.O.); (M.G.); (M.D.); (V.B.); (P.L.)
- Correspondence:
| | - Carol Duff
- Lincolnshire partnership NHS foundation Trust, Lincoln LN1 1FS, UK; (C.D.); (C.R.); (J.T.); (J.B.); (R.F.); (L.W.)
| | - Carol Rogers
- Lincolnshire partnership NHS foundation Trust, Lincoln LN1 1FS, UK; (C.D.); (C.R.); (J.T.); (J.B.); (R.F.); (L.W.)
| | - Jane Tuxworth
- Lincolnshire partnership NHS foundation Trust, Lincoln LN1 1FS, UK; (C.D.); (C.R.); (J.T.); (J.B.); (R.F.); (L.W.)
| | - Jocelyn Bell
- Lincolnshire partnership NHS foundation Trust, Lincoln LN1 1FS, UK; (C.D.); (C.R.); (J.T.); (J.B.); (R.F.); (L.W.)
| | - Rachael Fothergill
- Lincolnshire partnership NHS foundation Trust, Lincoln LN1 1FS, UK; (C.D.); (C.R.); (J.T.); (J.B.); (R.F.); (L.W.)
| | - Lindsey Wilkinson
- Lincolnshire partnership NHS foundation Trust, Lincoln LN1 1FS, UK; (C.D.); (C.R.); (J.T.); (J.B.); (R.F.); (L.W.)
| | - Alessandro Bosco
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK;
| | - Louise Howe
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (L.H.); (R.O.); (M.G.); (M.D.); (V.B.); (P.L.)
| | - Rebecca O’Brien
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (L.H.); (R.O.); (M.G.); (M.D.); (V.B.); (P.L.)
| | - Maureen Godfrey
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (L.H.); (R.O.); (M.G.); (M.D.); (V.B.); (P.L.)
| | - Marianne Dunlop
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (L.H.); (R.O.); (M.G.); (M.D.); (V.B.); (P.L.)
| | - Veronika van der Wardt
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps-Universität Marburg, 35037 Marburg, Germany;
| | - Vicky Booth
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (L.H.); (R.O.); (M.G.); (M.D.); (V.B.); (P.L.)
| | - Pip Logan
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (L.H.); (R.O.); (M.G.); (M.D.); (V.B.); (P.L.)
| | - Alison Cowley
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK;
| | - Rowan H. Harwood
- School of Health Sciences, University of Nottingham, Nottingham NG7 7TU, UK;
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Coronado RA, Albers HE, Allen JL, Clarke RG, Estrada VA, Simon CB, Galloway RV, Fisher SR. Pain-Reducing Effects of Physical Therapist-Delivered Interventions: A Systematic Review of Randomized Trials Among Older Adults With Dementia. J Geriatr Phys Ther 2021; 43:159-169. [PMID: 30998563 DOI: 10.1519/jpt.0000000000000235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Pain is common among older adults with dementia. There are nonpharmacological options for managing pain in this population. However, the effects of physical therapist-delivered interventions have not been summarized. The purpose of this systematic review was to summarize the literature on physical therapist-delivered interventions in randomized trials for reducing pain among older adults with dementia. METHODS A systematic search of MEDLINE/PubMed, CINAHL, PsycINFO, and Web of Science was conducted for randomized trials of pain management in individuals 60 years or older with medically diagnosed dementia of any severity. Included studies addressed the effects of nonpharmacological physical therapist-delivered interventions on pain outcomes. Pain outcomes included patient or caregiver self-report, observational or interactive measures. Independent reviewers extracted relevant data and assessed methodological quality using the PEDro scale. RESULTS AND DISCUSSION Three studies (total = 222 participants; mean age range = 82.2-84.0 years; 178 [80.2%] females) met inclusion criteria. PEDro scores ranged from 4 to 8/10. Interventions included passive movement and massage. Pain outcomes included the observational measures Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC), Pain in Advanced Dementia (PAINAD), and Doloplus-2 Scale. Passive movement did not show better results when compared with no treatment, while massage showed pain-reducing effects in 1 study compared with no treatment. CONCLUSIONS The evidence supporting pain-reducing physical therapy interventions for patients with dementia is limited. There is a clear gap in knowledge related to evidence-based physical therapy for managing pain in this population. Future studies should examine active physical therapist-delivered interventions and utilize interactive pain measures.
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Affiliation(s)
- Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hannah E Albers
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Jessica L Allen
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Rebecca G Clarke
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Victoria A Estrada
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Corey B Simon
- Division of Physical Therapy, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Rebecca V Galloway
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
| | - Steve R Fisher
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston
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High-intensity exercise programs in people with dementia — a systematic review and meta-analysis. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2020. [DOI: 10.1007/s12662-020-00688-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AbstractDementia is a syndrome characterized by a progressive deterioration of cognitive and physical functions. The aim of this systematic review was to investigate the effects of high-intensity exercise training (HIT) programs on cognitive and mental health, physical performance, activities of daily living (ADLs) and quality of life (QoL) in people with dementia. A systematic literature search for randomized controlled trials was performed until July 2019. We calculated mean difference (MD) or standardized MD (SMD) and the 95% confidence interval (CI), and assessed heterogeneity using I2 statistic. Nine studies from three large-scale research projects which were based on the high-intensity functional exercise (HIFE) program incorporating strength, balance and mobility exercises of the lower limbs, including 456 participants (85.5 ± 7.0 years), were considered. There was an overall good study quality (mean PEDro score = 7.6 ± 0.7). Compared to seated control activities, strength and balance HIT resulted in statistically significant but small positive effects on balance performance (MD = 2.31, 95% CI = 0.44–4.17, p = 0.02; I2 = 73%) and on the abilities to independently perform ADLs (SMD = 0.28, 95% CI = 0.12–0.44, p = 0.0006; I2 = 0%). No differences were found in cognitive function, depressive symptoms and QoL. The qualitative analyses yielded sporadic beneficial results (mobility, psychological well-being and apathetic behaviour) in favour of HIT. There is only limited evidence for an intensity-related dose–response relationship. Further well-designed studies are needed to identify the best exercise type for different types and stages of dementia.
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Kuan YC, Huang LK, Wang YH, Hu CJ, Tseng IJ, Chen HC, Lin LF. Balance and gait performance in older adults with early-stage cognitive impairment. Eur J Phys Rehabil Med 2020; 57:560-567. [PMID: 33258361 DOI: 10.23736/s1973-9087.20.06550-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND People with cognitive impairment are susceptible to fall. Previous studies regarding balance and gait enrolled patients with various severity of dementia. Quantification of the balance and gait performance of people with cognitive impairment may help identify their postural instability and fall risks. AIM We investigated the differences in balance and gait among older adults with preserved cognition, amnestic mild cognitive impairment, and mild dementia due to Alzheimer's disease. DESIGN Prospective observational study. SETTING Outpatient department of neurology or psychology. POPULATION Older adults (aged ≥65 years) with independent gait were evaluated using the Mini-Mental State Examination and Clinical Dementia Rating scale. People with other neurological or musculoskeletal disorders were excluded. METHODS Participants were classified into three groups: 30 healthy controls, 30 mild cognitive impairment and 30 mild dementia. Balance were evaluated through functional test (Berg Balance Scale [BBS]) and laboratory test (posturography). Gait was assessed by wearable device. Muscle strength and mass were measured through grip force, calf circumstance, and body composition. RESULTS The BBS (P=0.04), posturography of fall risk index (FR, P=0.01) and sensory integration indices in eyes open and firm surface (EOFIS, P=0.009), eyes open and foam surface (EOFOS, P=0.003) were substantially different among three groups. EOFIS and EOFOS indices of balance in mild dementia were significantly worse than in MCI. The gait speed (P=0.04) and stride length (P=0.04) were significantly different among three groups. The post-hoc analyses revealed that all above balance and gait indices in subjects with cognitive impairments were significantly worse than in healthy controls. The grip force, calf circumstance and body composition-muscle mass did not significantly differ among three groups. CONCLUSIONS It is a piece of evidence that cognitive dysfunction, even in early stage of memory decline, may have some bad impact on balance and gait regardless of the effect of musculoskeletal problems. CLINICAL REHABILITATION IMPACT Understanding the difference of specific indices of balance and gait among different severity of cognitive impairments and healthy controls could help to develop better balance-oriented rehabilitation programs in older adults at early-stage cognitive impairment.
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Affiliation(s)
- Yi-Chun Kuan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.,Department of Neurology and Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.,Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan, Taiwan
| | - Li-Kai Huang
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.,Department of Neurology and Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.,College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei, Taiwan
| | - Yuan-Hung Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Chaur-Jong Hu
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.,Department of Neurology and Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ing-Jy Tseng
- School of Gerontology Health Management College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hung-Chou Chen
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,Department of Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Fong Lin
- School of Gerontology Health Management College of Nursing, Taipei Medical University, Taipei, Taiwan - .,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan.,Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
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Yeh SW, Lin LF, Chen HC, Huang LK, Hu CJ, Tam KW, Kuan YC, Hong CH. High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis. Clin Rehabil 2020; 35:169-181. [PMID: 33040592 DOI: 10.1177/0269215520961637] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study aimed to investigate the efficacy of high-intensity functional exercise among older adults with dementia. METHODS In this systematic review and meta-analysis of randomized controlled trials, we collected articles published before August 2020 from PubMed, Embase, and the Cochrane Library to evaluate the effect of high-intensity functional exercise on older adults with dementia. Primary outcomes included improvements in balance function and gait performance (speed, cadence, and stride length). The secondary outcomes included lower limb strength, activities of daily living, psychiatric well-being, depression, and cognition. Furthermore, we performed subgroup analysis with two high-intensity functional exercise programs: the Umeå program and Hauer's program. RESULTS We identified 15 articles describing six trials including older adults with dementia undergoing high-intensity functional exercise or control activity. The meta-analysis indicated that high-intensity functional exercise, both in Hauer's program and in the Umeå program, significantly improved balance function (pooled standardized mean difference 0.57, 95% confidence interval 0.31-0.83). Hauer's program significantly improved gait speed, cadence, stride length, and lower limb strength. Beneficial effects on speed, cadence, and lower limb strength were retained for several months. The Umeå program facilitated activities of daily living and psychiatric well-being, with effects on activities of daily living lasting several months. In the only eligible trial, no effects on cognition were observed. Adverse effects of high-intensity functional exercise were minimal to none. CONCLUSIONS High-intensity functional exercise is generally safe and is recommended for older individuals with mild or moderate dementia to provide benefits in motor performance and daily functioning.
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Affiliation(s)
- Shu-Wei Yeh
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City.,School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Li-Fong Lin
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei.,Center for Evidence-Based Health Care, Taipei Medical University - Shuang Ho Hospital, New Taipei City.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Li-Kai Huang
- Taipei Neuroscience Institute, Taipei Medical University, Taipei.,Dementia Center and Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Chaur-Jong Hu
- Taipei Neuroscience Institute, Taipei Medical University, Taipei.,Dementia Center and Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Taipei Medical University - Shuang Ho Hospital, New Taipei City.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Division of General Surgery, Department of Surgery, Shuang-Ho Hospital, Taipei Medical University, New Taipei City.,Cochrane Taiwan, Taipei Medical University, Taipei
| | - Yi-Chun Kuan
- Center for Evidence-Based Health Care, Taipei Medical University - Shuang Ho Hospital, New Taipei City.,Taipei Neuroscience Institute, Taipei Medical University, Taipei.,Dementia Center and Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Cochrane Taiwan, Taipei Medical University, Taipei.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University
| | - Chien-Hsiung Hong
- School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei
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Pimontel MA, Kanellopoulos D, Gunning FM. Neuroanatomical Abnormalities in Older Depressed Adults With Apathy: A Systematic Review. J Geriatr Psychiatry Neurol 2020; 33:289-303. [PMID: 31635522 DOI: 10.1177/0891988719882100] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Apathy is a common phenomenon in late-life depression and is associated with poor outcomes. Apathy is often unrecognized in older depressed adults, and efficacious treatment options are lacking. This review provides a systematic review of the neuroanatomical abnormalities associated with apathy in late-life depression. In addition, the review summarizes the neuroimaging findings from studies of neurodegenerative and focal brain injury conditions that frequently present with apathy. The goal is to elucidate cerebral network abnormalities that give rise to apathy in older adults with mood disturbances and to inform future treatment targets. METHOD Systematic literature review. RESULTS The few studies that have directly examined the neuroanatomical abnormalities of apathy in late-life depression suggest disturbances in the anterior cingulate cortex, insula, orbital and dorsal prefrontal cortex, striatum, and limbic structures (ie, amygdala, thalamus, and hippocampus). Studies examining the neuroanatomical correlates of apathy in other aging populations are consistent with the pattern observed in late-life depression. CONCLUSIONS Apathy in late-life depression appears to be accompanied by neuroanatomical abnormalities in the salience and reward networks. These network findings are consistent with that observed in individuals presenting with apathy in other aging-related conditions. These findings may inform future treatments that target apathy.
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Affiliation(s)
- Monique A Pimontel
- Graduate Center, City University of New York, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | | | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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