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Holt J, Bhar S, Schofield P, Koder D, Owen P, Seitz D, Bhowmik J. Protocol for a systematic review and meta-analysis of the prevalence of mental illness among nursing home residents. Syst Rev 2024; 13:109. [PMID: 38627826 PMCID: PMC11020180 DOI: 10.1186/s13643-024-02516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND There is a high prevalence of mental illness in nursing home residents compared to older adults living in the community. This was highlighted in the most recent comprehensive systematic review on the topic, published in 2010. In the context of a rapidly aging population and increased numbers of older adults requiring residential care, this study aims to provide a contemporary account of the prevalence of mental illness among nursing home residents. METHODS This protocol was prepared in line with the PRISMA-P 2015 Statement. Systematic searches will be undertaken across six electronic databases: PubMed, Embase, Web of Science, PsycNET, CINAHL, and Abstracts in Social Gerontology. Peer-reviewed studies published from 2009 onwards which report the prevalence of mental illness within nursing home populations will be included. Database searches will be supplemented by forward and backward citation searching. Titles and abstracts of records will be screened using a semi-automated process. The full text of selected records will be assessed to confirm inclusion criteria are met. Study selection will be recorded in a PRISMA flowchart. A pilot-tested form will be used to extract data from included studies, alongside the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. A study characteristics and results table will be prepared to present key details from each included study, supported by a narrative synthesis. Random-effects restricted maximum likelihood meta-analyses will be performed to compute pooled prevalence estimates for mental illnesses represented in the identified studies. Heterogeneity will be assessed using Cochran's Q and Higgins' I2 statistics. A Funnel plot and Egger's test will be used to assess publication bias. The GRADE approach will be used to assess the quality of the body of evidence identified. DISCUSSION The study will provide a comprehensive and contemporary account of the prevalence of mental illness among nursing home residents. Meta-analyses will provide robust prevalence estimates across a range of presentations. Key insights will be highlighted, including potential sources of heterogeneity. Implications for residents, researchers, care providers, and policymakers will be noted. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42023456226.
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Affiliation(s)
- Jared Holt
- Department of Psychological Sciences, Swinburne University of Technology, John Street, Hawthorn, VIC, 3122, Australia.
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, John Street, Hawthorn, VIC, 3122, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, Swinburne University of Technology, John Street, Hawthorn, VIC, 3122, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, John Street, Hawthorn, VIC, 3122, Australia
- Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3052, Australia
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Deborah Koder
- Department of Psychological Sciences, Swinburne University of Technology, John Street, Hawthorn, VIC, 3122, Australia
| | - Patrick Owen
- Eastern Health Emergency Medicine Program, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Dallas Seitz
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Jahar Bhowmik
- Department of Health Science and Biostatistics, Swinburne University of Technology, John Street, Hawthorn, VIC, 3122, Australia
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Herz M, Bösl S, Gebhard D. Individual and organizational interventions to promote staff health and well-being in residential long-term care: a systematic review of randomized controlled trials over the past 20 years. BMC Nurs 2024; 23:195. [PMID: 38519896 PMCID: PMC10958844 DOI: 10.1186/s12912-024-01855-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Staff in residential long-term care (RLTC) experience significant physical and mental work demands. However, research on specific interventions to promote staff health and well-being in RLTC facilities is limited. This systematic review aimed to synthesize the current evidence on health promotion interventions among RLTC staff. METHODS A comprehensive systematic literature review was conducted on studies published between January 2000 and April 2023. Four electronic databases were searched, including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PsychArticles via EBSCO. The review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The methodological quality of the included studies was assessed using the Risk of Bias Assessment tool (RoB 2). RESULTS A total of 26 publications, referring to 23 different interventions with a randomized controlled design were included. Among these interventions, ten used training/educational approaches, six used behavioral approaches, and seven employed a multimodal approach. Significant improvements in health and well-being outcomes were found in four interventions using a training/educational approach, three interventions using a behavioral approach, and four interventions using a multimodal approach. Within the interventions studied, twelve specifically targeted the reduction of job demands, while only one intervention exclusively addressed job resources among RLTC staff. Furthermore, ten interventions addressed primary outcomes that encompassed both job demands and job resources. CONCLUSION Current evidence for health promotion interventions among RLTC staff is still limited, but research suggests that there is potential to improve certain outcomes related to RLTC staff health and well-being. Future research is recommended to contemplate a tailored intervention design that encompasses both individual-level and organizational-level approaches, and gender-specific physiological and sociological characteristics of RLTC staff. Moreover, detailed reporting of the development process, and research on the interaction between job demands and resources of RLTC staff are also recommended.
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Affiliation(s)
- Michael Herz
- Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
| | - Sabina Bösl
- Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
- European Foundation for the Care of Newborn Infants, Hofmannstrasse 7A, 81379, Munich, Germany
| | - Doris Gebhard
- Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
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Atchison K, Toohey AM, Ismail Z, Goodarzi Z. Understanding the Barriers to and Facilitators of Anxiety Management in Residents of Long-Term Care. Can J Aging 2024; 43:57-74. [PMID: 37665029 DOI: 10.1017/s0714980823000417] [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: 09/05/2023] Open
Abstract
Older adults, 65 years of age and older, living in long-term care (LTC) commonly experience anxiety. This study aimed to understand care providers' perspectives on the barriers to and facilitators of managing anxiety in residents of LTC. Ten semi-structured interviews with care providers in LTC were completed. Framework analysis methods were used to code, thematically analyze, designate codes as barriers or facilitators, and map the codes to the Theoretical Domains Framework. Themes were categorized as acting at the resident, provider, or system level, and were labelled as either barriers to or facilitators of anxiety care. Key barriers to anxiety care at each level were resident cognitive impairment or co-morbidities; lack of staff education, staff treatment uptake and implementation; as well as the care delivery environment and access to resources. There is a need to prioritize measurement-based care for anxiety, have increased access to non-pharmacological treatments, and have a care delivery environment that supports anxiety management to improve the care for anxiety that is delivered to residents.
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Affiliation(s)
- Kayla Atchison
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Ann M Toohey
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Brenda Strafford Centre on Aging, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Holloway H, Conroy B, Isbel S, D’Cunha NM. Immersive virtual reality in the promotion of health and well-being for people in residential aged care without cognitive impairment: A scoping review. Digit Health 2024; 10:20552076241249568. [PMID: 38680734 PMCID: PMC11055491 DOI: 10.1177/20552076241249568] [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: 01/25/2024] [Accepted: 04/08/2024] [Indexed: 05/01/2024] Open
Abstract
Objective Sustaining the health and well-being of older people living in residential aged care (RAC) requires new means of providing safe and stimulating recreational and therapeutic programs such as using virtual reality (VR). The aim of the scoping review was to investigate the utility of immersive VR interventions using head-mounted display technology to promote the health and well-being of people without cognitive impairment living in RAC. Method The following databases were searched from inception until January 2024: PubMed, PsycINFO, Scopus, Cochrane and CINAHL. The eligibility criteria were quantitative, qualitative or mixed methods studies published in English, conducted in RAC, using VR with head-mounted display with people without cognitive impairment. Results Of the 274 articles identified, 9 articles with a total of 310 residents and 50 staff met the inclusion criteria. Seven factors to either impede or enable the use of VR with head-mounted displays in RAC were: residents' agency; the nature of the VR experience; the content of the experience; the ease of use and comfort of the technology; the role of RAC staff; and the role of residents' family members. Conclusion Immersive VR has potential as a tool to promote the health and well-being of people without cognitive impairment living in RAC. Small sample sizes, variations in study design, and selection bias mean that generalisability of the results is limited. Further research is recommended to inform the design and implementation of immersive VR programs tailored specifically for this population.
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Affiliation(s)
- Helen Holloway
- School of Rehabilitation and Exercise Sciences, Faculty of Health, University of Canberra, Bruce, Australia
- Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australia
| | - Brenda Conroy
- School of Rehabilitation and Exercise Sciences, Faculty of Health, University of Canberra, Bruce, Australia
| | - Stephen Isbel
- School of Rehabilitation and Exercise Sciences, Faculty of Health, University of Canberra, Bruce, Australia
- Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australia
| | - Nathan M D’Cunha
- School of Rehabilitation and Exercise Sciences, Faculty of Health, University of Canberra, Bruce, Australia
- Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australia
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Souza EHEE, Leão LL, de Paula AMB, Rodrigues VD, Deslandes AC, Laks J, Monteiro RS. Floor Maze Test is capable of differentiating spatial navigation between frail and pre-frail institutionalized older persons. Dement Neuropsychol 2023; 17:e20220070. [PMID: 37496523 PMCID: PMC10367969 DOI: 10.1590/1980-5764-dn-2022-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/06/2023] [Accepted: 03/29/2023] [Indexed: 07/28/2023] Open
Abstract
Investigation of the association between physical frailty and cognitive performance through spatial navigation is important to enable the identification of individuals with cognitive impairment and physical comorbidity. Objective To analyze the association between spatial navigation and frailty in frail and pre-frail institutionalized older adults. Methods Forty older people of both sexes, aged 60 years or over, residing in four Brazilian Long-Term Care Facilities (LTCFs) participated in this study. The following tests were applied: Mini-Mental State Examination (MMSE), 2.44m Timed Up and Go, Floor Maze Test (FMT), and Fried's frailty criteria. For data analysis, the Mann-Whitney and independent t-tests were used to compare the groups (frail x pre-frail), principal component analysis was used to explore the main variables related to the data variance, and binary logistic regression to estimate associations. Results There was a significant difference in performance in the FMT immediate maze time (IMT) (p=0.02) and in the delayed maze time (DMT) (p=0.009) between the pre-frail and frail older adults. An association between FMT DMT performance and frailty was found, showing that older people with shorter times on the DMT (better performance) had approximately four times the chance of not being frail (odds ratio - OR=4.219, 95% confidence interval - 95%CI 1.084-16.426, p=0.038). Conclusion Frailty is associated with impaired spatial navigation ability in institutionalized older adults, regardless of gait speed performance.
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Affiliation(s)
| | - Luana Lemos Leão
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros MG, Brazil
| | | | - Vinícius Dias Rodrigues
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros MG, Brazil
| | - Andréa Camaz Deslandes
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil
| | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil
| | - Renato Sobral Monteiro
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros MG, Brazil
- Universidade Federal Fluminense, Programa de Pós-Graduação em Neurologia/Neurociência, Niterói RJ, Brazil
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de Melo RC, Schutz V, Wachholz PA, Villalonga-Olives E, Myer D, Corazzini K, Lepore M. Long-Term Care Staff Perspectives on the Care of Persons Living With Dementia During the COVID-19 Pandemic in São Paulo State, Brazil. J Gerontol Nurs 2023; 49:45-52. [PMID: 37126010 DOI: 10.3928/00989134-20230414-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, the Brazilian long-term care (LTC) sector faced many challenges, which accentuated other common issues experienced by persons living with dementia (PLWD). The current pilot study evaluated staff perspectives regarding the care of institutionalized PLWD during the COVID-19 pandemic. Using an online survey, we collected the perspectives of 24 workers from seven long-term care facilities (LTCFs) located in São Paulo State, Brazil, about the impact of COVID-19 in caring for PLWD. Results highlight concerns about challenges related to following precautionary measures and the negative effects of social distancing on PLWD. Aspects related to workforce and staffing and person-centered care approaches were recognized by staff as important to provide good care for PLWD. Future research is needed to consider how to support LTCFs in achieving a balance between the protection and well-being of PLWD. [Journal of Gerontological Nursing, 49(5), 45-52.].
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Atchison K, Watt JA, Ewert D, Toohey AM, Ismail Z, Goodarzi Z. Non-pharmacologic and pharmacologic treatments for anxiety in long-term care: a systematic review and meta-analysis. Age Ageing 2022; 51:6691375. [PMID: 36057989 DOI: 10.1093/ageing/afac195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND older adults living in long-term care (LTC) commonly suffer from anxiety symptoms and disorders. We completed a systematic review and meta-analysis to identify efficacious treatments for anxiety symptoms for older adults living in LTC. METHODS we searched five electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials) to identify treatments for anxiety that have been trialled in LTC. Included studies had to be randomised trials, include residents of LTC, and measure anxiety symptoms as an outcome. RESULTS the electronic search returned 6,617 articles, 519 were reviewed in full text, and 80 were included in the descriptive synthesis. Limited studies were meta-analysed (n = 10) due to differences in described treatment and comparator conditions. Limited clinically relevant evidence supporting the use of pharmacologic treatments for symptoms of anxiety in LTC was identified. Of the treatments trialled, music compared with usual care (standardised mean difference, SMD: -0.82; 95% confidence interval (CI): -1.31, -0.34), music compared with social interaction (SMD: -0.41; 95% CI: -0.72, -0.10) and massage compared with usual care (SMD: -4.32; 95% CI: -7.44, -1.19) were found to improve anxiety symptoms, however, significant heterogeneity was detected in two comparisons. CONCLUSIONS a range of non-pharmacologic treatments that improved anxiety symptoms were identified for use in LTC. Although limited evidence exists to support the use of particular treatments, most non-pharmacologic treatments were low-risk interventions that may be readily implemented. Further research is required to assess the treatment effect on residents of LTC with anxiety disorders or clinically relevant symptoms at baseline.
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Affiliation(s)
- Kayla Atchison
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Delaney Ewert
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ann M Toohey
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Brenda Strafford Centre on Aging, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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A Nationwide Survey of Dementia Prevalence in Long-Term Care Facilities in Taiwan. J Clin Med 2022; 11:jcm11061554. [PMID: 35329879 PMCID: PMC8955493 DOI: 10.3390/jcm11061554] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
Background: As the average life expectancy of global citizens has increased, the prevalence of dementia has increased rapidly. The number of patients with dementia has increased by 6.7 times, reaching 300,000 in the past three decades in Taiwan. To realize the latest actual situation, the need for institutional care for elderly patients with dementia, and also a reference basis for government agencies to formulate dementia-related care policies, we investigated the institutional prevalence of dementia. Methods: We randomly sampled 299 out of the 1607 registered long-term care facilities including senior citizens’ institutions, nursing homes, and veteran homes in every administrative region of Taiwan. Then, a two-phase survey including MMSE screening, CDR, and clinical confirmation was conducted on each subject from 2019 to 2020. Results: Among 5753 enrolled subjects, 4765 from 266 facilities completed the examinations with a response rate of 82.8%. A total of 4150 subjects were diagnosed with dementia, 7.4% of whom had very mild dementia. The prevalence of all-cause dementia, including very mild dementia, was 87.1% in all facilities, 87.4% in senior citizens’ institutions, 87.1% in nursing homes, and 83.3% in veteran homes. Advanced age, low education, hypertension, Parkinsonism, respiratory disease, stroke, and intractable epilepsy were associated with dementia risk. Conclusions: We show that in an aged society, the prevalence of all-cause dementia in long-term care institutions can be as high as 87.1%. This study was completed before the outbreak of COVID-19 and provides a precious hallmark for future epidemiological research. We recommend that the long-term care policy in an aged society needs to take into account the increasing high prevalence of dementia in the institution.
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Gonçalves JR, Sleath BL, Lopes MJ, Cavaco AM. Prescribing-Assessment Tools for Long-Term Care Pharmacy Practice: Reaching Consensus through a Modified RAND/UCLA Appropriateness Method. PHARMACY 2021; 9:194. [PMID: 34941626 PMCID: PMC8708836 DOI: 10.3390/pharmacy9040194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/20/2022] Open
Abstract
Medicines are the most used health technology in Long-Term Care. The prevalence of potentially inappropriate medicines amongst Long-Term Care patients is high. Pharmacists, assisted by prescribing-assessment tools, can play an important role in optimizing medication use at this level of care. Through a modified RAND/UCLA Appropriateness Method, 13 long-term care and hospital pharmacists assessed as 'appropriate', 'uncertain', or 'inappropriate' a collection of commonly used prescribing-assessment tools as to its suitability in assisting pharmacy practice in institutional long-term care settings. A qualitative analysis of written or transcribed comments of participants was pursued to identify relevant characteristics of prescribing-assessment tools and potential hinders in their use. From 24 different tools, pharmacists classified 9 as 'appropriate' for pharmacy practice targeted to long-term care patients, while 3 were classified as 'inappropriate'. The tools feature most appreciated by study participants was the indication of alternatives to potentially inappropriate medication. Lack of time and/or pharmacists and limited access to clinical information seems to be the most relevant hinders for prescribing-assessment tools used in daily practice.
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Affiliation(s)
- João R. Gonçalves
- iMed.ULisboa, Social Pharmacy Department, Faculty of Pharmacy, University of Lisbon, 1649-003 Lisboa, Portugal;
| | - Betsy L. Sleath
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Manuel J. Lopes
- College of Nursing S. João de Deus, University of Évora, 7000-811 Évora, Portugal;
| | - Afonso M. Cavaco
- iMed.ULisboa, Social Pharmacy Department, Faculty of Pharmacy, University of Lisbon, 1649-003 Lisboa, Portugal;
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Fagundes DF, Costa MT, Alves BBDS, Carneiro LSF, Nascimento OJM, Leão LL, Guimarães ALS, Paula AMBD, Monteiro-Junior RS. Dementia among older adults living in long-term care facilities: an epidemiological study. Dement Neuropsychol 2021; 15:464-469. [PMID: 35509803 PMCID: PMC9018080 DOI: 10.1590/1980-57642021dn15-040007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/20/2021] [Indexed: 05/31/2023] Open
Abstract
Institutionalization has been associated with social isolation, psychological and cognitive changes, and decreased levels of physical activity in older adults.
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Affiliation(s)
- Daniel Ferreira Fagundes
- Centro de Ciências Biológicas e da Saúde, Brazil; Programa de Pós-graduação em Neurologia, Brazil
| | | | | | - Lara Souza Fernandes Carneiro
- Departamento de Ciências da Educação Física e Desporto, Portugal; Centro de Investigação em Desporto, Saúde e Desenvolvimento Humano, Portugal
| | | | | | | | | | - Renato Sobral Monteiro-Junior
- Centro de Ciências Biológicas e da Saúde, Brazil; Programa de Pós-graduação em Neurologia, Brazil; Programa de Pós-graduação em Ciências da Saúde, Brazil
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