Long term caregiving: helping families of persons with mild cognitive impairment cope

Interaction between aluminum exposure and ApoEε4 gene on cognitive function of in-service workers

The occurrence and development of cognitive impairment, the early stage of AD, may be affected both by factors of environmental (aluminum exposure) and genetic (ApoEε4 gene). But whether there is an interaction between the two factors on cognitive function is still unknown. To explore the interaction between the two factors on cognitive function of in-service workers. A total of 1121 in-service workers in a large aluminum factory were investigated in Shanxi Province. Cognitive function was assessed by the Mini-mental State Examination (MMSE), the clock-drawing test (CDT), the Digit Span Test (DST, including DSFT and DSBT), the fuld object memory evaluation (FOM), and the verbal fluency task (VFT). The plasma-Al (p-Al) concentrations were measured by inductively coupled plasma-mass spectrometry (ICP-MS) as an internal exposure indicator, and the participants were divided into four Al exposure groups according to the quartile of p-Al concentrations, namely Q1, Q2, Q3, and Q4. ApoE genotype was determined by Ligase Detection Reaction (LDR). The multiplicative model was fitted using non-conditional logistic regression and additive model was fitted using crossover analysis to analyze the interaction between p-Al concentrations and the ApoEε4 gene. Finally, a dose-response relationship between p-Al concentrations and cognitive impairment was observed, with the p-Al concentrations increased, cognitive function performance gradually becomes worse (P_trend＜0.05), and the risk of cognitive impairment gradually increases (P_trend＜0.05), mainly in executive/visuospatial impairment, auditory memory impairment (particularly the working memory impairment). And ApoEε4 gene may be a risk factor for cognitive impairment, while no association between the ApoEε2 gene and cognitive impairment is observed. Additionally, an additive but no multiplicative interaction between p-Al concentrations and ApoEε4 gene is observed, and when the two factors work together, the risk of cognitive impairment further increased, of which 44.2% can be attributed to the interaction effect.

Effects of virtual reality combined cognitive and physical interventions on cognitive function in older adults with mild cognitive impairment: A systematic review and meta-analysis

OBJECTIVE

Combined cognitive and physical interventions based on virtual reality may help delay the progression of MCI to dementia or prevent dementia. However, their efficacy is less well studied compared to pharmaceutical treatments. The purpose of this review was to evaluate the effects of cognitive and physical interventions based on virtual reality on cognitive function (global cognition, memory or executive function/attention) of older adults with mild cognitive impairment.

METHODS

We searched the PubMed, Web of Science, Scopus, Embase, Cochrane Library, PsycINFO, CINAHL and IEEE from inception to 13 May 2021. Only randomized controlled trials which incorporated virtual reality cognitive and physical components targeted to individuals with mild cognitive impairment were eligible. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation.

RESULT

7 randomized controlled trials were included in a total of 8 articles. No studies were rated as having a "high" risk of overall bias. The results of a meta-analysis showed that VR combined cognitive and physical interventions enhanced the global cognitive (MD = 2.66, 95% CI = 1.79-3.54, P = 0.03, I ² = 68%) abilities of older adults with mild cognitive impairment. The meta-analysis indicated that after virtual reality combined cognitive and physical interventions, effects on memory (SMD = -0.03, 95% CI = -0.60 to 0.55, P = 0.78, I ² = 0%) and executive function/attention (SMD = -0.19, 95% CI = -0.74 to 0.36, P = 0.09, I ² = 53%) were not statistically significant.

CONCLUSIONS

The present meta-analysis verifies the potential rehabilitative effects of virtual reality combined cognitive and physical interventions for older adults with mild cognitive impairment. More research is also needed to determine the optimal intensity and timing of interventions in the future.

Rehabilitative Effects of Virtual Reality Technology for Mild Cognitive Impairment: A Systematic Review With Meta-Analysis

Objective: To evaluate the impact of virtual reality (VR) technology on the cognitive functions (overall cognitive ability, executive function, short-term memory, and long-term memory) of people with mild cognitive impairment (MCI).

Methods: All major databases, including Web of Science, PubMed, Scopus, Proquest, WanFang, and CNKI, were searched to identify all relevant studies published in English or Chinese since October 28th, 2019. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation.

Result: 15 randomized controlled trials were analyzed (N = 612 people with MCI), with the methodological quality evaluation score ranging from 5 to 7 points. A random effects model was selected to combine effect sizes. The result of the meta-analysis indicates that VR significantly enhanced MCI patients' overall cognitive ability (SMD = 0.869, 95% confidence interval [CI] = 0.330–1.407, P = 0.002, I² = 86.822, n = 537) and executive function (SMD = 1.083, 95%, 95%CI = 00.134–2.031, P = 0.025, I² = 93.748, n = 220). The meta-analysis indicated that after VR training, effects on short-term memory (SMD = 0.488, 95%CI = −0.108–1.084, P = 0.109, I² = 62.354, n = 131) and long-term memory (SMD = 0.335, 95%CI = −1.194–0.863, P = 0.0.214, I² = 58.868, n = 152) were not statistically significant.

Conclusions: The present meta-analysis verifies the potential rehabilitative effects of VR technology for mild cognitive impairment.

Patients' and Family Members' Subjective Experiences of a Diagnostic Evaluation of Mild Cognitive Impairment

BACKGROUND

People with a diagnosis of mild cognitive impairment (MCI) often struggle with uncertainty and fear when learning of and coping with their diagnosis. However, little is known about their experiences and perspectives, and those of their care partners, when seeking out and undergoing a diagnostic evaluation for their cognitive symptoms.

METHOD

This study is a secondary analysis of a focus group discussion that was initially conducted to learn the perspectives and experiences of participants and their care partners during a mock disclosure session of brain scan results. Participant's broader views on their experience of completing a cognitive evaluation resulting in an MCI diagnosis were evaluated in this study. Analysis used qualitative content methodology and line-by-line coding which generated categories and themes.

RESULTS

The (1) "presence of a threat" and (2) attempts to "minimize the threat" emerged as overarching themes driving the process of seeking out a diagnostic evaluation for cognitive symptoms. Subthemes that highlight the complexity of the presence of a threat included the "fear of stigma," and the "emotional reactions" related to an MCI diagnosis. Three additional subthemes represented approaches that participants and their care partners used to minimize threat of MCI: "use of language" to minimize the threat; "information sharing and withholding"; and the "use of social support to legitimize personal experiences."

CONCLUSION

These findings add to the literature by elucidating the uncertainty, fears, and coping strategies that accompany a diagnostic evaluation of MCI.

Ongoing Medical Management to Maximize Health and Well-being for Persons Living With Dementia

Background and Objectives

Persons living with dementia have complex care needs including memory loss that should be taken into account by providers and family caregivers involved with their care. The prevalence of comorbid conditions in people with dementia is high and, thus, how primary care, community providers and family caregivers provide best practice care, person-centered care is important.

Research Design and Methods

Care providers should understand the ongoing medical management needs of persons living with dementia in order to maximize their quality of life, proactively plan for their anticipated needs, and be as well prepared as possible for health crises that may occur.

Results

This article provides eight practice recommendations intended to promote understanding and support of the role of nonphysician care providers in educating family caregivers about ongoing medical management to improve the wellbeing of persons living with dementia.

Discussion and Implications

Key among these are recommendations to use nonpharmacological interventions to manage behavioral and psychological symptoms of dementia as the first line of treatment and recommendations on how to best support the use and discontinuation of pharmacological interventions as necessary.

Developing a Non-Pharmacological Intervention for Individuals With Mild Cognitive Impairment

The purpose of this study is to describe one potential intervention model that is designed to slow decline to disability for individuals at-risk for dementia due to Mild Cognitive Impairment. Strategy training is a treatment model that focuses on behavioral activation through addressing barriers to daily activities. Strategy training encourages development of goals and plans to address self-identified impaired processes, and it maintains or improves individuals' ability to perform desired activities. Progression to dementia may be slowed due to the link between engagement in daily activities and production of biological factors associated with neurocognitive health. We demonstrated that an older adult with mild cognitive impairment is able to develop goals, establish effective plans, and engage in daily activities through the strategy training intervention model.

Helping Dementia Caregivers Manage Medical Problems: Benefits of an Educational Resource

BACKGROUND/RATIONALE

Family caregivers of people with dementia must attend to medical care needs of their relative, yet few available resources address comorbidities in dementia. Consequently, caregivers feel ill-equipped when medical concerns arise. In response, an educational resource-Alzheimer's Medical Advisor ( AlzMed)-was developed in 2 forms (website and book) and evaluated.

METHODS

Family caregivers (143 website and 51 book) used an educational resource that provides information on medical problems, vital signs, pain, dehydration, and the healthcare system. Data were collected at baseline, 3 months, and 6 months regarding confidence in sign/symptom management, burden, depression, and anxiety.

RESULTS

Caregivers reported significantly improved confidence and (for website users) decreased role strain. Anxiety and depression also decreased, although not significantly. Improved confidence related to a reduction in role strain and anxiety, and care recipients did not experience adverse events.

CONCLUSION

An educational resource focusing on care of comorbid illness may benefit caregiver outcomes.

The smartphone in the memory clinic: A study of patient and care partner's utilisation habits

Smartphones have potential as cognitive aids for adults with cognitive impairments. However, little is known about how patients and their care partners utilise smartphones in their day-to-day lives. We collected self-reported smartphone utilisation data from patients referred for neuropsychological evaluations (N = 53), their care partners (N = 44), and an Amazon Mechanical Turk control sample (N = 204). Patient participants were less likely to own a smartphone than controls, with increasing age associated with less utilisation of smartphone features in all groups. Of the patients who owned smartphones, spontaneous use of cognitive aid features (e.g., reminders and calendars) occurred on only a monthly-to-weekly basis; by comparison, patients reported utilising social/general features (e.g., email and internet) on a weekly-to-daily basis. Individuals referred for geriatric cognitive disorder evaluations were less likely to own and use smartphones than individuals referred for other reasons. Care partners reported using their smartphones more frequently than control group adults, with 55% of care partners endorsing utilising their device in caring for the patient. Building upon existing smartphone use habits to increase the use of cognitive aid features may be a feasible intervention for some patients, and including care partners in such interventions is encouraged.

Caring for a Person With Amnestic Mild Cognitive Impairment

While much of the literature on caregiver burden has focused on caregiving for people living with Alzheimer's disease (AD) there is little information on the experience of caring for a loved one living with amnestic Mild Cognitive Impairment (aMCI), the group most likely to convert to AD. A hermeneutic phenomenological approach was used to understand the organizing principles that give experiences of being form and meaning in the lifeworld. Study findings highlight the precarious nature of caregiver role acquisition and the heterogeneity that is present among informal care providers. Specifically, the findings suggest that the wearing of multiple situational masks is required by the carer to cope with accumulated progressive losses suffered as they continually adjust to their new and evolving carer identity. Support groups specific to the carers of those living with aMCI are needed in an effort to remove these masks and to validate this unique caregiving experience.

Meaningful activity for persons with dementia: family caregiver perspectives

Dementia threatens the capacity to engage in activity, suggesting meaningful activity may be helpful for persons with dementia (PWDs). This study explores the concept of meaningful activity, as defined by caregivers of PWDs. Family caregivers of PWDs, who provide 3 hours of care over 3 days/week, were interviewed after 6 months of cholinesterase inhibitors (ChEIs) therapy. Caregiver responses (N = 906) to the open-ended question What do you believe getting involved in activities outside the home means for someone with dementia are assessed. The themes are analyzed in terms of content, frequency, co-occurrence, and dementia severity. Caregivers emphasize the benefits of social connectedness, physical health, and mental stimulation. Activity is also viewed as respite, difficult, and has no meaning for care recipient. The implications of activity for self- and social-identity in PWD and caregiver are discussed. The benefits of activity varied by stage of disease. This knowledge indicates areas for improved activity provision and health care support.

Mild cognitive impairment and its management in older people

Mild cognitive impairment (MCI) is a common condition in the elderly. It is characterized by deterioration of memory, attention, and cognitive function that is beyond what is expected based on age and educational level. MCI does not interfere significantly with individuals’ daily activities. It can act as a transitional level of evolving dementia with a range of conversion of 10%–15% per year. Thus, it is crucial to protect older people against MCI and developing dementia. The preventive interventions and appropriate treatments should improve cognitive performance, and retard or prevent progressive deficits. The avoidance of toxins, reduction of stress, prevention of somatic diseases, implementation of mental and physical exercises, as well as the use of dietary compounds like antioxidants and supplements can be protective against MCI. The modification of risk factors such as stopping smoking, as well as the treatment of deficiency in vitamins and hormones by correcting behaviors and lifestyle, can prevent cognitive decline in the elderly. The progressive increase in the growth rate of the elderly population can enhance the rate of MCI all over the world. There is no exact cure for MCI and dementia; therefore, further studies are needed in the future to determine causes of MCI and risk factors of progression from MCI to dementia. This will help to find better ways for prevention and treatment of cognitive impairment worldwide.

Family Caregiver's Perception of Alzheimer's disease and caregiving in Chinese culture

This study examined the perception of Alzheimer's disease (AD) and caregiving among family caregivers of individuals with mild cognitive impairment (MCI) and AD in China. In-depth semistructured interviews were conducted with 46 family caregivers of individuals with cognitive impairment in 2009 in Wuhan and Beijing, China. Participants included 38 spouses, 7 adult children, and 1 sibling, aged between 41 and 85 years old. The findings showed that all family caregivers thought the Chinese terminology of AD laonian chidai, brought discrimination to individuals with cognitive impairment. Caregivers of individuals with AD experienced burden and desired an increase of formal services. Traditional beliefs of respecting elders and caring for extended family members were held among family caregivers of individuals with cognitive impairment, and there was nearly no difference found between caregivers of AD and those of MCI. It implied that traditional culture provided positive influences on caring for elders with cognitive impairment. An alternative term for MCI may contribute to further reducing the discrimination brought by the old Chinese terminology of AD laonian chidai. Development of formal services for elders with cognitive impairment may contribute to reducing caregivers' worries about future caregiving.

Development of a Chronic Care Model for Neurological Conditions (CCM-NC)

Background

Persons with neurological conditions and their families face a number of challenges with the provision of health and community-based services. The purpose of this study was to understand the existing health and community service needs and gaps in care and to use this information to develop a model to specify factors and processes that may improve the quality of care and health and well-being for persons with neurological conditions.

Methods

We conducted semi-structured interviews with health care professionals, community-based non-health care professionals working with individuals with neurological conditions, and policy makers –from the Ministries of Health, Community and Social Services, Transportation and Education– across Canada. We used a purposive sampling and snowballing approach to obtain maximum variation across professions, sector and geography (provinces and territories, rural and urban). Data analysis was an iterative, constant comparative process involving descriptive and interpretive analyses and was initially guided by the components of the Expanded Chronic Care Model.

Results

A total of 180 individuals completed the interviews: 39% (n = 70) health care professionals, 47% (n = 85) community-based non-health care professionals, and 14% (n = 25) policy makers. Based on the data we developed the Chronic Care Model for Neurological Conditions (CCM-NC). The major needs/gaps are represented by the following themes: acceptance and openness to neurological conditions, evidence informed policy, investments and funding, supported transitions, caregiver support, and life enhancing resources (education, employment, housing and transportation), knowledge and awareness of neurological conditions and availability and access to health services. The model maintains that intersectoral collaboration across the health system, community and policy components is needed. It recognizes that attitudes, policies, enhanced community integration and health system changes are needed to develop activated patients and families, proactive service delivery teams, a person-centred health system and healthy public policy for persons with neurological conditions.

Conclusion

The CCM-NC will generate debate and discussion about the actions needed in each of the model components to enable people with neurological conditions to sustain healthier lives. Next steps include validating the model with persons with neurological conditions, in and outside of the Canadian context and developing and evaluating interventions to test the model.

Electronic supplementary material

The online version of this article (doi:10.1186/1472-6963-14-409) contains supplementary material, which is available to authorized users.

A typology of care-giving across neurodegenerative diseases presenting with dementia

The purpose of this study is to develop and extend our understanding of dementia care-giving by introducing a typology of informal care-giving across four different diseases. Care-giving factors were examined with respect to specific dementia presentation in mild cognitive impairment, Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease-associated dementia. Informal care-giving literature in the four diseases was systematically searched to identify specific disease symptoms and resultant care-giving strains and outcomes. Key concepts were extracted and grouped thematically. The first classification, ‘role-shift’, reflects care-giving where cognitive deterioration results in changing roles, uncertainty and relational deprivation among married partners. The second classification, ‘consumed by care-giving’, refers to those caring for persons with dementia-motor decline that greatly increases worry and isolation. Finally, in the ‘service use’ classification, formal support is needed to help care-givers cope with daily responsibilities and behaviour changes. In each case, the dementia presentation uniquely impacts care-giver strains. A major conclusion is that the same support to all care-givers under the umbrella term ‘dementia’ is unwarranted; the development of targeted support is required.

Exploring the experiences of people with mild cognitive impairment and their caregivers with particular reference to healthcare - a qualitative study

BACKGROUND

The aim of this study was to investigate the experiences of people with mild cognitive impairment (MCI; PWMCI) and their "advocates," particularly within healthcare services.

METHODS

Semi-structured interviews were conducted with 23 PWMCI diagnosed ≤6 months ago and 20 advocates recruited via patients. The resulting data were content-analyzed.

RESULTS

PWMCI interviewed rarely reported negative impressions of their general practitioner (GP). Reports regarding memory services were more mixed: positive impressions related to finding the service to be "well run" and the staff "pleasant," negative ones to the assessment process or a perceived lack of feedback. Aside from improved information provision, most PWMCI had no suggestions for improvements to their healthcare. However, these results should be interpreted with caution as many of the PWMCI interviewed displayed evidence of impaired recall and/or insight relating to their condition and healthcare. Advocates generally reported more negative impressions of both contact with the PWMCI's GP (most commonly reporting a "dismissive" attitude) and memory services (with common complaints relating to the assessments used in clinics and lengthy waiting times). This group generally had suggestions for improvements to services - particularly regarding information provision, changes in the assessment process, and improvements in communication by services.

CONCLUSIONS

To our knowledge, this is the first in-depth study of the difficulties experienced by PWMCI and their advocates which includes the context of healthcare provision. The specific needs of these groups, as described here, as well as those of people with dementia, should be considered when designing memory clinics and other related services.

Caregivers in China: knowledge of mild cognitive impairment

This study aimed to examine the experience and knowledge of mild cognitive impairment (MCI) among Chinese family caregivers of individuals with MCI. The sample was recruited from memory clinics in Zhongnan Hospital in Wuhan, China. In-depth semi-structured interviews were used. Thirteen family members of individuals diagnosed with MCI participated in the study. Data analysis revealed three themes: 1) initial recognition of cognitive decline; 2) experience of the diagnosis of MCI; 3) perception of cognitive decline as a normal part of aging. While family members recognized the serious consequences of memory loss (e.g. getting lost), they would typically not take their family members to see a doctor until something specific triggered their access to the medical care system. The Chinese traditional perception of dementia as part of normal aging may serve to lessen the stigma of individuals with MCI, while the term "laonian chidai" which literally translates to "stupid, demented elderly" may exacerbate the stigma associated with individuals with MCI. It is suggested that family members' worries may be relieved by improving their access to accurate knowledge of the disease, community-based and institutional care services, and culturally appropriately words are needed for MCI.

Behavioral symptoms in community-dwelling elderly Nigerians with dementia, mild cognitive impairment, and normal cognition

BACKGROUND

Few studies have examined the neuropsychiatric status of patients with dementia and cognitive impairment in the developing world despite the fact that current demographic trends suggest an urgent need for such studies.

OBJECTIVE

To assess the level of neuropsychiatric symptoms in community-dwelling individuals with dementia, cognitive impairment no dementia and normal cognition.

METHODS

Subjects were from the Ibadan site of Indianapolis-Ibadan Dementia Project with stable diagnoses of normal cognition, cognitive impairment, no dementia/mild cognitive impairment (CIND/MCI), and dementia. Informants of subjects made ratings on the neuropsychiatric inventory and blessed dementia scale; subjects were tested with the mini mental state examination.

RESULTS

One hundred and eight subjects were included in the analytic sample, 21 were cognitively normal, 34 were demented, and 53 were CIND/MCI. The diagnostic groups did not differ in age, per cent female, or per cent with any formal education. The most frequent symptoms among subjects with CIND/MCI were depression (45.3%), apathy (37.7%), night time behavior (28.3%), appetite change (24.5%), irritability (22.6%), delusions (22.6%), anxiety (18.9%), and agitation (17.0%). Depression was significantly more frequent among the CIND/MCI and dementia (44.1%) groups compared with the normal cognition group (9.5%). Distress scores were highest for the dementia group, lowest for the normal cognition group, and intermediate for the CIND/MCI group.

CONCLUSION

Significant neuropsychiatric symptomatology and distress are present among cognitively impaired persons in this community-based study of older adults in this sub-Saharan African country. Programs to assist family members of cognitively impaired and demented persons should be created or adapted for use in developing countries.

Living with mild cognitive impairment: the patient's and carer's experience

BACKGROUND

Mild cognitive impairment (MCI) is a relatively common condition and rates of diagnosis are likely to increase in the near future. Little is known about the experiences of patients with MCI and their carers nor about the most appropriate interventions to support this group.

METHODS

The existing literature on this topic up to July 2011 was identified via systematic searches of the Embase and Medline databases, the Cochrane Library and relevant sections of the National Electronic Library for Health. The main search term "mild cognitive impairment" was used in combination with other relevant terms. The reference lists of reviewed articles were also examined for any additional papers of significance. Papers identified by this method were examined and those deemed relevant were included in this review.

RESULTS

Twenty-one suitable papers were identified for inclusion in this review, a relatively small number. The studies reviewed suggest that patients with MCI and their carers face a variety of practical and emotional challenges. No interventional studies of support have been undertaken, but the authors of relevant observational studies have suggested provision of information, psychosocial support and strategies to enhance patient interaction with carers and social contacts.

CONCLUSIONS

MCI results in significant challenges for both patients and their carers. Further work is required in order to establish the best way to help patients and carers meet these challenges.

Content validity and acceptability of the daily enhancement of meaningful activity program: intervention for mild cognitive impairment patient-spouse dyads

Persons with mild cognitive impairment (PwMCI) are at greater risk for developing Alzheimer disease and experience various difficulties that decrease their quality of life. Very few interventions focus on helping PwMCI improve or maintain functional performance and enhance quality of life through meaningful activity engagement. The purpose of the study was to explore PwMCI and their spouses' perspectives on the content validity, usefulness, and acceptability of the Daily Enhancement of Meaningful Activity (DEMA) program, which included 6 biweekly face-to-face sessions between session assignments and a self-management tool kit of written educational handouts. Nine PwMCI-care partner dyads participated in 3 focus groups (PwMCI alone, spouses alone, and couples) to capture their perspectives on DEMA. The transcribed focus group data were analyzed through content analysis. The three groups provided support for content validity and acceptability of the program, and they suggested additional content areas important to couples experiencing MCI. They also attested to the usefulness of the tool kit and gave suggestions for its further improvement. The findings provide evidence of the content validity and acceptability of the DEMA program. A pilot study to assess feasibility and preliminary efficacy of the DEMA on health-related outcomes is the recommended next research step for this program.

Extra care burden in comorbid mental-somatic illnesses

PURPOSE OF REVIEW

Caregivers play a fundamental role in the lives of mental patients with whom they have an interdependent relationship. The current review provides evidence supporting the association between providing care for a mentally ill person and an often unrecognized burden on the life of the caregiver.

RECENT FINDINGS

Caregivers often sustain a significant physical, emotional, social, and financial stress related to providing care for a loved one with a mental disease. Caregiver-oriented psychoeducational programs and caregiver participation in mutual support groups are among interventions that could assist in relief from this burden.

SUMMARY

Further work needs to be done regarding the burden experienced by caregivers who are responsible for mental patients with somatic symptoms. Participation of the caregiver in programs that target this burden should be encouraged. Physicians should take into consideration caregivers' needs and worries and incorporate them in the healing process.