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Kłosińska U, Leszko M. Do I Have Symptoms of Dementia: A Discursive Study of Awareness and Shame Among People With Advanced Dementia. THE GERONTOLOGIST 2024; 64:gnae067. [PMID: 38835189 DOI: 10.1093/geront/gnae067] [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: 08/01/2023] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study explores the narrated experiences of individuals with advanced stages of late-onset dementia, focusing on their diagnosis awareness. Such framing is motivated by 2 reasons. Firstly, there is a lack of consensus regarding the prevalence of anosognosia among people with dementia. Secondly, research on anosognosia often neglects to address the important issues of shame and stigma associated with receiving a dementia diagnosis. RESEARCH DESIGN AND METHODS For this qualitative study, a total of 27 participants ranging in age from 66 to 94 were involved. The data collected were analyzed using textual-oriented discourse analysis. RESULTS Our findings indicated that individuals with dementia struggled to comprehend the medical terminology used to describe their experiences within biomedical standards. The interviewees utilized 5 negative discourses on dementia, which shaped their attitudes toward the condition and people diagnosed with it. These discourses depicted dementia as an illness, negative aging, a devaluation, a burden, and a life tragedy. Moreover, study participants did not outright reject the diagnosis but rather negotiated its acceptance within the context of shame associated with dementia. DISCUSSION AND IMPLICATIONS The concept of anosognosia can serve as a mechanism of social control and stigmatization of people with dementia within the dominant biomedical discourse.
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Affiliation(s)
| | - Magdalena Leszko
- Department of Psychology, Moravian University, Bethlehem, Pennsylvania, USA
- Department of Psychology, University of Szczecin, Szczecin, Poland
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Sommerlad A, Grothe J, Umeda S, Ikeda M, Kanemoto H, Livingston G, Luppa M, Rankin KP, Riedel-Heller SG, Röhr S, Suzuki M, Huntley J. Awareness of Social Functioning in People with Dementia and Its Association with Dementia Severity: Multi-Center Cross-Sectional Study. J Alzheimers Dis 2024:JAD240311. [PMID: 39031360 DOI: 10.3233/jad-240311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
Background People with dementia commonly have impaired social functioning and may not recognize this. This lack of awareness may result in worse outcomes for the person and their family carers. Objective We aimed to characterize awareness of social functioning in dementia and describe its association with dementia severity. Methods Multi-center cross-sectional study of people aged >65 years with dementia and family informants recruited from Germany, Japan and the United Kingdom. We used the Social Functioning in Dementia (SF-DEM) scale, assessing "spending time with other people" (domain 1), "communicating with other people" (domain 2), and "sensitivity to other people" (domain 3), and calculated lack of awareness into social functioning as the discrepancy between patient and informant ratings. Results 108 participants with dementia (50.9% women), mean age = 78.9 years, and mean MMSE score = 22.7. Patient and informant domain 1 ratings did not differ, but patient-rating was higher than carers for domain 2 (11.2 versus 10.1; p = 0.003) and domain 3 (9.7 versus 8.1; p < 0.001). Sixty people with dementia overestimated their overall social functioning, 30 underestimated, and 18 gave ratings congruent with their informant. Performance on the MMSE and its sub-domains was not associated with SF-DEM discrepancy score. Conclusions We found that awareness of social functioning in dementia was a multidimensional concept, which varies according to subdomains of social functioning. Clinicians should help family members understand and adapt by explaining their relative with dementia's lack of awareness about aspects of their social functioning.
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Affiliation(s)
- Andrew Sommerlad
- Division of Psychiatry, University College London, Gower Street, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Jessica Grothe
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Germany
| | - Sumiyo Umeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Psychiatry, Daini Osaka Police Hospital, Osaka, Japan
- Department of Psychiatry and Mental Health, Sumitomo Hospital, Osaka, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
- Health and Counseling Center, Osaka University, Osaka, Japan
| | - Gill Livingston
- Division of Psychiatry, University College London, Gower Street, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Germany
| | - Katherine P Rankin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, USA
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Germany
- Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
- School of Psychology, Massey University, Albany Campus, Auckland, Aotearoa New Zealand
| | - Maki Suzuki
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Osaka, Japan
| | - Jonathan Huntley
- Division of Psychiatry, University College London, Gower Street, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- The Medical School, University of Exeter, Exeter, UK
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Sun Z, Li C, Sun L, Yang W, Qu X, Li Y, Duan X, Guo F, Sun X, Yang M, Qi T, Zhu L, Wang S, Xia Y, Du Y, Luo S, Li L, Gu Y, Wang Y, Yang L. Electroacupuncture stimulation modulates functional brain connectivity in the treatment of pediatric cerebral palsy: a case report. Front Psychiatry 2024; 15:1392958. [PMID: 38751414 PMCID: PMC11094465 DOI: 10.3389/fpsyt.2024.1392958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
Background Pediatric cerebral palsy (CP) is a non-progressive brain injury syndrome characterized by central motor dysfunction and insufficient brain coordination ability. The etiology of CP is complex and often accompanied by diverse complications such as intellectual disability and language disorders, making clinical treatment difficult. Despite the availability of pharmacological interventions, rehabilitation programs, and spasticity relief surgery as treatment options for CP, their effectiveness is still constrained. Electroacupuncture (EA) stimulation has demonstrated great improvements in motor function, but its comprehensive, objective therapeutic effects on pediatric CP remain to be clarified. Methods We present a case of a 5-year-old Chinese female child who was diagnosed with CP at the age of 4. The patient exhibited severe impairments in motor, language, social, and cognitive functions. We performed a 3-month period of EA rehabilitation, obtaining resting state functional magnetic resonance imaging (rs-fMRI) of the patient at 0 month, 3 months and 5 months since treatment started, then characterized brain functional connectivity patterns in each phase for comparison. Results After a 12-month follow-up, notable advancements were observed in the patient's language and social symptoms. Changes of functional connectivity patterns confirmed this therapeutic effect and showed specific benefits for different recovery phase: starting from language functions then modulating social participation and other developmental behaviors. Conclusion This is a pioneering report demonstrating the longitudinal effect of EA stimulation on functional brain connectivity in CP patients, suggesting EA an effective intervention for developmental disabilities (especially language and social dysfunctions) associated with pediatric CP.
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Affiliation(s)
- Zongbo Sun
- School of Medicine, Liao Cheng University, Liaocheng, Shandong, China
| | - Chenglin Li
- Department of Rehabilitation, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Laixin Sun
- Department of Rehabilitation, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Wenwen Yang
- Department of Rehabilitation, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Xueli Qu
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Yuanyuan Li
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Xiao Duan
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Fengyu Guo
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Xuejing Sun
- Medical Genetics Laboratory, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Mingzhu Yang
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Tong Qi
- Department of Rehabilitation, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Longyun Zhu
- Department of Rehabilitation, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Shuai Wang
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Yu Xia
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Yanan Du
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Shuhui Luo
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Lingling Li
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Yu Gu
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Yaya Wang
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
| | - Li Yang
- Department of Radiology, Maternal and Child Health Hospital, Dongchangfu, Liaocheng, China
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Ruíz-González C, González-López MDC, García-Ramón MJ, Ruiz-Fernández MD, Rebollo-Lavado B, Andújar-Rodríguez E, Ventura-Miranda MI. A description of risk associated with use of antipsychotics among community dwelling older adults: A descriptive cross-sectional study. Geriatr Nurs 2024; 55:362-367. [PMID: 38171187 DOI: 10.1016/j.gerinurse.2023.12.009] [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: 10/07/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Abstract
The objective of this research was to analyze the risk of adverse effects in patients older than 65 years with dementia and in concomitant treatment with antidementia and antipsychotic drugs and who are cared for by community nurses. A retrospective cross-sectional descriptive study was carried out. A total of 332 patients who were cared for by primary care teams participated. Most of the patients were women, totally dependent for the basic activities of daily living and residing in the family home. They were polymedicated and there was poor therapeutic adherence. The risk of adverse effects was higher in polymedicated patients who had been taking antipsychotics for longer periods and in those who had a main caregiver. However, those patients who had been assessed by the community nurse were protected from suffering adverse effects. This study demonstrates how integrated and continuous nursing care can reduce adverse effects in this type of patient.
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Affiliation(s)
- Carlos Ruíz-González
- Primary Health Care District of Almeria, Andalusian Health Service, 04006 Almería, Spain
| | | | | | - María Dolores Ruiz-Fernández
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Providencia, Chile.
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Wadsley M, Ihssen N. A Systematic Review of Structural and Functional MRI Studies Investigating Social Networking Site Use. Brain Sci 2023; 13:brainsci13050787. [PMID: 37239257 PMCID: PMC10216498 DOI: 10.3390/brainsci13050787] [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: 03/10/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
An understanding of the neurocognitive profile underlying the use of social networking sites (SNSs) can help inform decisions about the classification of problematic SNS use as an addictive disorder and elucidate how/when 'SNS addiction' might develop. The present review aimed to synthesize structural and functional MRI research investigating problematic/compulsive forms of SNS use or regular (non-addicted) SNS use behaviours. We conducted a systematic search for research articles published in English using the Web of Science, PubMed, and Scopus databases up to October 2022. Studies meeting our inclusion criteria were assessed for quality and a narrative synthesis of the results was conducted. Twenty-eight relevant articles were identified comprising structural MRI (n = 9), resting-state fMRI (n = 6) and task-based fMRI studies (n = 13). Current evidence suggests that problematic SNS use might be characterised by (1) reduced volume of the ventral striatum, amygdala, subgenual anterior cingulate cortex, orbitofrontal cortex and posterior insula; (2) increased ventral striatum and precuneus activity in response to SNS cues; (3) abnormal functional connectivity involving the dorsal attention network; (4) inter-hemispheric communication deficits. Regular SNS use behaviours appear to recruit regions involved in the mentalising network, the self-referential cognition network, the salience network, the reward network and the default mode network. Such findings are at least partially consistent with observations from the substance addiction literature and provide some provisional support for the addictive potential of SNSs. Nonetheless, the present review is limited by the small number of eligible studies and large heterogeneity in the methods employed, and so our conclusions should remain tentative. Moreover, there is a lack of longitudinal evidence suggesting SNSs cause neuroadaptations and thus conclusions that problematic SNS use represents a disease process akin to substance use addictions are premature. More well-powered longitudinal research is needed to establish the neural consequences of excessive and problematic SNS use.
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Affiliation(s)
- Michael Wadsley
- Department of Psychology, Durham University, Durham DH1 3LE, UK
| | - Niklas Ihssen
- Department of Psychology, Durham University, Durham DH1 3LE, UK
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de Morais VAC, de Oliveira-Pinto AV, Mello Neto AF, Freitas JS, da Silva MM, Suemoto CK, Leite RP, Grinberg LT, Jacob-Filho W, Pasqualucci C, Nitrini R, Caramelli P, Lent R. Resilience of Neural Cellularity to the Influence of Low Educational Level. Brain Sci 2023; 13:brainsci13010104. [PMID: 36672086 PMCID: PMC9857353 DOI: 10.3390/brainsci13010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Education is believed to contribute positively to brain structure and function, as well as to cognitive reserve. One of the brain regions most impacted by education is the medial temporal lobe (MTL), a region that houses the hippocampus, which has an important role in learning processes and in consolidation of memories, and is also known to undergo neurogenesis in adulthood. We aimed to investigate the influence of education on the absolute cell numbers of the MTL (comprised by the hippocampal formation, amygdala, and parahippocampal gyrus) of men without cognitive impairment. METHODS The Isotropic Fractionator technique was used to allow the anisotropic brain tissue to be transformed into an isotropic suspension of nuclei, and therefore assess the absolute cell composition of the MTL. We dissected twenty-six brains from men aged 47 to 64 years, with either low or high education. RESULTS A significant difference between groups was observed in brain mass, but not in MTL mass. No significant difference was found between groups in the number of total cells, number of neurons, and number of non-neuronal cells. Regression analysis showed that the total number of cells, number of neurons, and number of non-neuronal cells in MTL were not affected by education. CONCLUSIONS The results indicate a resilience of the absolute cellular composition of the MTL of typical men to low schooling, suggesting that the cellularity of brain regions is not affected by formal education.
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Affiliation(s)
- Viviane A. Carvalho de Morais
- Neuroplasticity Laboratory, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
| | - Ana V. de Oliveira-Pinto
- Neuroplasticity Laboratory, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
| | - Arthur F. Mello Neto
- Neuroplasticity Laboratory, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
| | - Jaqueline S. Freitas
- Neuroplasticity Laboratory, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
| | - Magnólia M. da Silva
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Claudia Kimie Suemoto
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Renata P. Leite
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Lea T. Grinberg
- Memory and Aging Center, University of California San Francisco, San Francisco, CA 94158, USA
| | - Wilson Jacob-Filho
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
- Laboratory of Medical Research in Aging (LIM-66), Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Carlos Pasqualucci
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Ricardo Nitrini
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Roberto Lent
- Neuroplasticity Laboratory, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
- D’Or Institute of Research and Education, Rio de Janeiro 22281-100, RJ, Brazil
- Correspondence:
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Duff K, Wan L, Embree L, Hoffman JM. Change in the Quick Dementia Rating System Across Time in Older Adults with and without Cognitive Impairment. J Alzheimers Dis 2023; 93:449-457. [PMID: 37038819 DOI: 10.3233/jad-221252] [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] [Indexed: 04/12/2023]
Abstract
BACKGROUND The Quick Dementia Rating System (QDRS) is a brief, informant-reported dementia staging tool that approximates scores on the Clinical Dementia Rating Scale in patients with Alzheimer's disease (AD). OBJECTIVE The current study sought to examine change in the QDRS across time, which is necessary for clinical and research efforts. METHODS One-hundred ten older adults (intact, mild cognitive impairment [MCI], mild AD, classified with Alzheimer's Disease Neuroimaging Initiative criteria) were rated on the QDRS by an informant and had an amyloid positron emission tomography scan at baseline. The informant re-rated each participant on the QDRS after one year. Dependent t-tests compared the entire sample and various subgroups (e.g., cognitive status, amyloid status) on baseline and follow-up QDRS scores. RESULTS In the entire sample, the Total score on the QDRS significantly increased (i.e., worsened) on follow-up (p < 0.001). When subgroups were analyzed, the MCI and mild AD subjects showed increasing (i.e., worsening) QDRS Total scores (both p < 0.001), but the intact subjects remained stable over time (p = 0.28). Additionally, those classified as being amyloid positive at baseline showed significantly increased QDRS Total scores at follow-up (p < 0.001) compared to those who were amyloid negative at baseline, whose QDRS Total scores remained stable over time (p = 0.63). CONCLUSION The QDRS can potentially demonstrate worsening functioning status across one year, especially in those who have MCI or mild AD and those who are amyloid positive. Therefore, the current results preliminarily suggest that the QDRS may provide an efficient tool for tracking progression in clinical trials in AD.
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Affiliation(s)
- Kevin Duff
- Department of Neurology, Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
- Department of Neurology, Center for Alzheimer's Care, Imaging and Research, University of Utah, Salt Lake City, UT, USA
| | - Laura Wan
- Vanderbilt University, Nashville, TN, USA
| | - Lindsay Embree
- Department of Neurology, Center for Alzheimer's Care, Imaging and Research, University of Utah, Salt Lake City, UT, USA
| | - John M Hoffman
- Department of Neurology, Center for Alzheimer's Care, Imaging and Research, University of Utah, Salt Lake City, UT, USA
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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