logo logo
Effects of brain activity, morning salivary cortisol, and emotion regulation on cognitive impairment in elderly people. Medicine OBJECTIVE:Cognitive impairment subjects exhibit high cortisol levels that are associated with low brain activity, but negative emotions with high cortisol are associated with high brain activity and reduced cognition. Emotion regulation, glucocorticoid hormones, and brain activity all interact with cognitive impairment. Therefore, we aimed to investigate cognitive impairment differences related to sex, morning salivary cortisol, emotion regulation, and brain activity in elderly people. METHODS:A total of 64 participants (19 males and 45 females) were tested by the Montreal cognitive assessment. Next, morning saliva was collected from each participant and analyzed by enzyme-linked immunosorbent assay, and the brain activity of the participants was subsequently recorded. Finally, emotion regulation was assessed via the Brunel mood scale questionnaire. RESULTS:The results revealed that attention was significantly lower in elderly females than in elderly males. Depression and vigor were significantly higher in elderly females than in elderly males. Brain activity of the slow (delta and theta) and fast (beta and high beta) waves was significantly higher in elderly females than in elderly males. Moreover, attention was negatively correlated with the theta wave, whereas delayed recall was positively correlated with the theta wave and salivary cortisol. Depression was positively correlated with the high beta wave and language skill, whereas the high beta wave was negatively correlated with visuoconstructional skill. CONCLUSION:The brain activity, emotion, and cortisol were influenced by cognitive impairments, although the relation of brain activity with glucocorticoid hormones remains inconclusive. This finding may be useful to the brain aging process, promote healthy brain aging, and prevent neurodegenerative conditions. 10.1097/MD.0000000000016114
Relationships Between Cognitive Dysfunction and Health-Related Quality of Life Among Older Persons in Taiwan: A Nationwide Population-Based Survey. Liu Hsin-Yun,Tsai Wen-Che,Chiu Ming-Jang,Tang Li-Yu,Lee Huey-Jane,Shyu Yea-Ing L,Wang Woan-Shyuan American journal of Alzheimer's disease and other dementias BACKGROUND:To examine the relationships between cognitive dysfunction status and quality of life. METHODS:Secondary analysis of a nationwide population-based survey (≥65 years) in Taiwan. The 5-dimension EuroQoL questionnaire (EQ-5D) was completed by 10 013 participants. RESULTS:Participants with mild cognitive impairment (MCI; odds ratio = 4.88), very mild dementia (VMD; 7.96), or dementia (32.85) were more likely than those with normal cognition to report self-care problems. Participants with MCI (3.86), VMD (9.26), or dementia (31.61) were more likely to have usual-activity problems, and those with MCI (3.04), VMD (3.82), or dementia (9.23) were more likely to have mobility problems. Participants with MCI (2.10 and 2.14), VMD (2.77 and 2.18), or dementia (3.04 and 3.02) were more likely to report pain/discomfort and anxiety/depression. CONCLUSION:Dementia was negatively associated with EQ-5D, especially self-care, usual activities, and mobility. Mild cognitive impairment or VMD was also negatively associated, with VMD more negatively associated. Developing interventions for patients with specific cognitive dysfunctions is critical. 10.1177/1533317518813548
Using virtual reality-based training to improve cognitive function, instrumental activities of daily living and neural efficiency in older adults with mild cognitive impairment. Liao Ying-Yi,Tseng Han-Yun,Lin Yi-Jia,Wang Chung-Jen,Hsu Wei-Chun European journal of physical and rehabilitation medicine BACKGROUND:A combination of physical and cognitive training appears to be the effective intervention to improve cognitive function in older adults with mild cognitive impairment (MCI). Computing technology such as virtual reality (VR) may have the potential to assist rehabilitation in shaping brain health. However, little is known about the potential of VR-based physical and cognitive training designed as an intervention for cognition and brain activation in elderly patients with MCI. Moreover, whether a VR program designed around functional tasks can improve their instrumental activities of daily living (IADL) requires further investigation. AIM:This study investigated the effects of 12 weeks of VR-based physical and cognitive training on cognitive function, brain activation and IADL and compared the VR intervention with combined physical and cognitive training. DESIGN:A single-blinded randomized controlled trial. SETTING:Communities and day care centers in Taipei, Taiwan. POPULATION:Older adults with mild cognitive impairment. METHODS:Thirty-four community-dwelling older adults with MCI were randomized into either a VR-based physical and cognitive training (VR) group or a combined physical and cognitive training (CPC) group for 36 sessions over 12 weeks. Participants were assessed for their cognitive function (global cognition, executive function and verbal memory) and IADL at pre- and postintervention. Changes in prefrontal cortex activation during the global cognition test were also captured by functional near-infrared spectroscopy (NIRS) to identify the potential mediating pathway of the intervention. RESULTS:Both groups showed improved executive function and verbal memory (immediate recall). However, only the VR group showed significant improvements in global cognition (P<0.001), verbal memory (delayed recall, P=0.002), and IADL (P<0.001) after the intervention. The group × time interaction effects further demonstrated that IADL were more significantly improved with VR training than with CPC training (P=0.006). The hemodynamic data revealed decreased activation in prefrontal areas after training (P=0.0015), indicative of increased neural efficiency, in the VR-trained subjects. CONCLUSIONS:VR-based physical and cognitive training improves cognitive function, IADL and neural efficiency in older adults with MCI. CLINICAL REHABILITATION IMPACT:VR training could be implemented for older adults with MCI. 10.23736/S1973-9087.19.05899-4
Art therapy is associated with sustained improvement in cognitive function in the elderly with mild neurocognitive disorder: findings from a pilot randomized controlled trial for art therapy and music reminiscence activity versus usual care. Mahendran Rathi,Gandhi Mihir,Moorakonda Rajesh Babu,Wong Jonathan,Kanchi Madhu Mathi,Fam Johnson,Rawtaer Iris,Kumar Alan Prem,Feng Lei,Kua Ee Heok Trials BACKGROUND:Mild cognitive impairment (MCI) is a phase in cognitive decline when it is still possible to intervene to reverse the decline. Cognitive stimulation delivered through psychosocial interventions provides both psychological intervention and social stimulation to improve cognition. A pilot open-label parallel-arms randomized controlled trial was undertaken to examine the effects of art therapy (AT) and music reminiscence activity (MRA) compared to the control, on the primary outcome of neurocognitive domain assessments in elderly people with MCI. METHODS:Community-living elderly people with MCI (Petersen's criteria), assessed for study eligibility, were randomized using a web-based system with equal allocation to two intervention arms: AT (guided viewing of art pieces and production of visual arts) and MRA (listening, and recalling memories related to music) and a control arm (standard care without any intervention). Interventions were led by trained therapists weekly for 3 months, then fortnightly for 6 months. Neurocognitive domains (mean of memory, attention, and visuo-spatial abilities standardized scores), psychological wellbeing (subsyndromal depression and anxiety) and telomere length as a biological marker of cellular ageing, were assessed by intervention-blinded assessors at baseline, 3 months and 9 months. RESULTS:In total, 250 people were screened and 68 were randomized and included in the analysis. In the AT arm, neurocognitive domains improved compared to the control arm at 3 months (mean difference (d) = 0.40; 90% CI 0.126, 0.679) and were sustained at 9 months (d = 0.31; 90% CI 0.068, 0.548). There was some improvement in depression and anxiety at 3 and 9 months and in telomere length at 9 months, but this was not significant. Similar improvements were observed in the MRA arm over the control arm, but they were not significant. There were no intervention-related adverse effects. CONCLUSIONS:Art therapy delivered by trained staff as "art as therapy" and "art psychotherapy" may have been the significant contributor to cognitive improvements. The findings support cognitive stimulation for elderly people with cognitive decline and signal the need for larger studies and further investigation of carefully designed psycho-social interventions for this group. TRIAL REGISTRATION:Clinical Trials.gov, NCT02854085 . Registered on 7 July 2016. 10.1186/s13063-018-2988-6
A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Livingston Gill,Kelly Lynsey,Lewis-Holmes Elanor,Baio Gianluca,Morris Stephen,Patel Nishma,Omar Rumana Z,Katona Cornelius,Cooper Claudia Health technology assessment (Winchester, England) BACKGROUND:Agitation is common, persistent and distressing in dementia and is linked with care breakdown. Psychotropic medication is often ineffective or harmful, but the evidence regarding non-pharmacological interventions is unclear. OBJECTIVES:We systematically reviewed and synthesised the evidence for clinical effectiveness and cost-effectiveness of non-pharmacological interventions for reducing agitation in dementia, considering dementia severity, the setting, the person with whom the intervention is implemented, whether the effects are immediate or longer term, and cost-effectiveness. DATA SOURCES:We searched twice using relevant search terms (9 August 2011 and 12 June 2012) in Web of Knowledge (incorporating MEDLINE); EMBASE; British Nursing Index; the Health Technology Assessment programme database; PsycINFO; NHS Evidence; System for Information on Grey Literature; The Stationery Office Official Documents website; The Stationery National Technical Information Service; Cumulative Index to Nursing and Allied Health Literature; and The Cochrane Library. We also searched Cochrane reviews of interventions for behaviour in dementia, included papers' references, and contacted authors about 'missed' studies. We included quantitative studies, evaluating non-pharmacological interventions for agitation in dementia, in all settings. REVIEW METHOD:We rated quality, prioritising higher-quality studies. We separated results by intervention type and agitation level. As we were unable to meta-analyse results except for light therapy, we present a qualitative evidence synthesis. In addition, we calculated standardised effect sizes (SESs) with available data, to compare heterogeneous interventions. In the health economic analysis, we reviewed economic studies, calculated the cost of effective interventions from the effectiveness review, calculated the incremental cost per unit improvement in agitation, used data from a cohort study to evaluate the relationship between health and social care costs and health-related quality of life (DEMQOL-Proxy-U scores) and developed a new cost-effectiveness model. RESULTS:We included 160 out of 1916 papers screened. Supervised person-centred care, communication skills (SES = -1.8 to -0.3) or modified dementia care mapping (DCM) with implementing plans (SES = -1.4 to -0.6) were all efficacious at reducing clinically significant agitation in care home residents, both immediately and up to 6 months afterwards. In care home residents, during interventions but not at follow-up, activities (SES = -0.8 to -0.6) and music therapy (SES = -0.8 to -0.5) by protocol reduced mean levels of agitation; sensory intervention (SES = -1.3 to -0.6) reduced mean and clinically significant symptoms. Advantages were not demonstrated with 'therapeutic touch' or individualised activity. Aromatherapy and light therapy did not show clinical effectiveness. Training family carers in behavioural or cognitive interventions did not decrease severe agitation. The few studies reporting activities of daily living or quality-of-life outcomes found no improvement, even when agitation had improved. We identified two health economic studies. Costs of interventions which significantly impacted on agitation were activities, £80-696; music therapy, £13-27; sensory interventions, £3-527; and training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM, £31-339. Among the 11 interventions that were evaluated using the Cohen-Mansfield Agitation Inventory (CMAI), the incremental cost per unit reduction in CMAI score ranged from £162 to £3480 for activities, £4 for music therapy, £24 to £143 for sensory interventions, and £6 to £62 for training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM. Health and social care costs ranged from around £7000 over 3 months in people without clinically significant agitation symptoms to around £15,000 at the most severe agitation levels. There is some evidence that DEMQOL-Proxy-U scores decline with Neuropsychiatric Inventory agitation scores. A multicomponent intervention in participants with mild to moderate dementia had a positive monetary net benefit and a 82.2% probability of being cost-effective at a maximum willingness to pay for a quality-adjusted life-year of £20,000 and a 83.18% probability at a value of £30,000. LIMITATIONS:Although there were some high-quality studies, there were only 33 reasonably sized (> 45 participants) randomised controlled trials, and lack of evidence means that we cannot comment on many interventions' effectiveness. There were no hospital studies and few studies in people's homes. More health economic data are needed. CONCLUSIONS:Person-centred care, communication skills and DCM (all with supervision), sensory therapy activities, and structured music therapies reduce agitation in care-home dementia residents. Future interventions should change care home culture through staff training and permanently implement evidence-based treatments and evaluate health economics. There is a need for further work on interventions for agitation in people with dementia living in their own homes. PROTOCOL REGISTRATION:The study was registered as PROSPERO no. CRD42011001370. FUNDING:The National Institute for Health Research Health Technology Assessment programme. 10.3310/hta18390
Preferred Music Listening Intervention in Nursing Home Residents with Cognitive Impairment: A Randomized Intervention Study. Pérez-Ros Pilar,Cubero-Plazas Laura,Mejías-Serrano Trinidad,Cunha Cristina,Martínez-Arnau Francisco M Journal of Alzheimer's disease : JAD BACKGROUND:The current trend in addressing symptoms of dementia comprises non-pharmacological strategies such as music interventions for the management and improvement of cognitive function, memory, agitation, depression, or anxiety. OBJECTIVE:To determine the impact of a preferred music listening group intervention upon the functional, cognitive, and emotional dimensions in nursing home residents. METHODS:A randomized intervention study was carried out. The study was conducted from June to August 2015, and involved a preferred music listening group intervention lasting 60 minutes, 5 days/week during 8 weeks. A total of 119 adults aged ≥65 years, with annual permanent residence in the nursing home (Málaga, Spain) were included in the study. 47 (39.5%) subjects were randomized to the music group intervention. The nurses and physiotherapists were blinded to the assessments. RESULTS:The sample had a mean age of 80.52 (SD7.44) years, with female predominance. The subjects presented dependency in Barthel, and cognitive impairment as determined by the MMSE. The Tinetti scores yielded fall risk and depression as evidenced by the Yesavage scale. The Cornell scores evidenced no depression in elderly people with dementia. Following the intervention, function improved significantly with a medium effect size, as did emotional state, with a large effect size. Cognitive function was seen to worsen in the control group, but remained stable in the intervention group, with a large effect size. CONCLUSIONS:A preferred music listening group intervention among elderly people in nursing homes is effective, resulting in improvements in functional and emotional condition. 10.3233/JAD-190361
The use of involuntary treatment among older adults with cognitive impairment receiving nursing care at home: A cross-sectional study. Moermans Vincent R A,Bleijlevens Michel H C,Verbeek Hilde,Tan Frans E S,Milisen Koen,Hamers Jan P H International journal of nursing studies BACKGROUND:Respect for inherent dignity and individual autonomy is a basic principle in health care. However, several studies indicate that care-dependent older adults with a cognitive impairment, receiving nursing care at home, are at risk of care without their consent, referred to as 'involuntary treatment'. This includes the application of physical restraints (e.g. measures to prevent leaving bed or chair), psychotropic drugs (e.g. antidepressants, sedatives) and non-consensual care (e.g. forced hygiene, hiding medication). Research about involuntary treatment is scarce and only recently first studies have been conducted. OBJECTIVE:To investigate 1) the prevalence of involuntary treatment, 2) associated factors and 3) who requests and applies their use among older adults with cognitive impairment receiving nursing care at home. DESIGN:Cross- sectional study. SETTING:Homes of older adults receiving nursing care from district nurses in the eastern part of Belgium. PARTICIPANTS:Data were collected from 1194 randomly selected older adults with cognitive impairments receiving nursing care at home (mean age 83; 67% female). METHOD:District nurses completed an online questionnaire for each selected older adult in their caseload. Involuntary treatment was measured using a questionnaire identifying use of physical restraints, psychotropic medication and non-consensual care. In addition who requests involuntary treatment and who applies it was examined. Older adults sociodemographic characteristics, diagnosis of dementia, activities of daily living (ADL), cognitive status and informal caregiver burden were assessed. RESULTS:Involuntary treatment was used in 52% (95%; CI 49-55) of the total sample. Non-consensual care was most often used (73%; 95% CI 70-77), followed by psychotropic drugs (43%; 95% CI 39-47) and physical restraints (38%; 95% CI 35-42). The use of involuntary treatment was associated with dependency for activities of daily life (OR 1.50; 95% CI 1.33-1.69), cognitive impairment (1.39; 95% CI 1.25-1.55), informal caregiver burden (OR 1.05; 95% CI 1.01-1.10) and aging (OR 0.97; 95% CI 0.95-0.99). Informal caregivers (71%), followed by general practitioners (47%) most frequently requested the use of involuntary treatment, and nurses (81%) mostly applied it. CONCLUSION:In Belgium, involuntary treatment is often used in older adults with a cognitive impairment receiving nursing care at home. The implication of this study for clinical practice is that it confirms the need to develop an approach to prevent and reduce it. Further research is needed to plan and develop such an approach, in order to prevent and reduce the use of involuntary treatment. 10.1016/j.ijnurstu.2018.09.004