Search results for: subcortical dementia

Authors: Eman Al-khateeba, Ebaa Al-Zayadneha, Osama Al-Dalahmahb, Zeinab Alawadib, Faisal Khatiba, Randa Naffaa, Yanal Shafagoj

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The purpose of the current study was to examine the association of plasma copper and lipid concentrations with changes in cognitive function in elderly Jordanian individuals. The study population consisted of two groups; 52 subjects with dementia, and 50 controls. All individuals were screened with Mini-Mental State Examination (MMSE) and Clock drawing test (CDT).Serum copper and lipid profile were assessed in all subjects, and the results were statistically evaluated at P < 0.05 level of significance. Dementia group had 10.1 % higher copper levels than controls however the difference was not statistically significant. No significant differences could be found between the two groups in lipid profile levels. There was no significant correlation between serum copper, lipid profile and cognitive decline in elderly Jordanians. Demographic variables indicate that educational level less than 12 years and illiterate demonstrated a 3.29 fold (p=0.026) and 6.29 fold (p=0.002) increase in risk of developing dementia, respectively. While coffee intake showed a protective effect against cognitive decline with 6.25 fold lower risk with increased coffee intake.

Keywords: copper, cholesterol, dementia, Alzheimer's disease, lipid profile, coffee

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Authors: Ryuji Yamazaki, Masahiro Kochi, Weiran Zhu, Hiroko Kase

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In care for older adults, behavioral and psychological symptoms of dementia (BPSD) like agitation and aggression are distressing for patients and their caretakers, often resulting in premature institutionalization with increased costs of care. To improve mood and mitigate symptoms, as a non-pharmaceutical approach, emotion-oriented therapy like reminiscence work is adopted in face-to-face communication. Telecommunication support is expected to be provided by robotic media as a bridge for digital divide for those with dementia and facilitate social interaction both verbally and nonverbally. The purpose of this case study is to explore the conditions in which robotic media can effectively attract attention from older adults with dementia and promote their well-being. As a pilot study, we introduced the pillow-phone Hugvie^®, a huggable humanly shaped communication medium to five residents with dementia at a care facility, to investigate how the following conditions work for the elderly when they use the medium; 1) no sound, 2) radio, non-interactive, 3) daily conversation, and 4) reminiscence work. As a result, under condition 4, reminiscence work, the five participants kept concentration in interacting with the medium for a longer duration than other conditions. In condition 4, they also showed larger amount of utterances than under other conditions. These results indicate that providing topics related to personal histories through robotic media could affect communication positively and should, therefore, be further investigated. In addition, the issue of ethical implications by using persuasive technology that affects emotions and behaviors of older adults is also discussed.

Keywords: BPSD, reminiscence, tactile telecommunication, utterances

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Authors: Ayşe Defne Öz, Özlem Bozkurt

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Alzheimer's Disease (AD) is counted as one of the most important global health problems and the main cause of dementia. The term dementia refers to a wide spectrum of disorders characterized by global, chronic, and generally irreversible cognitive deterioration. It is estimated that %60 % to 80 of the cases of dementia are because of AD. Alzheimer's is a slowly progressive brain disease. The reason for AD is unknown to the author's best knowledge, yet it is one of the topics that is most researched. AD shows the histopathologically abnormal accumulation of the protein beta-amyloid (plague) outside neurons and twisted strands of the protein tau (tangles) inside neurons in the brain. These changes are accompanied by damage to the brain tissue and the death of neurons. AD causes people to have difficulty remembering names or conversations. Some of the later symptoms are difficulty in talking and walking. Alzheimer's Disease is elevated by the illness and mortality of COVID-19. COVID-19 has affected many lives globally and had profound effects on human lives. COVID-19 is caused by SARS-CoV-2, which is a virus that attacks the respiratory and central nervous system and has neuroinvasive potential. More than %80 of COVID-19 patients have ageusia or anosmia, representing the pathognomic features of the disease. Patients with dementia are frail, and with the COVID-19 pandemic, including isolation, cognitive decline may exacerbate. Furthermore, patients with AD can be unable to follow the directions, such as covering their mouth and nose while coughing and can live in nursing homes which makes them more open to being infected. As COVID-19 is highly infectious and its management requires isolation and quarantine, the need for caregivers for AD management conflicts with that of COVID-19 and adds an extra burden on AD patients, caregivers, families, society, and the economy. Due to the entry of SARS-CoV-2 into the central nervous system, inflammation caused by COVID-19, prolonged hospitalization, and delirium, it has been reported that COVID-19 causes many neurological disorders and predisposition to AD.

Keywords: Alzheimer's disease, COVID-19, dementia, SARS-CoV-2

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Authors: Murat Emre, Zeynep Tufekcioglu

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Objective: We describe a patient with late onset phenylketonuria which presented with rapidly progressive dementia and parkinsonism that were reversible after management. Background: Phenylketonuria is an autosomal recessive disorder due to mutations in the phenylalanine hydroxlase gene. It normally presents in childhood, in rare cases, however, it may have its onset in adulthood and may mimic other neurological disorders. Case description: A previously normal functioning, 59 year old man was admitted for blurred vision, cognitive impairment and gait difficulty which emerged over the past eight months. In neurological examination he had brisk reflexes, slow gait and left-dominant parkinsonism. Mini-mental state examination score was 25/30, neuropsychological testing revealed a dysexecutive syndrome with constructional apraxia and simultanagnosia. In cranial MRI there were bilateral diffuse hyper-intense lesions in parietal and occipital white matter with no significant atrophy. Electroencephalography showed diffuse slowing with predominance of teta waves. In cerebrospinal fluid examination protein level was slightly elevated (61mg/dL), oligoclonal bands were negative. Electromyography was normal. Routine laboratory examinations for rapidly progressive dementia and parkinsonism were also normal. Serum amino acid levels were determined to explore metabolic leukodystrophies and phenylalanine level was found to be highly elevated (1075 µmol/L) with normal tyrosine (61,20 µmol/L). His cognitive impairment and parkinsonian symptoms improved following three months of phenylalanine restricted diet. Conclusions: Late onset phenylketonuria is a rare, potentially reversible cause of rapidly progressive parkinsonism with dementia. It should be considered in the differential diagnosis of patients with suspicious features.

Keywords: dementia, neurology, Phenylketonuria, rapidly progressive parkinsonism

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Authors: Jonathan Turner, Julie Doyle, Laura O’Philbin, Dympna O’Sullivan

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People living with dementia should be at the centre of decision-making regarding goals for daily living. These goals include basic activities (dressing, hygiene, and mobility), advanced activities (finances, transportation, and shopping), and meaningful activities that promote well-being (pastimes and intellectual pursuits). However, there is limited involvement of people living with dementia in the design of technology to support their goals. A project is described that is co-designing intelligent computer-based support for, and with, people affected by dementia and their carers. The technology will support self-management, empower participation in shared decision-making with carers and help people living with dementia remain healthy and independent in their homes for longer. It includes information from the patient’s care plan, which documents medications, contacts, and the patient's wishes on end-of-life care. Importantly for this work, the plan can outline activities that should be maintained or worked towards, such as exercise or social contact. The authors discuss how to integrate care goal information from such a care plan with data collected from passive sensors in the patient’s home in order to deliver individualized planning and interventions for persons with dementia. A number of scientific challenges are addressed: First, to co-design with dementia patients and their carers computerized support for shared decision-making about their care while allowing the patient to share the care plan. Second, to develop a new and open monitoring framework with which to configure sensor technologies to collect data about whether goals and actions specified for a person in their care plan are being achieved. This is developed top-down by associating care quality types and metrics elicited from the co-design activities with types of data that can be collected within the home, from passive and active sensors, and from the patient’s feedback collected through a simple co-designed interface. These activities and data will be mapped to appropriate sensors and technological infrastructure with which to collect the data. Third, the application of machine learning models to analyze data collected via the sensing devices in order to investigate whether and to what extent activities outlined via the care plan are being achieved. The models will capture longitudinal data to track disease progression over time; as the disease progresses and captured data show that activities outlined in the care plan are not being achieved, the care plan may recommend alternative activities. Disease progression may also require care changes, and a data-driven approach can capture changes in a condition more quickly and allow care plans to evolve and be updated.

Keywords: care goals, decision-making, dementia, self-care, sensors

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Authors: Salma A. El-Marasy, Reham M. Abd-Elsalam, Omar A. Ahmed-Farid

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Dementia is characterized by impairments in memory and other cognitive abilities. This study aims to elucidate the possible ameliorative effect of silymarin on scopolamine-induced dementia using the object recognition test (ORT). The study was extended to demonstrate the role of cholinergic activity, oxidative stress, neuroinflammation, brain neurotransmitters and histopathological changes in the anti-amnestic effect of silymarin in demented rats. Wistar rats were pretreated with silymarin (200, 400, 800 mg/kg) or donepezil (10 mg/kg) orally for 14 consecutive days. Dementia was induced after the last drug administration by a single intraperitoneal dose of scopolamine (16 mg/kg). Then behavioral, biochemical, histopathological, and immunohistochemical analyses were then performed. Rats pretreated with silymarin counteracted scopolamine-induced non-spatial working memory impairment in the ORT and decreased acetylcholinesterase (AChE) activity, reduced malondialdehyde (MDA), elevated reduced glutathione (GSH), restored gamma-aminobutyric acid (GABA) and dopamine (DA) contents in the cortical and hippocampal brain homogenates. Silymarin dose-dependently reversed scopolamine-induced histopathological changes. Immunohistochemical analysis showed that silymarin dose-dependently mitigated protein expression of a glial fibrillary acidic protein (GFAP) and nuclear factor kappa-B (NF-κB) in the brain cortex and hippocampus. All these effects of silymarin were similar to that of the standard anti-amnestic drug, donepezil. This study reveals that the ameliorative effect of silymarin on scopolamine-induced dementia in rats using the ORT maybe in part mediated by, enhancement of cholinergic activity, anti-oxidant and anti-inflammatory activities as well as mitigation in brain neurotransmitters and histopathological changes.

Keywords: dementia, donepezil, object recognition test, rats, silymarin, scopolamine

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Authors: Yuji Fujino, Kazu Amimoto, Kazuhiro Fukata, Masahide Inoue, Hidetoshi Takahashi, Shigeru Makita

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Aim: Pusher behavior (PB) is a disorder in which stroke patients shift their body weight toward the affected side of the body (the hemiparetic side) and push away from the non-hemiparetic side. These patients often use further pushing to resist any attempts to correct their position to upright. It is known that the subcortical white matter lesion (SWML) usually correlates of gait or balance function in stroke patients. However, it is unclear whether the SWML influences PB. The purpose of this study was to investigate if the damage of SWML affects the severity of PB on acute stroke patients. Methods: Fourteen PB patients without thalamic or cortical lesions (mean age 73.4 years, 17.5 days from onset) participated in this study. Evaluation of PB was performed according to the Scale for Contraversive Pushing (SCP) for sitting and/or standing. We used modified criteria wherein the SCP subscale scores in each section of the scale were >0. As a clinical measurement, patients were evaluated by the Stroke Impairment Assessment Set (SIAS). For the depiction of SWML, we used T2-weighted fluid-attenuated inversion-recovery imaging. The degree of damage on SWML was assessed using the Fazekas scale. Patients were divided into two groups in the presence of SWML (SWML+ group; Fazekas scale grade 1-3, SWML- group; Fazekas scale grade 0). The independent t-test was used to compare the SCP and SIAS. This retrospective study was approved by the Ethics Committee. Results: In SWML+ group, the SCP was 3.7±1.0 points (mean±SD), the SIAS was 28.0 points (median). In SWML- group, the SCP was 2.0±0.2 points, and the SIAS was 31.5 points. The SCP was significantly higher in SWML+ group than in SWML- group (p<0.05). The SIAS was not significant in both groups (p>0.05). Discussion: It has been considered that the posterior thalamus is the neural structures that process the afferent sensory signals mediating graviceptive information about upright body orientation in humans. Therefore, many studies reported that PB was typically associated with unilateral lesions of the posterior thalamus. However, the result indicates that these extra-thalamic brain areas also contribute to the network controlling upright body posture. Therefore, SMWL might induce dysfunction through malperfusion in distant thalamic or other structurally intact neural structures. This study had a small sample size. Therefore, future studies should be performed with a large number of PB patients. Conclusion: The present study suggests that SWML can be definitely associated with PB. The patients with SWML may be severely incapacitating.

Keywords: pushing behavior, subcortical white matter lesion, acute phase, stroke

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Authors: Holly D. Shan, Monique L. Bautista Neughebauer

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Sunscreen usage is emphasized in public health strategy as it reduces the risk of sunburns and skin cancers. This study aims to explore factors that influence sun protective behavior and outcomes. Data was received from the National Health Interview Survey (NHIS) 2020. Adults were asked how often they wore sunscreen when outside on a sunny day. Consistent use (“always”) of sunscreen, the incidence of sunburn within a year, and ever having a diagnosis of skin melanoma were compared by gender, race, and the diagnosis of anxiety, depression, and dementia. Individuals identifying as a mixed race were excluded. Statistical analysis was adjusted for large-scale surveys using STATA VSN 7.0, and a two-sided p<0.05 was considered significant. Of the 37,352 participants (53.18% females, 75.01% white, 10.49% black, 0.76% Indian Americans,5.60% Asian), 13.11% had a diagnosis of anxiety, 14.78% depression, and 0.84% dementia. Females wore sunscreen more often than males (24.72% vs. 10.91%, p<0.001). White individuals wore sunscreen most frequently; black individuals the least (17.37% vs. 6.49%, p<0.001). White individuals had the highest rate of sunburn (25.61%, p<0.001) and a history of skin melanoma (3.38%, p<0.001). Participants with anxiety, depression, and dementia all had statistically significantly decreased sunscreen use and increased frequency of sunburn compared to the general population. Only those with dementia had an increased incidence of skin melanoma (2.85% vs. 1.22%, p=0.009). Dermatologists and public health professionals should consider gender, race, and psychiatric comorbidities when counseling patients on sun protection.

Keywords: sun protective behavior, psychiatric disorder, melanoma, sunburn

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Authors: Suresh Lokiah

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The emerging trend of integrating robots into elderly care, particularly for assisting patients with dementia, holds the potential to greatly transform the sector. Assisted living facilities, which house a significant number of elderly individuals and dementia patients, constantly strive to engage their residents in stimulating activities. However, due to staffing shortages, they often rely on volunteers to introduce new activities. Despite the availability of social interaction, these residents, frequently overlooked in society, are in desperate need of additional support. Robots designed for elder care are categorized based on their design and functionality. These categories include companion robots, telepresence robots, health monitoring robots, and rehab robots. However, the integration of such robots raises significant ethical concerns, notably regarding privacy, autonomy, and the risk of dehumanization. Privacy issues arise as these robots may need to continually monitor patient activities. There is also a risk of patients becoming overly dependent on these robots, potentially undermining their autonomy. Furthermore, the replacement of human touch with robotic interaction may lead to the dehumanization of care. This paper delves into the ethical considerations of incorporating robotic assistance in eldercare. It proposes a series of guidelines and strategies to ensure the ethical deployment of these robots. These guidelines suggest involving patients in the design and development process of the robots and emphasize the critical need for human oversight to respect the dignity and rights of the elderly and dementia patients. The paper also recommends implementing robust privacy measures, including secure data transmission and data anonymization. In conclusion, this paper offers a thorough examination of the ethical implications of using robotic assistance in elder care. It provides a strategic roadmap to ensure this technology is utilized ethically, thereby maximizing its potential benefits and minimizing any potential harm.

Keywords: human-robot interaction, robots for eldercare, ethics, health, dementia

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Authors: Vijaykumar M. Baragi, Ramtilak Gattu, Gabriela Trifan, John L. Woodard, K. Meyers, Tim S. Halstead, Eric Hipple, Ewart Mark Haacke, Randall R. Benson

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NFL players, by virtue of their exposure to repetitive head injury, are at least twice as likely to develop Alzheimer's disease (AD) and dementia as the general population. Early recognition and intervention prior to onset of clinical symptoms could potentially avert/delay the long-term consequences of these diseases. Since AD is thought to have a long preclinical incubation period, the aim of the current research was to determine whether former NFL players, referred to a depression center, showed evidence of incipient dementia in their structural imaging prior to diagnosis of dementia. Thus, to identify neuroimaging markers of AD, against which former NFL players would be compared, we conducted a comprehensive volumetric analysis using a cohort of early stage AD patients (ADNI) to produce a set of brain regions demonstrating sensitivity to early AD pathology (i.e., the “AD fingerprint”). A cohort of 46 former NFL players’ brain MRIs were then interrogated using the AD fingerprint. Brain scans were done using a T1-weighted MPRAGE sequence. The Free Surfer image analysis suite (version 6.0) was used to obtain the volumetric and cortical thickness data. A total of 55 brain regions demonstrated significant atrophy or ex vacuo dilatation bilaterally in AD patients vs. healthy controls. Of the 46 former NFL players, 19 (41%) demonstrated a greater than expected number of atrophied/dilated AD regions when compared with age-matched controls, presumably reflecting AD pathology.

Keywords: alzheimers, neuroimaging biomarkers, traumatic brain injury, free surfer, ADNI

Procedia PDF Downloads 154

Authors: Akram Farhadi, Mahshid Froughan, Farahnaz Mohammadi, Maryam Rassouli, Maryam Noroozian, Leila Sadeghmoghaddam

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Background: The caregivers’ assessment of their own caregiving is considered the most important concept in exploring their experiences and has a major role in care outcomes. The rising number of people with dementia and their need for care makes family caregiving really important matter to consider and evaluate. Objectives: This study was conducted with the aim to naturalize and validate the Persian version of the Revised Caregiving Appraisal Scale (RCAS) in family caregivers of older adults with dementia. Patients and Method: In this cross-sectional methodological study, the Revised Caregiving Appraisal Scale (RCAS) was translated using International Quality of Life Assessment (IQOLA) protocol, and then a panel of experts examined its face and content validities. To ensure construct validity, the translated Revised Caregiving Appraisal Scale (RCAS) was completed by 236 family caregivers, and factor construct of the scale was assessed with 5 initial factors using confirmatory factor analysis. Internal consistency was found using Cronbach's alpha, and test-retest using intraclass correlation coefficient. Confirmatory factor analysis was performed in LISREL-8.8 software in Windows®. Results: Participating caregivers' mean age was 53.5±13.13 years. Content and face validities of the scale were confirmed according to the views expressed by family caregivers and panel of experts. The confirmatory factor analysis (CFA) results showed appropriate values for all fitness indices (RMSEA=0.046, df/X2=2.428, CFI=0.98, AGFI=0.84, GFI=0.9), and the 5-factor model was confirmed with 27 items. Overall Cronbach's alpha was reported 0.894, and test retest showed overall ICC=0.94. Conclusion: The Persian version of RCAS is a valid and reliable tool for family caregivers' assessment of their caregiving of older adults with dementia, and can be useful in assessing family caregiving interventions.

Keywords: psychometric, family caregivers, reliability and validity, elderly, dementia, self-appraisal

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Authors: Louise Moles, Steve Riley, Sarah D. Lichenstein, Marzieh Babaeianjelodar, Robert Kohler, Annie Cheng, Corey Horien Abigail Greene, Wenjing Luo, Jonathan Ahern, Bohan Xu, Yize Zhao, Chun Chieh Fan, R. Todd Constable, Sarah W. Yip

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Background: Risks for depression are myriad and include both genetic and brain-based factors. However, relationships between these systems are poorly understood, limiting understanding of disease etiology, particularly at the developmental level. Methods: We use a data-driven machine learning approach connectome-based predictive modeling (CPM) to identify functional connectivity signatures associated with polygenic risk scores for depression (DEP-PRS) among youth from the Adolescent Brain and Cognitive Development (ABCD) study across diverse brain states, i.e., during resting state, during affective working memory, during response inhibition, during reward processing. Results: Using 10-fold cross-validation with 100 iterations and permutation testing, CPM identified connectivity signatures of DEP-PRS across all examined brain states (rho’s=0.20-0.27, p’s<.001). Across brain states, DEP-PRS was positively predicted by increased connectivity between frontoparietal and salience networks, increased motor-sensory network connectivity, decreased salience to subcortical connectivity, and decreased subcortical to motor-sensory connectivity. Subsampling analyses demonstrated that model accuracies were robust across random subsamples of N’s=1,000, N’s=500, and N’s=250 but became unstable at N’s=100. Conclusions: These data, for the first time, identify neural networks of polygenic depression risk in a large sample of youth before the onset of significant clinical impairment. Identified networks may be considered potential treatment targets or vulnerability markers for depression risk.

Keywords: genetics, functional connectivity, pre-adolescents, depression

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Authors: Ayse Inel Manav, Nuray Simsek

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The number of people with dementia and the problems that are experienced by these people are increasing along with aging world population. This study was carried out to assess the effects of reminiscence therapy using internet videos on the cognitive condition and apathy levels of elderly people who had mild dementia and lived in nursing homes. This randomly controlled experimental study was conducted between 25 May-25 August 2016 in the nursing home, elderly care and rehabilitation centers in Adana and Seyhan, Turkey. A total of 32 individuals participated in this study, 16 in the experimental group and 16 in the control group. Data were collected using a personal information form developed on the basis of the published literature, the Standardized Mini Mental Test (SMMT) and the Apathy Rating Scale (ARS). The Clinical Research Ethics Committee's approval, written institutional permission, and the written consent of the participants were obtained before data collection. The individuals in the experimental group received reminiscence therapy using internet videos for 60 minutes one day a week for three months. During the same period, 25-30 minutes of unstructured interviews on subjects unrelated to reminiscence were carried out with individuals in the control group. The SMMT and ARS were administered before the applications in the experimental group and at the end of the third month. The collected data were analyzed using descriptive statistics (means, standard deviations, and frequencies) as well as Student's t-test, the Mann-Whitney U-test, and Wilcoxon's signed ranks test. In this study, the total SMMT post-test scores of the experimental group were higher than those of the control group (p = 0.001; p < 0.01). There was a difference between experimental and control groups' total SMMT post-test scores (p = 0.001; p < 0.01). The experimental group's ARS total post-test scores were higher than those of the control group (p = 0.001; p < 0.01). This study found that group reminiscence therapy using internet videos improved the cognitive functions and apathy levels of elderly individuals with mild dementia.

Keywords: apaty, cognitive testing, dementia, elderly, reminisence threapy

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Authors: Walter Rafael Ramos Villanueva

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The overwhelming majority of scholarship on David Chariandy’s novel Soucouyant focuses on how Adele’s dementia represents the preservation of “cultural memory” and the perniciousness of “historical trauma.” However, by metaphorizing Adele’s mental condition, these critics risk treating her dementia as mostly figurative, and they thus elide a more detailed discussion of the literal ramifications of her dementia diagnosis. To move beyond these readings, then, my paper will approach Adele’s disorder as a literal medical condition and explore how her caregiving needs affect not only her but also those around her. Soucouyant subverts traditional caregiving narratives by depicting the difficult and typically invisible labour of informal caregiving that is undertaken by the families and friends of those who are ill or otherwise disabled. Because Adele’s family is unable to access proper public healthcare resources within the community, the burden of care falls upon the protagonist and his brother, who become “parentified children.” Parentified children, according to Nancy D. Chase, are “parents to their parents, and fulfill this role at the expense of their own developmentally appropriate needs and pursuits.” The novel provides a depiction of informal caregiving that is multi-faceted and asks us to question why is it exactly that we place the burden of care on those who are not equipped to handle such pressures instead of putting the onus on the government and the public healthcare system to take care of its most vulnerable members. Ageing Studies scholar Larry Polvika notes that although policymakers often offer “pious expressions of appreciation” and acknowledge that informal caregiving is “the backbone of our long-term care system,” governmental support for these caregivers remains inadequate. It is my belief that, by showcasing the struggles of informal caregivers, Chariandy’s text combats this dangerous and empty political rhetoric.

Keywords: caregiving, dementia, literature, parentified children

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Authors: Alexander Street, Nina Wollersberger, Paul Fernie, Leonardo Muller, Ming Hung HSU, Helen Odell-Miller, Jorg Fachner, Patrizia Di Campli San Vito, Stephen Brewster, Hari Shaji, Satvik Venkatesh, Paolo Itaborai, Nicolas Farina, Alexis Kirke, Sube Banerjee, Eduardo Reck Miranda

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Escalating neuropsychiatric symptoms (NPS) in people with dementia may lead to earlier care home admission. Music listening has been reported to stimulate cognitive function, potentially reducing agitation in this population. We present a scoping review, reporting on current developments and discussing the potential for music listening with related technology in managing agitation in dementia care. Of two searches for music listening studies, one focused on older people or people living with dementia where music listening interventions, including technology, were delivered in participants’ homes or in institutions to address neuropsychiatric symptoms, quality of life and independence. The second included any population focusing on the use of music technology for health and wellbeing. In search one 70/251 full texts were included. The majority reported either statistical significance (6, 8.5%), significance (17, 24.2%) or improvements (26, 37.1%). Agitation was specifically reported in 36 (51.4%). The second search included 51/99 full texts, reporting improvement (28, 54.9%), significance (11, 21.5%), statistical significance (1, 1.9%) and no difference compared to the control (6, 11.7%). The majority in the first focused on mood and agitation, and the second on mood and psychophysiological responses. Five studies used AI or machine learning systems to select music, all involving healthy controls and reporting benefits. Most studies in both reviews were not conducted in a home environment (review 1 = 12; 17.1%; review 2 = 11; 21.5%). Preferred music listening may help manage NPS in the care home settings. Based on these and other data extracted in the review, a reasonable progression would be to co-design and test music listening systems and protocols for NPS in all settings, including people’s homes. Machine learning and automated technology for music selection and arousal adjustment, driven by live biodata, have not been explored in dementia care. Such approaches may help deliver the right music at the appropriate time in the required dosage, reducing the use of medication and improving quality of life.

Keywords: music listening, dementia, agitation, scoping review, technology

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Authors: Elzbieta Sikorska-Simmons

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Advanced dementia is a progressive terminal brain disease that is accompanied by a syndrome of difficult to manage symptoms and complications that eventually lead to death. The management of advanced dementia poses major challenges to family caregivers who act as patient health care proxies in making medical treatment decisions. Little is known, however, about how they manage advanced dementia and how their treatment choices influence the quality of patient life. This prospective qualitative study examines the key medical treatment decisions that family caregivers make while managing advanced dementia. The term ‘family caregiver’ refers to a relative or a friend who is primarily responsible for managing patient’s medical care needs and legally authorized to give informed consent for medical treatments. Medical decision-making implies a process of choosing between treatment options in response to patient’s medical care needs (e.g., worsening comorbid conditions, pain, infections, acute medical events). Family caregivers engage in this process when they actively seek treatments or follow recommendations by healthcare professionals. Better understanding of medical decision-making from the family caregiver perspective is needed to design interventions that maximize the quality of patient life and limit inappropriate treatments. Data were collected in three waves of semi-structured interviews with 20 family caregivers for patients with advanced dementia. A purposive sample of 20 family caregivers was recruited from a senior care center in Central Florida. The qualitative personal interviews were conducted by the author in 4-5 months intervals. The ethical approval for the study was obtained prior to the data collection. Advanced dementia was operationalized as stage five or higher on the Global Deterioration Scale (GDS) (i.e., starting with the GDS score of five, patients are no longer able survive without assistance due to major cognitive and functional impairments). Information about patients’ GDS scores was obtained from the Center’s Medical Director, who had an in-depth knowledge of each patient’s health and medical treatment history. All interviews were audiotaped and transcribed verbatim. The qualitative data analysis was conducted to answer the following research questions: 1) what treatment decisions do family caregivers make while managing the symptoms of advanced dementia and 2) how do these treatment decisions influence the quality of patient life? To validate the results, the author asked each participating family caregiver if the summarized findings accurately captured his/her experiences. The identified medical decisions ranged from seeking specialist medical care to end-of-life care. The most common decisions were related to arranging medical appointments, medication management, seeking treatments for pain and other symptoms, nursing home placement, and accessing community-based healthcare services. The most challenging and consequential decisions were related to the management of acute complications, hospitalizations, and discontinuation of treatments. Decisions that had the greatest impact on the quality of patient life and survival were triggered by traumatic falls, worsening psychiatric symptoms, and aspiration pneumonia. The study findings have important implications for geriatric nurses in the context of patient/caregiver-centered dementia care. Innovative nursing approaches are needed to support family caregivers to effectively manage medical care needs of patients with advanced dementia.

Keywords: advanced dementia, family caregiver, medical decision-making, symptom management

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Authors: Spyridon Komaitis, Christos Koutsarnakis, Evangelos Drosos, Aristotelis Kalyvas

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This study opts to investigate the intrinsic architecture, morphology, and spatial relationship of the subcortical pathways implicated in the connectivity of the motor/premotor cortex and SMA/pre-SMA complex. Twenty normal, adult, formalin-fixed cerebral hemispheres were explored through the fiber micro-dissection technique. Lateral to medial and medial to lateral dissections focused on the area of interest were performed in a tandem manner and under the surgical microscope. We traced the subcortical architecture, spatial relationships, and axonal connectivity of four major pathways: a) the dorsal component of the SLF (SLF-I) was found to reside in the medial aspect of the hemisphere and seen to connect the precuneus with the SMA and pre-SMA complex, b) the frontal longitudinal system (FLS) was consistently encountered as the natural anterior continuation of the SLF-II and SLF-III and connected the premotor and prefrontal cortices c) the fronto-caudate tract (FCT), a fan-shaped tract, was documented to participate in connectivity of the prefrontal and premotor cortices to the head and body of the caudate nucleus and d) the cortico-tegmental tract(CTT) was invariably recorded to subserve the connectivity of the tegmental area with the fronto-parietal cortex. No hemispheric asymmetries were recorded for any of the implicated pathways. Sub-segmentation systems were also proposed for each of the aforementioned tracts. The structural connectivity and functional specialization of motor and premotor areas in the human brain remain vague to this day as most of the available evidence derives either from animal or tractographic studies. By using the fiber-microdissection technique as our main method of investigation, we provide sound structural evidence on the delicate anatomy of the related white matter pathways.

Keywords: neuroanatomy, premotor, motor, connectivity

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Authors: Leigh G. Hayden, Susan E. Shepley, Cristina Passarelli, William Tingo

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Introduction: Sensory interventions are popular therapeutic and recreational approaches for people living with all stages of dementia. However, it is unknown which sensory interventions are used to achieve which outcomes across all subtypes of dementia. Methods: To address this gap, we conducted a scoping review of sensory interventions for people living with dementia. We conducted a search of the literature for any article published in English from 1 January 1990 to 1 June 2019, on any sensory or multisensory intervention targeted to people living with any kind of dementia, which reported on patient health outcomes. We did not include complex interventions where only a small aspect was related to sensory stimulation. We searched the databases Medline, CINHAL, and Psych Articles using our institutional discovery layer. We conducted all screening in duplicate to reduce Type 1 and Type 2 errors. The data from all included papers were extracted by one team member, and audited by another, to ensure consistency of extraction and completeness of data. Results: Our initial search captured 7654 articles, and the removal of duplicates (n=5329), those that didn’t pass title and abstract screening (n=1840) and those that didn’t pass full-text screening (n=281) resulted in 174 articles included. The countries with the highest publication in this area were the United States (n=59), the United Kingdom (n=26) and Australia (n=15). The most common type of interventions were music therapy (n=36), multisensory rooms (n=27) and multisensory therapies (n=25). Seven articles were published in the 1990’s, 55 in the 2000’s, and the remainder since 2010 (n=112). Discussion: Multisensory rooms have been present in the literature since the early 1990’s. However, more recently, nature/garden therapy, art therapy, and light therapy have emerged since 2008 in the literature, an indication of the increasingly diverse scholarship in the area. The least popular type of intervention is a traditional food intervention. Taste as a sensory intervention is generally avoided for safety reasons, however it shows potential for increasing quality of life. Agitation, behavior, and mood are common outcomes for all sensory interventions. However, light therapy commonly targets sleep. The majority (n=110) of studies have very small sample sizes (n=20 or less), an indicator of the lack of robust data in the field. Additional small-scale studies of the known sensory interventions will likely do little to advance the field. However, there is a need for multi-armed studies which directly compare sensory interventions, and more studies which investigate the use of layering sensory interventions (for example, adding an aromatherapy component to a lighting intervention). In addition, large scale studies which enroll people at early stages of dementia will help us better understand the potential of sensory and multisensory interventions to slow the progression of the disease.

Keywords: sensory interventions, dementia, scoping review

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Authors: Retno Supriyanti, Ays Rahmadian Subhi, Yogi Ramadhani, Haris B. Widodo

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Alzheimer is one type of disease in the elderly that may occur in the world. The severity of the Alzheimer can be measured using a scale called Clinical Dementia Rating (CDR) based on a doctor's diagnosis of the patient's condition. Currently, diagnosis of Alzheimer often uses MRI machine, to know the condition of part of the brain called Hippocampus and Ventricle. MRI image itself consists of 3 slices, namely Coronal, Sagittal and Axial. In this paper, we discussed the measurement of the area of the ventricle especially in the Coronal slice based on the severity level referring to the CDR value. We use Active Contour method to segment the ventricle’s region, therefore that ventricle’s area can be calculated automatically. The results show that this method can be used for further development in the automatic diagnosis of Alzheimer.

Keywords: Alzheimer, CDR, coronal, ventricle, active contour

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Authors: Nasreen Basoudan, Andrea Tales, Frederic Boy

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Non-clinical anxiety may be comprised of state anxiety - temporarily experienced anxiety related to a specific situation, and trait anxiety - a longer lasting response or a general disposition to anxiety. While temporary and occasional anxiety whether as a mood state or personality dimension is normal, nonclinical anxiety may influence many more components of information processing than previously recognized. In ageing and dementia-related research, disease characterization now involves attempts to understand a much wider range of brain function such as loss of inhibitory control, as against the more common focus on memory and cognition. However, in many studies, the tendency has been to include individuals with clinical anxiety disorders while excluding persons with lower levels of state or trait anxiety. Loss of inhibitory cognitive control can lead to behaviors such as aggression, reduced sensitivity to others, sociopathic thoughts and actions. Anxiety has also been linked to inhibitory control, with research suggesting that people with anxiety are less capable of inhibiting their emotions than the average person. This study investigates the relationship between anxiety and loss of inhibitory control in younger and older adults, using a variety of questionnaires and computers-based tests. Based on the premise that irrespective of classification, anxiety is associated with a wide range of physical, affective, and cognitive responses, this study explores evidence indicative of the potential influence anxiety per se on loss of inhibitory control, in order to contribute to discussion and appropriate consideration of anxiety-related factors in methodological practice.

Keywords: anxiety, ageing, dementia, inhibitory control

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Authors: Sadeq Al Yaari, Fayza Alhammadi, Ayman Al Yaari, Montaha Al Yaari, Aayah Al Yaari, Adham Al Yaari, Sajedah Al Yaari, Saleh Al Yami

Abstract:

Background: There has been a debate in the literature over the years as to whether or not MossTalk Words program fits Arab Broca’s aphasics (BAs) due to that language differences and also the fact that the technique has not yet been used for aphasics with semantic dementia (SD aphasics). Aims: To oversimplify the above mentioned debate slightly for purposes of exposition, the purpose of the present study is to investigate the “usability” of this program as well as pictures and community as therapeutic techniques for both Arab BAs and SD aphasics. Method: The subjects of this study are two Saudi aphasics (53 and 57 years old, respectively). The former suffers from Broca’s aphasia due to a stroke, while the latter suffers from semantic dementia. Both aphasics can speak English and have used the Moss Talk Words program in addition to intensive picture-naming therapeutic sessions for two years. They were tested by one of the researchers four times (a time per six months). The families of the two subjects, in addition to their relatives and friends, played a major part in all therapeutic sessions. Conclusion: Results show that in averages across the entire therapeutic sessions, MossTalk Words program was clearly found more effective in modeling BAs’ pronunciation than that of SD aphasic. Furthermore, picture-naming intensive exercises in addition to the positive role of the community members played a major role in the progress of the two subjects’ performance.

Keywords: moss talk words, program, technique, Broca’s aphasia, semantic dementia, subjects, picture, community

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Authors: Salman Abdul Majeed, Vidur Solanki, Ruqiya Shama Tareen

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BACKGROUND: The COVID-19 pandemic has affected the way of living as we have known for all strata of society. While disease containment measures imposed by governmental agencies have been instrumental in controlling the spread of the virus, it has had profound collateral impacts on all populations. However, the disruption caused in the lives of one segment of population has been far more damaging than most others: the emotional wellbeing of our child and adolescent populations. This impact was even more pronounced in children who already suffered from neurodevelopmental or psychiatric disorders. In particular, school closures have not only led to profound social isolation, but also negative impacts on normal developmental opportunities and interruptions in mental health services obtained through school systems. It is too soon to understand the full impacts of quarantine, isolation, stress of social detachment and fear of pandemic, but we have started to see the devastating impact on C&A already. This review intends to shed light on the current understanding of psychiatric wellbeing of C&A during COVID-19 pandemic. METHOD: Literature search utilizing key words COVID-19 and children, quarantine and children, social isolation, Loneliness, pandemic stress and children, and mental health of children, disease containment measures was carried out. Over 200 articles were identified, out of which 81 articles were included in this review article. RESULTS: The disruption caused by COVID-19 in the lives of C&A is much more damaging and its impact is far reaching. The C&A ED visits for possible suicide attempts have jumped to 22.3% in 2020 and 39.1% during 2021. One study utilizing T1-weighted structural images, computed the thickness of cortical and subcortical structures including amygdala, hippocampus, and nucleus accumbens. The Peri-COVID group showed reduced cortical and subcortical thickness and more advanced brain aging compared to pre pandemic studies. CONCLUSION: Mental health resources for C&A remain under funded, neglected, and inaccessible to population that needs it most. Children with ongoing mental health disorders were impacted worst, along with those with predisposed biopsychosocial risk factors.

Keywords: COVID-19 and children, quarantine and children, social isolation, Loneliness, pandemic stress and children, disease containment measures, mental health of children

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Authors: Rina Yadav, Lih-Yau Song

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The claim for elderly care center has increased enormously with the world demographic revolution as the number of senior citizens increased in the 21st century. As per the world progress into contemporaneousness, a large number of people are engaged in daily routine to bring about the senior citizens to lose the care that they in fact need. New design suggestions have been made on the basis of available guidelines and two case studies in Taiwan. Interior design can provide positive and sensory stimulation through memory stimulation, and by creating a friendly and comfortable environment for demented older people, which can reduce patient anxiety and reduce stress on caregivers. This report pursues to reveal the better design of an elderly care center with a new tactic in a direction to offer better service for demented elderly people which could upraise their living standard.

Keywords: daycare center, dementia patients, interior designing, older adults

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Authors: Nuraisyah H. Zulkifley, Suriani Ismail, Rosliza Abdul Manaf, Poh Y. Lim

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Taking care of a person with dementia (PWD) is one of the most problematic and challenging caregiving situations. Without proper support, caregiver would need to deal with the impact of caregiving that would lead to caregiver burden. One of the most common tools used to measure caregiver burden among caregivers of PWD is Zarit Burden Interview (ZBI). A systematic review has been conducted through searching Medline, Science Direct, Cochrane Library, Embase, PsycINFO, ProQuest, and Scopus databases to identify relevant articles that elaborate on intervention and outcomes on ZBI among informal caregiver of PWD. The articles were searched in October 2019 with no restriction on language or publication status. Inclusion criteria are randomized control trial (RCT) studies, participants were informal caregivers of PWD, ZBI measured as outcomes, and intervention group was compared with no intervention control or usual care control. Two authors reviewed and extracted the data from the full-text articles. From a total of 344 records, nine studies were selected and included in this narrative review, and eight studies were included in the meta-analysis. The types of interventions that were implemented to ease caregiver burden are psychoeducation, physical activity, psychosocial, and computer-based intervention. The meta-analysis showed that there is a significant difference in the mean score of ZBI (p = 0.006) in the intervention group compared to the control group after implementation of intervention. In conclusion, interventions such as psychoeducation, psychosocial, and physical activity can help to reduce the burden experiencing by the caregivers of PWD.

Keywords: dementia, informal caregiver, randomized control trial, Zarit burden interview

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Authors: Konrad Rejdak

Abstract:

Introduction: Neurodegenerative diseases are frequently accompanied by loss and unwanted change in functional independence, social relationships, and economic circumstances. Currently, the achievements of social robots to date is being projected to improve multidimensional quality of life among people with cognitive impairment and others. Objectives: Identification of particular human needs in the context of the changes occurring in course of neurodegenerative diseases. Methods: Based on the 110 surveys performed in the Medical University of Lublin from medical staff, patients, and caregivers we made prioritization of the users' needs as high, medium, and low. The issues included in the surveys concerned four aspects: user acceptance, functional requirements, the design of the robotic assistant and preferred types of human-robot interaction. Results: We received completed questionnaires; 50 from medical staff, 30 from caregivers and 30 from potential users. Above 90% of the respondents from each of the three groups, accepted a robotic assistant as a potential caregiver. High priority functional capability of assistive technology was to handle emergencies in a private home-like recognizing life-threatening situations and reminding about medication intake. With reference to the design of the robotic assistant, the majority of the respondent would like to have an anthropomorphic appearance with a positive emotionally expressive face. The most important type of human-robot interaction was a voice-operated system and by touchscreen. Conclusion: The results from our study might contribute to a better understanding of the system and users’ requirements for the development of a service robot intended to support patients with dementia.

Keywords: assistant robot, dementia, long term care, patients

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Authors: Ruth Elvish, Alex Turner, Jen Wells

Abstract:

Over recent years there has been an increasing interest in the topic of well-being at work, and staff support is an area of continued growth. The present qualitative study explored the impact of a staff well-being service that was specifically attached to a five-year multi-site research programme (the Neighbourhoods and Dementia Study, funded by the ESRC/NIHR). The well-being service was led by a clinical psychologist, who offered 1:1 sessions for staff and co-researchers with dementia. To our knowledge, this service was the first of its kind. Methodology: Interviews were undertaken with staff who had used the service and who opted to take part in the study (n=7). Thematic analysis was used as the method of analysis. Findings: Themes included: triggers, mechanisms of change, impact/outcomes, and unique aspects of a dedicated staff well-being service. Conclusions: The study highlights stressors that are pertinent amongst staff within academic settings, and shows the ways in which a dedicated staff well-being service can impact on both professional and personal lives. Positive change was seen in work performance, self-esteem, relationships, and coping. This exploratory study suggests that this well-being service model should be further trialled and evaluated.

Keywords: academic, service, staff, support, well-being

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Authors: D. Furuya, H. Ryujin, S. Takahira, Y. Sekine, Y. Oya, K. Sonoda, H. Ogawa, Y. Nomura, R. Maruyama, H. Kim, T. Kudo, A. Nakano, T. Saruta, S. Sugita, M. Nemoto, N. Tanahashi

Abstract:

Purpose: To study the clinical characteristics of hypoglycemic coma in adult patients with type 1 or type 2 diabetes mellitus (DM). Methods: Participants in this retrospective study comprised 91 patients (54 men, 37 women; mean age ± standard deviation, 71.5 ± 12.6 years; range, 42-97 years) brought to our emergency department by ambulance with disturbance of consciousness in the 7 years from April 2007 to March 2014. Patients with hypoglycemia caused by alcoholic ketoacidosis, nutrition disorder, malignancies and psychological disorder were excluded. Results: Patients with type 1 (8 of 91) or type 2 DM (83 of 91) were analyzed. Mean blood sugar level was 31.6 ± 10.4 in all patients. A sulfonylurea (SU) was more commonly used in elderly (>75 years old; n=44)(70.5%) than in younger patients (36.2%, p < 0.05). Cases showing prolonged unconsciousness (range, 1 hour to 21 days; n=30) included many (p < 0.05) patients with dementia (13.3%; 0.5% without dementia) and fewer (p < 0.05) patients with type 1 DM (0%; 13.1% in type 2 DM). Specialists for DM (n=33) used SU less often (24.2%) than general physicians (69.0%, p < 0.05). Conclusion: In cases of hypoglycemic coma, SU was frequently used in elderly patients with DM.

Keywords: hypoglycemic coma, Diabetes mellitus, unconsciousness, elderly patients

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Authors: Kaisy Xinhong Ye, Su Lin Lim, Jialiang Li, Lei Feng

Abstract:

background: Multiple healthful dietary patterns have been linked with dementia, but limited studies have looked at the role of diet in cognitive health in Asians whose eating habits are very different from their counterparts in the west. This study aimed to derive a dietary pattern that is associated with the risk of cognitive impairment (CI) in the Singaporean population. Method: The analysis was based on 719 community older adults aged 60 and above. Dietary intake was measured using a validated semi-quantitative food-frequency questionnaire (FFQ). Reduced rank regression (RRR) was used to extract dietary pattern from 45 food groups, specifying sugar, dietary fiber, vitamin A, calcium, and the ratio of polyunsaturated fat to saturated fat intake (P:S ratio) as response variables. The RRR-derived dietary patterns were subsequently investigated using multivariate logistic regression models to look for associations with the risk of CI. Results: A dietary pattern characterized by greater intakes of green leafy vegetables, red-orange vegetables, wholegrains, tofu, nuts, and lower intakes of biscuits, pastries, local sweets, coffee, poultry with skin, sugar added to beverages, malt beverages, roti, butter, and fast food was associated with reduced risk of CI [multivariable-adjusted OR comparing extreme quintiles, 0.29 (95% CI: 0.11, 0.77); P-trend =0.03]. This pattern was positively correlated with P:S ratio, vitamin A, and dietary fiber and negatively correlated with sugar. Conclusion: A dietary pattern providing high P:S ratio, vitamin A and dietary fiber, and a low level of sugar may reduce the risk of cognitive impairment in old age. The findings have significance in guiding local Singaporeans to dementia prevention through food-based dietary approaches.

Keywords: dementia, cognitive impairment, diet, nutrient, elderly

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Authors: Konrad Rejdak, Agnieszka Korchut, Sebastian Szklener, Urszula Skrobas, Justyna Gerlowska, Katarzyna Grabowska-Aleksandrowicz, Dorota Szczesniak-Stanczyk

Abstract:

Introduction: Neurodegenerative diseases are frequently accompanied by loss and unwanted change in functional independence, social relationships, and economic circumstances. Currently, the achievements of social robots to date is being projected to improve multidimensional quality of life among people with cognitive impairment and others. Objectives: Identification of particular human needs in context of the changes occurring in course of neurodegenerative diseases. Methods: Based on the 110 surveys performed in Medical University of Lublin from medical staff, patients, and caregivers we made prioritization of the users' needs as: high, medium, and low. The issues included in the surveys concerned four aspects: user acceptance, functional requirements, design of the robotic assistant and preferred types of human-robot interaction. Results: We received completed questionnaires: 50 from medical staff, 30 from caregivers and 30 from potential users. Above 90% of the respondents from each of the three groups, accepted robotic assistant as a potential caregiver. High priority functional capability of assistive technology was to handle emergencies in a private home like recognizing life-threatening situations and reminding about medication intake. With reference to design of the robotic assistant, the majority of the respondent would like to have an anthropomorphic appearance with positive emotionally expressive face. The most important type of human-robot interaction was voice-operated system and by touchscreen. Conclusion: The results from our study might contribute to a better understanding of the system and users’ requirements for the development of a service robot intended to support patients with dementia.

Keywords: social robot, dementia, requirements, patients needs

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Authors: Ana B. Vivas, Antonia Ypsilanti, Aristea I. Ladas, Angeles F. Estevez

Abstract:

Mild Cognitive Impairment (MCI) is considered an intermediate stage between normal and pathological aging, as a substantial percentage of people diagnosed with MCI converts later to dementia of the Alzheimer’s type. Memory is of the first cognitive processes to deteriorate in this condition. In the present study we employed the differential outcomes procedure (DOP) to improve visuospatial memory in a group of participants with MCI. The DOP requires the structure of a conditional discriminative learning task in which a correct choice response to a specific stimulus-stimulus association is reinforced with a particular reinforcer or outcome. A group of 10 participants with MCI, and a matched control group had to learn and keep in working memory four target locations out of eight possible locations where a shape could be presented. Results showed that participants with MCI had a statistically significant better terminal accuracy when a unique outcome was paired with a location (76% accuracy) as compared to a non differential outcome condition (64%). This finding suggests that the DOP is useful in improving working memory in MCI patients, which may delay their conversion to dementia.

Keywords: mild cognitive impairment, working memory, differential outcomes, cognitive process

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