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The Development of an Intradisciplinary Staff Training Intervention on the Optimal Management of Behavioural and Psychological Symptoms of Dementia: A Qualitative Study. 就痴呆症行为和心理症状的最佳管理制定跨学科员工培训干预措施:定性研究。
IF 1.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-10-09 eCollection Date: 2024-01-01 DOI: 10.1159/000541517
Daphnée Carrier, Élodie Toulouse, Christian M Rochefort

Introduction: Behavioural and psychological symptoms of dementia (BPSDs) are a group of highly prevalent symptoms in residents with a neurocognitive disorder, including agitation and depressive symptoms. Caregiving staff often mention knowledge and skills deficits regarding optimal BPSD management. While several staff training on BPSDs management exist internationally, their transferability to other clinical contexts is limited, owing to methodological challenges. Therefore, to address this implementation gap, there is a strong need for training based on high-quality research to strengthen existing evidence, and ensure feasibility and reproducibility.

Methods: This qualitative study, part of a larger research project, occurred in 2022 on long-term care (LTC) centre unit and an alternate level of care (ALC) hospital unit located in the Province of Quebec, Canada. This study aimed to (1) evaluate the needs and perceptions of staff caregivers regarding BPSD management, (2) identify the training content and modalities to prioritize according to experts, (3) develop intradisciplinary training on BPSD management, and (4) pretest the preliminary version of the training. Objectives one and two were evaluated using focus groups and objective four using individual cognitive interviews. Qualitative interview data was audio-recorded with participants' consent, transcribed verbatim, and thematically content analysed using an established method.

Results: Overall, thirteen caregivers participated in objective one (8 from the LTC unit, and 6 from the ALC unit). The main staff training need identified on each site was the management of resident's aggressive behaviours. Staff verbalized a preference for virtual training. Objective 2 involved a panel of eight experts. Experts recommended the use of an online training platform, and certain training models and indicators. Based on caregivers' and experts' input, five interactive online staff training capsules lasting from 20 to 25 min each and an algorithm guiding the evaluation and management of BPSDs were created. The training capsules and the algorithm were iteratively improved following cognitive interviews with 4 caregivers from the participating sites.

Conclusion: An interactive virtual staff training on BPSD management was created based on staff and expert consultation. The next step in the investigation will be to evaluate the feasibility and acceptability of the training.

简介痴呆症的行为和心理症状(BPSDs)是神经认知障碍患者的一组高发症状,包括激动和抑郁症状。护理人员经常提到,在对 BPSD 进行最佳管理方面存在知识和技能上的不足。虽然国际上已有一些关于 BPSDs 管理的员工培训,但由于方法上的挑战,这些培训在其他临床环境中的可移植性有限。因此,要解决这一实施差距,亟需基于高质量研究的培训,以加强现有证据,并确保可行性和可重复性:这项定性研究是一项大型研究项目的一部分,于 2022 年在加拿大魁北克省的一个长期护理(LTC)中心单位和一个替代护理(ALC)医院单位进行。本研究旨在:(1)评估员工护理人员对 BPSD 管理的需求和看法;(2)根据专家意见确定培训内容和方式的优先顺序;(3)开发 BPSD 管理的学科内培训;(4)对培训的初步版本进行预测试。目标一和目标二通过焦点小组进行评估,目标四通过个人认知访谈进行评估。在征得参与者同意后,对定性访谈数据进行了录音、逐字转录,并采用既定方法进行了主题内容分析:共有 13 名护理人员参与了目标一(8 人来自长者照护中心,6 人来自高度临终关怀中心)。在每个地点,员工的主要培训需求都是处理住院患者的攻击行为。员工表示更倾向于接受虚拟培训。目标 2 涉及一个由八位专家组成的小组。专家们建议使用在线培训平台以及某些培训模式和指标。根据护理人员和专家的意见,我们制作了五个互动式在线员工培训胶囊,每个胶囊的培训时间为 20 到 25 分钟,同时还制作了指导评估和管理 BPSD 的算法。在与来自参与地点的 4 名护理人员进行认知访谈后,对培训胶囊和算法进行了反复改进:结论:根据员工和专家的意见,创建了关于 BPSD 管理的互动式虚拟员工培训。下一步将对培训的可行性和可接受性进行评估。
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引用次数: 0
Fear of Dementia among Middle-Aged and Older Adults in Germany. 德国中老年人对痴呆症的恐惧。
IF 1.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-12 eCollection Date: 2024-01-01 DOI: 10.1159/000541066
Jan-Luca Meyer, Elzbieta Buczak-Stec, Hans-Helmut König, André Hajek

Introduction: The objective of this study was to clarify the frequency of fear of dementia and the factors associated with it.

Methods: Data were taken from a nationally representative sample (n = 4,000; average age was 54.9 years, SD: 8.5 years, age ranges from 40 to 70 years, 49.6% of the respondents were women). Similar to prior research, fear of dementia was quantified using a tool ranging from 1 (no fear of dementia) to 4 (severe fear of dementia).

Results: In sum, 19.0% reported no fear of dementia, 34.6% reported a little fear of dementia, 33.8% reported some fear of dementia, and 12.7% reported severe fear of dementia. Regressions showed that greater fear of dementia was significantly associated with being female, being younger, poorer self-rated health, the presence of at least one chronic disease, not living in the same household with a partner or not being in a relationship at all, having depressive symptoms and anxiety symptoms.

Conclusion: Study findings showed that fear of dementia is particularly associated with health-related factors, age and gender. Lifestyle factors and other socioeconomic factors were only occasionally significant. Future research should explore the reasons for such a higher frequency of people's fear of dementia. It would also be interesting to find out new factors associated with the fear of dementia. Furthermore, further research could focus on cross-country comparisons and could stratify the results by important groups, e.g., by sex or education, but also cultural and ethnic aspects.

导言本研究旨在明确人们对痴呆症的恐惧频率及其相关因素:数据来自一个具有全国代表性的样本(n = 4000;平均年龄为 54.9 岁,SD:8.5 岁,年龄在 40 岁至 70 岁之间,49.6% 的受访者为女性)。与之前的研究类似,对痴呆症的恐惧程度也采用了从 1(不恐惧痴呆症)到 4(严重恐惧痴呆症)的量化工具:总之,19.0% 的人表示不害怕痴呆症,34.6% 的人表示有点害怕痴呆症,33.8% 的人表示有点害怕痴呆症,12.7% 的人表示严重害怕痴呆症。回归结果显示,对痴呆症的恐惧与女性、年龄较小、自评健康状况较差、至少患有一种慢性疾病、未与伴侣生活在同一家庭或根本没有伴侣关系、有抑郁症状和焦虑症状有明显关联:研究结果表明,对痴呆症的恐惧尤其与健康相关因素、年龄和性别有关。生活方式因素和其他社会经济因素只是偶尔有意义。未来的研究应探讨人们对痴呆症的恐惧频率如此之高的原因。此外,找出与痴呆症恐惧相关的新因素也很有意义。此外,进一步的研究可以侧重于跨国比较,并按重要群体(如性别或教育程度,以及文化和种族方面)对结果进行分层。
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引用次数: 0
Characteristics of Alzheimer's Disease and Mild Cognitive Impairment Influenced by the Time of Onset. 阿尔茨海默病和轻度认知障碍的特征受发病时间的影响。
IF 1.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-09 eCollection Date: 2024-01-01 DOI: 10.1159/000541092
Hiroyuki Sato, Miho Ota, Ayako Kitabatake, Yuriko Numata, Takumi Takahashi, Masashi Tamura, Kiyotaka Nemoto, Tetsuaki Arai

Introduction: Although the prevalence of Alzheimer's disease (AD) is higher in older people compared to younger people, dementia has also been documented in younger adults. Although early-onset dementia and late-onset dementia had been considered a single disease in pathological investigations, many studies revealed differences in cognitive and neuroimaging changes between them. We evaluated differences in cognitive and neuroimaging changes among the following groups: individuals with early-onset AD (EOAD), late-onset AD (LOAD), early-onset mild cognitive impairment (EOMCI), or late-onset MCI (LOMCI), and healthy controls (HCs).

Methods: Patients underwent both a 1.5 Tesla magnetic resonance imaging scan and the Mini-Mental State Examination (MMSE). Differences in regional gray matter volumes and MMSE subscales were investigated among the five diagnostic groups.

Results: Compared to the EOAD group, the LOAD group had significantly higher scores on orientation in place. Compared to the LOMCI patients, the EOMCI patients achieved significantly higher recall scores. The LOAD and LOMC groups showed significant volume reductions in bilateral medial temporal regions compared to the HCs. The EOAD and EOMCI groups did not show significant atrophy of the medial temporal region compared to the HC group.

Conclusions: The hippocampal volume and memory were preserved in the patients with EOMCI or EOAD compared to those with LOMCI or LOAD. These findings may indicate that the distinct and differing patterns of neuropsychological changes between EOAD and LOAD are also common in MCI, which is intermediate between normal cognition and AD.

简介虽然阿尔茨海默病(AD)在老年人中的发病率高于年轻人,但在年轻人中也有痴呆症的记录。虽然在病理研究中,早发性痴呆症和晚发性痴呆症被认为是同一种疾病,但许多研究揭示了这两种疾病在认知和神经影像学变化上的差异。我们评估了以下群体在认知和神经影像学变化方面的差异:早发 AD(EOAD)、晚发 AD(LOAD)、早发轻度认知障碍(EOMCI)或晚发 MCI(LOMCI)患者,以及健康对照组(HCs):患者同时接受 1.5 特斯拉磁共振成像扫描和迷你精神状态检查(MMSE)。结果:与 EOAD 组相比,MMSE 组患者的灰质体积更小,而 EOAD 组患者的灰质体积更大:结果:与EOAD组相比,LOAD组在原地定向方面的得分明显更高。与 LOMCI 患者相比,EOMCI 患者的回忆得分明显更高。与HCs相比,LOAD组和LOMC组的双侧颞内侧区域体积明显缩小。与HC组相比,EOAD组和EOMCI组的内侧颞区并未出现明显萎缩:结论:与LOMCI或LOAD患者相比,EOMCI或EOAD患者的海马体积和记忆力均有所保留。这些发现可能表明,EOAD和LOAD之间不同的神经心理学变化模式在介于正常认知和AD之间的MCI中也很常见。
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引用次数: 0
Prevalence of Geriatric Syndromes among Older Outpatients with Dementia. 老年痴呆症老年门诊病人的老年综合症患病率。
IF 1.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-02 eCollection Date: 2024-01-01 DOI: 10.1159/000541237
Luc Viet Tran, Thanh Xuan Nguyen, Thu Thi Hoai Nguyen, Huong Thi Thu Nguyen, Tam Ngoc Nguyen, Anh Lan Nguyen, Vasikaran Naganathan, Janani Thillainadesan, Huong Thi Thanh Nguyen, Anh Trung Nguyen, Huyen Thi Thanh Vu

Introduction: The identification of geriatric syndromes in people with dementia is important. The aim of the study was to assess the prevalence of geriatric syndromes among dementia outpatients.

Methods: A cross-sectional study was conducted enrolling outpatients with dementia aged ≥60 years old. Dementia was diagnosed by neuropsychiatrists following DSM-5 criteria. The geriatric syndromes assessed included nutritional status (Mini Nutritional Assessment Scale-Short Form), polypharmacy, comorbidities, alcohol use, depression (quality of life in Alzheimer disease), functional status (Barthel Index, Instrumental Activities of Daily Living); lower body strength (30 s stand chair test), and frailty (Timed Up and Go test ≥14 s).

Results: A total of 87 participants was recruited in the study (mean age: 76.8 ± 1.2 years; female: 65.5%). The median number of geriatric syndromes per participant was 5 (IQR = 2); all participants had two or more geriatric syndromes. The most common geriatric syndromes were loss of independence (96.6% impairment in >1 IADL task score and 74.7% dependency in physical function at based on Barthel Index), reduced lower body strength (86.2%), malnutrition and risk of malnutrition (78.2%), and frailty (67.8%). Current and history of smoking, drinking alcohol, using memantine therapy, malnourishment and risk of malnourishment were significantly associated with increasing severity of dementia.

Conclusion: The presence and coincidence of geriatric syndromes is common among outpatients with dementia. These findings have important clinical implications in terms of the assessment and service delivery for older adults in Vietnam. We are exploring ways to enhance our services to provide comprehensive, multidisciplinary approaches to screening, recognition, and treatment of geriatric syndromes in older adults with dementia.

引言识别痴呆症患者的老年综合征非常重要。本研究旨在评估老年痴呆症门诊患者中老年综合征的发病率:方法:对年龄≥60 岁的痴呆症门诊患者进行横断面研究。痴呆症由神经精神科医生根据 DSM-5 标准诊断。评估的老年综合征包括营养状况(迷你营养评估量表-简表)、多药治疗、合并症、饮酒、抑郁(阿尔茨海默病的生活质量)、功能状况(巴特尔指数、日常生活器械活动)、下肢力量(30 秒站立坐椅测试)和虚弱程度(≥14 秒定时起立行走测试):研究共招募了 87 名参与者(平均年龄:76.8 ± 1.2 岁;女性:65.5%)。每位参与者的老年综合征中位数为 5 种(IQR = 2);所有参与者都有两种或两种以上的老年综合征。最常见的老年病综合征是丧失独立能力(根据巴特尔指数,96.6%的人在>1 项 IADL 任务中受损,74.7%的人在身体功能上依赖)、下半身力量减弱(86.2%)、营养不良和营养不良风险(78.2%)以及虚弱(67.8%)。吸烟、饮酒、使用美金刚治疗、营养不良和营养不良风险与痴呆症的严重程度显著相关:结论:老年痴呆症门诊患者中,老年综合征的存在和并发很常见。这些发现对越南老年人的评估和服务提供具有重要的临床意义。我们正在探索如何加强我们的服务,为老年痴呆症患者提供全面、多学科的老年综合征筛查、识别和治疗方法。
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引用次数: 0
Criterion-Related Validity of the Cognitive Function Score with the Revised Hasegawa's Dementia Scale and the Bedriddenness Rank with the Barthel Index and the Katz Index: A Multi-Center Retrospective Study. 认知功能评分与修订版长谷川痴呆量表以及卧床不起等级与巴特尔指数和卡茨指数的标准相关有效性:一项多中心回顾性研究。
IF 1.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-07-30 eCollection Date: 2024-01-01 DOI: 10.1159/000540430
Risa Hirata, Naoko E Katsuki, Hitomi Shimada, Eiji Nakatani, Kiyoshi Shikino, Maiko Ono, Chihiro Saito, Kaori Amari, Kazuya Kurogi, Mariko Yoshimura, Tomoyo Nishi, Shizuka Yaita, Yoshimasa Oda, Midori Tokushima, Yuka Hirakawa, Masahiko Nakamura, Shun Yamashita, Yoshinori Tokushima, Hidetoshi Aihara, Motoshi Fujiwara, Masaki Tago

Introduction: The cognitive function score (CFS) is a public scale for assessing the activities of daily living (ADL) in older adults with dementia in Japan. In contrast, the scores of the revised Hasegawa's dementia scale (HDS-R), an easy-to-use dementia screening tool developed in Japan, are significantly correlated with mini-mental state examination scores and are widely utilized in various countries. This novel study aimed to elucidate the previously unexplored criterion-related validity of the CFS and HDS-R and the Bedriddenness Rank (BR), Barthel index (BI), and Katz index (KI).

Methods: This was a multicenter retrospective study and a secondary analysis of our previous study. The study included patients aged ≥20 years hospitalized in chronic care settings between April 1, 2018, and March 31, 2021. We collected data from medical charts on admission, including age, sex, the BR, CFS, BI, KI, and HDS-R scores. Correlations between the CFS and HDS-R score, as well as between the BR and BI or KI, were analyzed using Spearman's rank correlation coefficients.

Results: A total of 749 participants were included in the analysis of criterion-related validity between the CFS and HDS-R. In the CFS cohort analysis, 202 patients (27.0%) were categorized as having a normal CFS, and the median HDS-R score was 18 (range: 6-26). The correlation coefficient between the CFS and HDS-R scores was -0.834 (p < 0.001). The correlation coefficient between BR and BI was -0.741 (p < 0.001), BR and KI was -0.740 (p < 0.001).

Conclusion: The CFS revealed significant criterion-related validity compared with the established cognitive assessment scale, the HDS-R. The BR also demonstrated significant criterion-related validity with the BI and KI.

简介认知功能评分(CFS)是日本用于评估老年痴呆症患者日常生活活动能力(ADL)的公共量表。相比之下,修订版长谷川痴呆量表(HDS-R)是日本开发的一种易于使用的痴呆筛查工具,其得分与迷你精神状态检查得分显著相关,并在各国广泛使用。这项新研究旨在阐明 CFS 和 HDS-R 与 Bedriddenness Rank (BR)、Barthel index (BI) 和 Katz index (KI) 标准相关的有效性:这是一项多中心回顾性研究,也是对我们之前研究的二次分析。研究对象包括2018年4月1日至2021年3月31日期间在慢性病护理机构住院的年龄≥20岁的患者。我们从入院时的病历中收集了数据,包括年龄、性别、BR、CFS、BI、KI 和 HDS-R 评分。我们使用斯皮尔曼等级相关系数分析了CFS和HDS-R评分之间以及BR和BI或KI之间的相关性:共有 749 名参与者参与了 CFS 和 HDS-R 标准相关有效性分析。在CFS队列分析中,有202名患者(27.0%)被归类为正常CFS,HDS-R评分的中位数为18分(范围:6-26)。CFS和HDS-R评分之间的相关系数为-0.834(p < 0.001)。BR与BI的相关系数为-0.741(P < 0.001),BR与KI的相关系数为-0.740(P < 0.001):与已有的认知评估量表(HDS-R)相比,CFS具有明显的标准相关有效性。与 BI 和 KI 相比,BR 也显示出明显的标准相关有效性。
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引用次数: 0
The Relation of Sleep Characteristics and Cognitive Impairment in Community-Dwelling Middle-Aged and Older Adults: Ardakan Cohort Study on Aging (ACSA). 社区中老年人的睡眠特征与认知障碍的关系:阿尔达坎老龄化队列研究》(ACSA)。
IF 1.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-04-29 eCollection Date: 2024-01-01 DOI: 10.1159/000539060
Ahmad Delbari, Fatemeh Sadat Tabatabaei, Payam Jannatdoust, Amirali Azimi, Mohammad Bidkhori, Mohammad Saatchi, Mahshid Foroughan, Elham Hooshmand

Introduction: The rise in the elderly population has brought attention to mild cognitive impairment (MCI). Sleep disorders also affect many older adults, indicating an important area of research for disturbed sleep and faster brain aging. This population-based study aimed to investigate the association of several sleep indicators with cognitive performance.

Methods: This cross-sectional study focused on adults over 50 in the Ardakan Cohort Study on Aging (ACSA). MCI was evaluated using the Mini-Mental State Examination (MMSE) and the Abbreviated Mental Test score (AMTS) in literate and illiterate individuals. Sleep characteristics were collected using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and Berlin questionnaire. The logistic regression models were used to analyze the data.

Results: Overall, 3,380 literate and 1,558 illiterate individuals were included. In both groups, participants with MCI had a significantly higher PSQI global score (p < 0.05). Also, among the literate individuals, a significantly higher risk of having sleep-disordered breathing and poor sleep quality was observed in participants with MCI (p < 0.05). In illiterate individuals, higher sleep latency than 15 min increased odds of MCI (p < 0.05). However, after adjusting for all variables, only literate individuals with a sleep duration of more than 8 h had 66 percent increased odds of having MCI (p = 0.033).

Conclusion: Sleep duration might be associated with cognitive function in the older Iranian population. Our findings underscore the importance of considering sleep patterns in relation to cognitive health.

简介老年人口的增加引起了人们对轻度认知障碍(MCI)的关注。睡眠障碍也影响着许多老年人,这表明睡眠紊乱和大脑加速衰老是一个重要的研究领域。这项基于人群的研究旨在调查几项睡眠指标与认知能力的关系:这项横断面研究主要针对阿尔达坎老龄队列研究(ACSA)中 50 岁以上的成年人。在识字和不识字的人群中,使用迷你精神状态检查(MMSE)和简短智力测验得分(AMTS)对 MCI 进行评估。使用匹兹堡睡眠质量指数(PSQI)、爱普沃斯嗜睡量表和柏林问卷调查收集睡眠特征。采用逻辑回归模型对数据进行分析:研究共纳入了 3380 名识字者和 1558 名文盲。两组中,MCI 患者的 PSQI 总分都明显较高(P < 0.05)。此外,在识字者中,患有 MCI 的参与者出现睡眠呼吸紊乱和睡眠质量差的风险明显更高(p < 0.05)。在文盲中,睡眠潜伏期高于 15 分钟会增加 MCI 的几率(p < 0.05)。然而,在对所有变量进行调整后,只有睡眠时间超过8小时的文盲患MCI的几率增加了66%(p = 0.033):结论:睡眠时间可能与伊朗老年人群的认知功能有关。我们的研究结果强调了考虑睡眠模式与认知健康关系的重要性。
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引用次数: 0
A Psychosocial Intervention for Carers of Individuals Diagnosed with Dementia in Social Isolation. 为处于社会隔离状态的被诊断为痴呆症患者的照护者提供社会心理干预。
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2023-11-18 eCollection Date: 2023-01-01 DOI: 10.1159/000535207
Grace Wei, Olivier Piguet, Fiona Kumfor

Introduction: Growing research has shown the negative impact of social isolation on the health and psychological well-being of individuals with dementia and their carers. This study investigated the effectiveness of a psychosocial intervention for dementia carers during a lockdown period of the COVID-19 pandemic.

Methods: Twenty-three family carers of individuals diagnosed with dementia living in the community were recruited and provided with an online psychoeducation toolkit that aims to improve health literacy, management of social and behavioural symptoms in dementia, carer social engagement, and coping skills. Carers were divided into "mild" or "moderate" groups based on the disease severity of the person with dementia they cared for. Outcome measures including distress and severity of neuropsychiatric symptoms, carer self-efficacy and burden, social network, and feelings of loneliness were assessed at baseline and 2 weeks later.

Results: Carers in the moderate group reported higher levels of distress (p = 0.001) and severity (p < 0.001) of neuropsychiatric symptoms and greater carer burden (p = 0.003) than carers in the mild group. Following the intervention, both groups reported increased social networks (p = 0.001). In addition, carers in the moderate group reported significantly reduced distress for neuropsychiatric symptoms (p = 0.013), enhanced carer self-efficacy for controlling upsetting thoughts (p = 0.040), and decreased loneliness (p = 0.023).

Conclusions: This study demonstrated that psychosocial interventions improve outcomes for carers of individuals with dementia, particularly those caring for individuals with greater disease severity. Findings from this study will inform the development of support services that meet the evolving needs of individuals with dementia and their carers in social isolation, during and in a post-pandemic context.

导言:越来越多的研究表明,社会隔离对痴呆症患者及其照护者的健康和心理健康有负面影响。本研究调查了在 COVID-19 大流行封锁期间对痴呆症照护者进行社会心理干预的效果:研究招募了 23 名在社区生活的被确诊为痴呆症患者的家庭照护者,并为他们提供了一个在线心理教育工具包,旨在提高他们的健康素养、痴呆症的社会和行为症状管理、照护者的社会参与和应对技能。根据照护者所照护的痴呆症患者的病情严重程度,照护者被分为 "轻度 "和 "中度 "两组。在基线和两周后对结果进行评估,包括神经精神症状的痛苦和严重程度、照护者的自我效能感和负担、社交网络和孤独感:与轻度组的照护者相比,中度组照护者的神经精神症状的痛苦程度(p = 0.001)和严重程度(p < 0.001)更高,照护者的负担(p = 0.003)更大。干预后,两组照护者都表示社交网络有所增加(p = 0.001)。此外,中度组的照护者表示神经精神症状的困扰明显减轻(p = 0.013),照护者控制烦躁想法的自我效能得到提高(p = 0.040),孤独感减少(p = 0.023):本研究表明,社会心理干预可改善痴呆症患者照护者的疗效,尤其是那些照护病情较重患者的照护者。这项研究的结果将为支持服务的发展提供参考,以满足社会隔离期间和大流行后痴呆症患者及其照护者不断变化的需求。
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引用次数: 0
COGNITIVE PROFILE IN PD DEMENTIA PATIENTS WITH LOW VERSUS NORMAL CSF AMYLOID BETA 脑脊液β淀粉样蛋白低与正常pd痴呆患者的认知特征
Q4 CLINICAL NEUROLOGY Pub Date : 2023-10-26 DOI: 10.1159/000534552
Zeynep Tufekcioglu, Johannes Lange, Kenn Freddy Pedersen, Ole-Bjørn Tysnes, Guido Alves, Murat Emre
Background: In patients with Parkinson’s disease (PD) low cerebrospinal fluid (CSF) amyloid beta 1-42 (Ab42) at baseline is the most consistent CSF biomarker as a risk factor for developing dementia. Low CSF Ab42 is, however, a typical hallmark of Alzheimer's disease (AD). Hence, low CSF Ab42 in patients with PD may indicate presence of co-morbid AD pathology and may predict a more AD-like cognitive profile when they develop dementia. Our study aims to investigate if low CSF Ab42 at baseline is associated with a more AD-like cognitive profile in PD patients with dementia. Methods: In a prospectively followed-up, population-based cohort of newly diagnosed PD patients, we compared the cognitive profile of dementia in those with a low CSF Ab42 level at baseline with that of patients who had normal levels, at the time when they developed dementia. Four different cognitive domain z scores (memory, attention, executive, visuospatial) were calculated. Patients were subdivided into three tertiles or categorized dichotomously, based on the baseline CSF Ab42 levels as measured by ECL and ELISA. Results: During 10-year follow-up, 37 patients met the inclusion criteria. Memory domain composite z-scores, memory subtests z-scores and the difference between long-delay free recall versus recognition scores were not significantly different between the groups. Composite z-scores of visuospatial functions significantly differed between the tertiles, which was not significant after Bonferroni correction. In the dichotomous group analysis, z-scores of visuospatial functions significantly differed between the two groups. The other cognitive domain z-scores were not significantly different. Conclusions: In patients with PD dementia low CSF Ab42 level at baseline is not associated with a specific cognitive profile.
背景:在帕金森病(PD)患者中,基线时低脑脊液(CSF)淀粉样蛋白β 1-42 (Ab42)是最一致的脑脊液生物标志物,是发生痴呆的危险因素。然而,低脑脊液Ab42是阿尔茨海默病(AD)的典型标志。因此,PD患者脑脊液Ab42水平低可能表明存在共病性AD病理,并可能预测当他们发展为痴呆时更像AD的认知特征。我们的研究旨在调查基线时低CSF Ab42是否与PD合并痴呆患者更类似ad的认知特征相关。方法:在一项前瞻性随访的、基于人群的新诊断PD患者队列中,我们比较了基线时CSF Ab42水平低的患者与基线时CSF Ab42水平正常的患者在痴呆发生时的认知特征。计算了四种不同的认知领域z分数(记忆、注意、执行、视觉空间)。根据ECL和ELISA测定的基线CSF Ab42水平,将患者细分为三分位数或二分类。结果:在10年随访中,37例患者符合纳入标准。记忆领域复合z-得分、记忆子测试z-得分以及长延迟自由回忆与识别得分之间的差异在组间无显著差异。视觉空间功能的综合z-分数在三分位之间差异显著,经Bonferroni校正后差异不显著。在二分类组分析中,两组的视觉空间功能z分数差异显著。其他认知领域z-score差异不显著。结论:在PD痴呆患者中,基线时低CSF Ab42水平与特定的认知特征无关。
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引用次数: 0
Artificial Intelligence for Detection of Dementia Using Motion Data: A Scoping Review. 利用运动数据检测痴呆症的人工智能:范围界定综述。
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-13 eCollection Date: 2023-01-01 DOI: 10.1159/000533693
Lily Puterman-Salzman, Jory Katz, Howard Bergman, Roland Grad, Vladimir Khanassov, Genevieve Gore, Isabelle Vedel, Machelle Wilchesky, Narges Armanfard, Negar Ghourchian, Samira Abbasgholizadeh Rahimi

Background: Dementia is a neurodegenerative disease resulting in the loss of cognitive and psychological functions. Artificial intelligence (AI) may help in detection and screening of dementia; however, little is known in this area.

Objectives: The objective of this study was to identify and evaluate AI interventions for detection of dementia using motion data.

Method: The review followed the framework proposed by O'Malley's and Joanna Briggs Institute methodological guidance for scoping reviews. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist for reporting the results. An information specialist performed a comprehensive search from the date of inception until November 2020, in five bibliographic databases: MEDLINE, EMBASE, Web of Science Core Collection, CINAHL, and IEEE Xplore. We included studies aimed at the deployment and testing or implementation of AI interventions using motion data for the detection of dementia among a diverse population, encompassing varying age, sex, gender, economic backgrounds, and ethnicity, extending to their health care providers across multiple health care settings. Studies were excluded if they focused on Parkinson's or Huntington's disease. Two independent reviewers screened the abstracts, titles, and then read the full-texts. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. The reference lists of included studies were also screened.

Results: After removing duplicates, 2,632 articles were obtained. After title and abstract screening and full-text screening, 839 articles were considered for categorization. The authors categorized the papers into six categories, and data extraction and synthesis was performed on 20 included papers from the motion tracking data category. The included studies assessed cognitive performance (n = 5, 25%); screened dementia and cognitive decline (n = 8, 40%); investigated visual behaviours (n = 4, 20%); and analyzed motor behaviors (n = 3, 15%).

Conclusions: We presented evidence of AI systems being employed in the detection of dementia, showcasing the promising potential of motion tracking within this domain. Although some progress has been made in this field recently, there remain notable research gaps that require further exploration and investigation. Future endeavors need to compare AI interventions using motion data with traditional screening methods or other tech-enabled dementia detection mechanisms. Besides, future works should aim at understanding how gender and sex, and ethnic and cultural sensitivity can contribute to refining AI interventions, ensuring they are accessible, equitable, and beneficial across all society.

背景:痴呆症是一种导致认知和心理功能丧失的神经退行性疾病。人工智能(AI)可能有助于痴呆症的检测和筛查;然而,在这方面知之甚少。目的:本研究的目的是利用运动数据识别和评估人工智能干预措施对痴呆症的检测。方法:审查遵循了奥马利和乔安娜·布里格斯研究所提出的范围审查方法指南框架。我们遵循系统评价的首选报告项目和范围界定评价的荟萃分析扩展(PRISMA ScR)检查表来报告结果。一位信息专家从成立之日到2020年11月,在五个书目数据库中进行了全面搜索:MEDLINE、EMBASE、Web of Science Core Collection、CINAHL和IEEE Xplore。我们纳入了旨在部署、测试或实施人工智能干预措施的研究,这些干预措施使用运动数据在不同人群中检测痴呆症,包括不同的年龄、性别、性别、经济背景和种族,并扩展到多个医疗保健环境中的医疗保健提供者。如果研究的重点是帕金森氏症或亨廷顿舞蹈症,则被排除在外。两名独立评审员对摘要、标题进行筛选,然后阅读全文。分歧以协商一致的方式解决,如果不可能,则征求第三位审查员的意见。纳入研究的参考文献列表也进行了筛选。结果:去除重复项后,共获得2632篇文章。经过标题和摘要筛选以及全文筛选,839篇文章被考虑进行分类。作者将论文分为六类,并对运动跟踪数据类别中的20篇论文进行了数据提取和合成。纳入的研究评估了认知表现(n=5/25%);筛查痴呆和认知能力下降(n=8.40%);调查的视觉行为(n=4,20%);并分析了运动行为(n=3,15%)。结论:我们提供了人工智能系统用于痴呆症检测的证据,展示了该领域运动跟踪的潜力。尽管最近在这一领域取得了一些进展,但仍存在显著的研究空白,需要进一步探索和调查。未来的努力需要将使用运动数据的人工智能干预与传统的筛查方法或其他技术支持的痴呆症检测机制进行比较。此外,未来的工作应旨在了解性别和性别以及种族和文化敏感性如何有助于完善人工智能干预措施,确保这些干预措施在整个社会都是可获得的、公平的和有益的。
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引用次数: 0
Cognitive Impairment and Risk Factors in Post-COVID-19 Hospitalized Patients. 新冠肺炎住院患者认知功能障碍及危险因素分析
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2023-08-02 eCollection Date: 2023-01-01 DOI: 10.1159/000531743
Jedsada Khieukhajee, Arada Rojana-Udomsart, Pinnakarn Srisarakorn, Tanaphon Wongsurit, Saharat Aungsumart

Introduction: Numerous reports regarding cognitive deficits after the coronavirus disease 2019 (COVID-19), described as "brain fog," have been published. However, the clinical presentations and risk factors of post-COVID-19 cognitive impairment are controversial. This study aimed to assess (a) the prevalence of cognitive impairment after COVID-19 hospitalization, (b) characteristics of the cognitive deficits, (c) risk factors of post-COVID-19 cognitive impairment, and (d) comparison of cognitive function between post-COVID-19 patients and healthy people.

Methods: The study comprised 34 SARS-CoV-2-infected patients, admitted to the Neurological Institute of Thailand during the peak of COVID-19 pandemic in 2021-2022. These patients came for neuropsychological and clinical evaluations at 2-week follow-up visit. The cognitive impairment and characteristics were measured by TMSE and MoCA. Clinical risk factors and post-COVID-19 cognitive impairment were assessed. The comparison of cognitive function in post-acute COVID-19 patients and 22 healthy controls was also performed.

Results: The prevalence of post-COVID-19 cognitive impairment defined by a total MoCA score below 25 points was 61.76%. Years of education were the only predictive factors related to cognitive impairment. Our multivariate analysis revealed no statistical difference in cognitive outcomes between post-acute COVID-19 patients and healthy controls.

Conclusion: This study showed a moderate prevalence of cognitive dysfunction after COVID-19 hospitalization similar to previous reports. However, there was no significant difference in cognitive measurements between these patients and healthy people. Whether SARS-CoV-2 infection causes cognitive dysfunction is a myth or fact that still has a long way to prove via further longitudinal study.

导读:关于被称为“脑雾”的2019冠状病毒病(COVID-19)后的认知缺陷的许多报道已经发表。然而,COVID-19后认知障碍的临床表现和危险因素存在争议。本研究旨在评估a)新冠肺炎住院后认知功能障碍的患病率,b)认知功能障碍的特征,c)新冠肺炎后认知功能障碍的危险因素,d)新冠肺炎后患者与健康人群的认知功能比较。方法:选取2021-2022年COVID-19大流行高峰期间泰国神经病学研究所收治的34例SARS-CoV-2感染患者。这些患者在两周的随访中接受神经心理学和临床评估。采用TMSE和MoCA测量认知功能障碍及其特征。评估临床危险因素和COVID-19后认知功能障碍。比较急性后COVID-19患者与22名健康对照者的认知功能。结果:MoCA总分低于25分的新冠肺炎后认知功能障碍患病率为61.76%。受教育年限是与认知障碍相关的唯一预测因素。我们的多变量分析显示,COVID-19急性后患者与健康对照组的认知结果无统计学差异。结论:本研究显示,与之前的报道相似,COVID-19住院后认知功能障碍的发生率中等。然而,这些患者与健康人之间的认知测量没有显著差异。SARS-CoV-2感染是否会导致认知功能障碍是一个神话还是一个事实,仍有很长的路要通过进一步的纵向研究来证明。
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引用次数: 0
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Dementia and Geriatric Cognitive Disorders Extra
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