Dementia and Geriatric Cognitive Disorders Extra最新文献

Introduction: Nurses in Saudi Arabia lack sufficient training in dementia care, a challenge compounded by cultural beliefs that frame dementia as fate rather than a medical condition. This gap in knowledge and skills hinders nurses' ability to provide appropriate support to people living with dementia in hospital settings. This study investigated Saudi Arabian hospital nurses' knowledge (cognitive expertise), attitudes (feelings and behaviors), and perceptions (thoughts, concerns, and interpretations of behaviors) of caring for people living with dementia to inform future training programs.

Methods: The study used a sequential explanatory mixed-methods design, conducted in six hospital settings in Jeddah, Saudi Arabia. Data were collected between March and July 2018. Quantitative data were gathered using two validated tools: the Dementia Attitude Scale and the Dementia Knowledge Assessment Tool Version 2. Qualitative data consisted of diary entries for ten working days followed by semi-structured interviews. Data integration was performed using the Pillar Integration Process.

Results: A paper survey was completed by 710 nurses, with 17 keeping a diary and 18 participating in interviews. The survey identified themes of knowledge-attitude links, work environment impact, cultural and educational influences, low confidence levels, and gaps in dementia care knowledge. Diary-interviews revealed themes such as knowledge acquisition, attitude-driven behaviors, perceptions of dementia care, professional challenges, and suggestions for improving care. The Pillar Integration Process highlighted five key findings: (1) a lack of knowledge is linked to low confidence in nursing people with dementia, (2) nurses are eager to learn but face limited access to resources, (3) attitudes, emotions, and communication challenges influence care delivery, (4) stigmas and cultural norms negatively impact dementia care, and (5) organizational factors hinder care quality.

Conclusion: Saudi Arabian nurses face significant challenges in dementia care, including inadequate knowledge, resource constraints, and negative attitudes. These findings emphasize the need for targeted training and policy interventions to improve dementia care quality. This study highlights nurses' emotional strain and practical difficulties in dementia care, providing insights for global improvements in dementia care practices and support for nurses' well-being.

Introduction: People with dementia are eligible for rehabilitation for functional difficulties resulting from cognitive symptoms, but no method for this is used in Norwegian municipalities. GREAT cognitive rehabilitation (CR) is an approach which has shown significant positive effects. The study aimed to explore the experiences of dementia case managers using the GREAT CR approach to address the rehabilitation goals of people with dementia.

Method: Six dementia case managers, from four Norwegian municipalities, participated. The pilot study had two phases: phase 1: the participants learnt the approach, and each used it with two clients, to become CR practitioners; phase 2: the participants could use CR in their normal practice. Their experiences were explored in two focus groups. The focus groups were audiotaped, transcribed, and analysed in line with directed content analysis.

Results: Three categories were described: (1) the training and written material, (2) professional development, and (3) proposals for solutions on how to use CR in clinical practice. The case managers found it both engaging and challenging to use CR. They observed that the experience had changed their usual practice: they asked people with dementia more questions about their everyday functioning and resources. The most important barrier to implementing CR was lack of time, although funds were provided to allow municipalities to provide cover for participants' time, participants still found they lacked the time to use the approach as planned.

Conclusion: This study has demonstrated that it is feasible to implement CR in a Norwegian municipality if enough time is available and sufficient resources are provided. There is an urgent need to identify how healthcare services can be enabled to make rehabilitation methods like CR a regular part of post-diagnostic support.

Introduction: The aim of this study was to investigate whether exposure to noninvasive brain stimulation with high-frequency repetitive transcranial magnetic stimulation (rTMS) applied over the left dorsolateral prefrontal cortex (DLPFC) can improve memory and regulate white matter (WM) microstructure.

Methods: Twenty-two mild cognitive impairment participants who were randomly assigned to the real and the sham groups received 10 sessions and sham-controlled 10 Hz rTMS over the DLPFC. All patients underwent cognitive assessments and diffusion tensor imaging scans before and after the intervention. Brain regions that showed significant differences in fractional anisotropy (FA) values were selected as the regions of interest to calculate the correlation with cognitive scores.

Results: In the real group, FA values in the left middle frontal gyrus and bilateral parahippocampal gyrus increased and in the right superior frontal gyrus decreased. No significant FA change was detected in the sham group. Furthermore, the FA value of the left middle frontal gyrus was positively correlated with Boston Naming Test (BNT) scores. The change of FA value in the right superior frontal gyrus was positively correlated with the change in the Trail Making Test (TMT-B) score.

Conclusions: This study provides new evidence for rTMS to regulate the abnormal WM microstructure in some special regions and causally ameliorate cognitive performance in MCI, which may be the underlying neural mechanism of intervention.

Introduction: Cognitive impairment is a major cause of dependency in older people. The aim of this study was to identify factors associated with severe cognitive decline, as assessed by the mini-mental state examination (MMSE), in community-dwelling adults aged 55+ in Cameroon.

Method: Data are from a cross-sectional survey carried out in Cameroon. The cognitive status was assessed using the MMSE and a score of 18/30 or lower is considered as a proxy of severe cognitive decline.

Result: A total of 403 adults participated in the study. Of these, 16 (3.9%) had an MMSE score <18 and were considered to have cognitive impairment. The rate of severe cognitive decline increased with rising age, from 2.1% in those aged 55-64 years, to 3.3% in those aged 65-74, and 11% in those aged 75 and older. The factors associated with cognitive impairment (MMSE score <18) by multivariate analysis in our population are level of education (OR 0.10 [95% CI: 0.02-0.37], p < 0.01), body mass index (BMI) (OR 0.88 [95% CI: 0.78-0.99], p = 0.03), and IADL score (OR 0.12 [95% CI: 0.03-0.38], p < 0.001).

Conclusion: The three main factors associated with cognitive impairment were education, IADL (Instrumental Activity of Daily Living) dependency, and BMI. This study shows that among older people in sub-Saharan Africa, the effect of BMI, IADL dependency, and education on cognitive function appears similar to that observed in middle- and high-income countries.

Introduction: The current study examined the efficacy of the 10-session Kessler Foundation modified Story Memory Technique (KF-mSMT^®) to improve new learning in older adults.

Methods: This double-blind, placebo-controlled randomized clinical trial included twenty-eight individuals over age 65 randomized to the treatment group (n = 17) or placebo control group (n = 13). Participants completed a baseline neuropsychological assessment, including questionnaires assessing everyday memory, and a repeat assessment immediately post-treatment. The primary outcome measure was the total learning score from the California Verbal Learning Test II (CVLT-II) and the secondary outcome measure was the total score from the Memory Functioning Questionnaire.

Results: A significant effect of the KF-mSMT^® was noted on the CVLT-II total learning score in the treatment group, demonstrating a large effect size. Post hoc analysis examining benefit from the KF-mSMT^® in the healthy aging group as compared with the mild cognitive impairment (MCI) group showed a trend toward significance (p = 0.069), with a large effect size. With benefit defined as a 10% or greater improvement in the CVLT total learning, 65% of patients in the treatment group showed improvement from baseline to immediate follow-up, compared with 31% of the control group (p = 0.06). Significant treatment effects were also noted in a self-report measure of memory in daily life, the Memory Functioning Questionnaire. Post-treatment changes in depression or anxiety from before to after treatment were not significant between the groups.

Conclusion: The current study presents preliminary evidence in support of the KF-mSMT^® for improving learning and memory abilities in older populations of those aging normally and those meeting criteria for MCI.

Introduction: Normative data on structural brain volume changes with age and sex differences are required as a reference standard for future research and clinical use.

Methods: We studied a two-center, metropolitan-based, prospective cohort of adults aged 55 years and older who were recruited from community-dwelling settings and outpatient clinics without cognitive impairment at baseline and who were followed up for 2 years. The clinical data, neuropsychological tests, and brain MRI obtained with FreeSurfer software were utilized for quantitative volumetric measurements.

Results: A total of 296 participants were recruited at the beginning, with 17 participants (5.8%, excluding 2 subjects with claustrophobia) excluded due to abnormal MRI findings and 27 participants (9.1%) excluded due to MCI/dementia. Among the 250 remaining, 14 patients dropped out or were lost to follow-up, and 35 had MCI or AD converters (14.8%). The remaining 201 subjects with normal cognitive function aged 55-85 years were analyzed for structural brain volume. There were significant correlations between age and brain parameters, including the hippocampus, corpus callosum, thalamus, and ventricular volume changes (p value <0.05). There were significant differences between males and females in total intracranial volume, caudate, temporal lobe, and ventricle volumes in subjects aged 65-74 years, and in total intracranial volume and ventricle volumes in subjects aged 55-64 years (p value <0.05).

Conclusion: Age and sex contributed to differences in brain structure and ventricular volume. These data could be used as a normative reference for clinical interpretation in people up to 85 years old and for understanding the physiological aging-related changes in the brain.

Introduction: Studies about dementia in Indigenous communities are still scarce worldwide, especially in low-middle-income countries, limiting timely intervention in minority groups. Our research aimed to bridge this gap by determining the prevalence of dementia and mild cognitive impairment no dementia (CIND), and the associated factors, in a multiethnic Indigenous community in Manaus, Brazil.

Methods: A cross-sectional observational study evaluated the cognitive and functional performances of 141 Indigenous individuals (aged 50 and above). A panel of dementia neurologist experts independently analyzed cognitive (Mini-Mental State Exam [MMSE], Brief Cognitive Screening Battery, verbal fluency), functional (Pfeffer questionnaire) performances, and depression symptoms (Geriatric Depression Scale) to classify participants as cognitively unimpaired, CIND, and dementia.

Results: CIND rate was 11.3% and 12.8% for dementia. None of the participants classified as CIND had a prior diagnosis, and only three out of 18 participants with dementia had a diagnosis. Stratified analysis showed that age (p = 0.017) and lower education (p = 0.047) were associated with higher CIND and dementia. However, only age was significantly associated with dementia in the regression models (OR = 1.078; 95% CI: 1.011-1.149). Sex, living in extreme poverty, hypertension, diabetes, smoking, or excessive alcohol use was not linked to CIND or dementia.

Conclusion: The Indigenous community of Manaus exhibited higher rates of dementia and CIND than national and global estimates. These findings may set the stage for additional research into the interplay of social, economic, biological, and behavioral factors affecting dementia risk in underrepresented groups such as Indigenous communities.

Introduction: This study aimed to clarify the relationship between anxiety about the possibility of developing dementia (dementia onset anxiety) and subjective memory impairment in frail older individuals who require long-term care and are experiencing declining cognitive function.

Methods: This study included 30 frail older individuals requiring long-term care who completed the Everyday Memory Checklist (EMC), which was simultaneously performed by an occupational therapist (OT). Individuals were divided into two groups: with and without anxiety about dementia onset. We examined the relationship between the presence of anxiety about dementia onset and assessment scores on EMC by the individuals and by the OT.

Results: Approximately 40% of participants expressed anxiety about developing dementia. No significant differences existed between the two groups in terms of age, sex, number of years of education, number of ongoing medical conditions under treatment, types of oral medications, Mini-Mental State-Japanese scores, and total functional independence measure scores. Self-assessed EMC scores by the individuals showed a significant difference between the two groups (p = 0.012, φ = 0.41), while no significant difference in the OT-assessed EMC scores.

Conclusion: Despite similar levels of objective cognitive decline and objective everyday memory impairment, individuals with anxiety about developing dementia have more severe subjective memory impairment than those without such anxiety.

Introduction: After Alzheimer's disease, frontotemporal lobar degeneration (FTLD) is the second most common form of early-onset dementia. Despite the heavy burden of care for FTLD, pharmacological and non-pharmacological treatments with sufficient efficacy remain scarce. This study aimed to evaluate the feasibility of a multimodal exercise program for FTLD and to examine preliminary changes in the clinical outcomes of the program in FTLD.

Methods: This single-arm preliminary study was conducted from July 2017 to July 2018 and recruited 4 male patients with FTLD aged 60-78 years. Patients exercised under the supervision of an exercise instructor once every 2 weeks for 48 weeks. The multimodal exercise program comprised cognitive training, moderate-intensity continuous training, strength training, balance training, and flexibility and relaxation training. Feasibility was measured using dropout and attendance rates. Cognitive, psychological, physical, and behavioral function tests were conducted before and after the intervention.

Results: All patients completed the intervention (100%) and attended well (93.6%). Positive changes in scores in the Stroop Color-Word Test (cognitive; 5 out of 6 items), Mood Check List-short form 2 (psychological), movement subscales of the Stereotypy Rating Inventory (behavioral), and Timed Up and Go (TUG, physical) assessments demonstrated a medium-to-high effect size (open effect size: 0.52-0.97). While there were improvements in some domains, such as recovery self-efficacy and exercise efficacy, the MMSE-J scores showed an overall slight decline, especially in the semantic dementia case where a marked decrease was observed. Additionally, three physical function items showed no effect, except for a positive outcome in the TUG test. Functional near-infrared spectroscopy revealed increased activation in the frontal lobe, indicated by elevated oxygenated hemoglobin levels before and after the exercise intervention. This pattern of activation suggests that the intervention may have stimulated neural activity in the frontal lobe, potentially enhancing cognitive and behavioral functions, including executive function and attention.

Conclusion: The long-term multimodal exercise intervention may be feasible and positively change the cognitive, psychological, physical, and behavioral functions in older adults with FTLD. Although the intervention led to improvements in certain areas, there were also declines observed in various functions, which may not necessarily be due to the intervention itself but rather reflect the natural progression of the disease.

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.