Burden of family caregivers in Alzheimer's disease: The role of caregivers' perception of cognitive impairment.

OBJECTIVES: This study examined the role of caregivers' perception of cognitive impairment in burden of family caregivers in Alzheimer's disease (AD). We hypothesized that the evaluation of cognitive impairment by family caregivers plays a pivotal role in burden. METHODS: The study included 110 dyads (person with AD and their caregiver) recruited from a Memory Unit in France. The cognitive impairment and depressive symptoms of person with AD were evaluated by a geriatrician using the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15). Caregivers provided self-reports on the perception of cognitive impairment (IQCODE) of the care recipient, the caregiving burden (ZBI), depressive symptoms (GDS-15), and self-esteem (RSE). Descriptive analyses, comparison of different caregiver burden groups, and multinomial logistic regression analyses to understand correlates of caregiver burden were conducted with SPSS®, version 20. RESULTS: The findings show that the caregivers are on average 60 years old and the majority are women. They care for persons with AD, who are on average 82 years old and most of whom are women. Our results show that the duration of caregiving, depression of the caregiver, and caregivers' perception of cognitive impairment contribute significantly to burden of caregiver. DISCUSSION: This study shows that it is necessary to adopt the caregiver-centered approach to support the dyad. The role of the caregivers' perception of cognitive impairment in AD should be developed when supporting caregivers in suffering.

Negative effects of institutionalization on the sense of self in Alzheimer's Disease.

In this longitudinal study, we investigated the effects of institutionalization on the sense-of-self in individuals with Alzheimer's Disease (AD). We recruited two groups of participants: one living in care facilities (i.e., institutionalized-group) and another group living in their own home (i.e., non-institutionalized-group). In the two groups, we assessed the "Who-am-I" task on which participants were invited to provide statements beginning with the phrase "I am" that they felt were essential in defining who they are. We assessed this task, in the two groups, at a baseline (approximately one-month before-institutionalization) and at a follow-up (approximately six months after institutionalization). We analyzed whether responses on the "Who-am-I" task reflected physical-, social-, or psychological-self. Unlike at the baseline, fewer statements describing physical-, social-, and psychological-self were observed in the institutionalization than in the non-institutionalized group at the follow up. These findings demonstrate negative effects of institutionalization on the sense of self in AD.

ChatGPT as a Diagnostic Aid in Alzheimer's Disease: An Exploratory Study.

Background: The potential of ChatGPT in medical diagnosis has been explored in various medical conditions. Objective: We assessed whether ChatGPT can contribute to the diagnosis of Alzheimer's disease (AD). Methods: We provided ChatGPT with four generated cases (mild, moderate, or advanced stage AD dementia, or mild cognitive impairment), including descriptions of their complaints, physical examinations, as well as biomarker, neuroimaging, and neuropsychological data. Results: ChatGPT accurately diagnosed the test cases similarly to two blinded specialists. Conclusions: While the use of generated cases can be a limitation to our study, our findings demonstrate that ChatGPT can be a useful tool for symptom assessment and the diagnosis of AD. However, while the use of ChatGPT in AD diagnosis is promising, it should be seen as an adjunct to clinical judgment rather than a replacement.

Imagine Yourself Dancing Waltz: The Effect of Imagination on Memory in Alzheimer's Disease.

BACKGROUND: Self-imagination refers to a mnemonic strategy of imagining oneself at a scene related to a cue. OBJECTIVE: We tested the effect of self-imagination on memory recall in Alzheimer's disease (AD) Methods: Individuals with AD and healthy controls were invited to perform two conditions. In the control (i.e., semantic elaboration) condition, participants were asked to define to which semantic category (e.g., dance) words (e.g., waltz) belong. However, in a self-imagining condition, participants were asked to imagine themselves in a scene related to the stimuli (e.g., dancing waltz). Both conditions were followed by two free memory tests with two different intervals (20 seconds vs. 20 minutes). RESULTS: Analysis showed a beneficial effect of self-imagination for the 20-second but not for the 20- minute recall in AD participants and controls. CONCLUSION: Clinicians can incorporate our findings when assessing, especially when trying to rehabilitate, episodic memory in AD.

"I Remember the Fall": Memory of Falls in Older Adults.

OBJECTIVES: While there is a large body of research on falls and their consequences in older adults, little is known about how older adults remember them. We addressed this gap by inviting older adults to remember falls and control memories. METHODS: We analyzed specificity of memories and invited participants to rate emotional valence, mental time travel, visual imagery, importance, and rehearsal, as experienced during retrieval. RESULTS: Although analysis demonstrated no significant differences between memories of falls and control memories regarding specificity, participants rated memories of falls as more negative than control memories. Furthermore, they rated memories of falls as triggering higher mental time travel, higher visual imagery, higher importance, and higher rehearsal than control memories. CONCLUSIONS: The negative emotional valence of memories of falls, as well as their ability to trigger significant levels of mental time travel, visual imagery, importance, and rehearsal, demonstrate how these memories are different from other memories in older adults. CLINICAL IMPLICATIONS: The findings demonstrate how falls can modulate memory of personal events in older adults.

Empathy of individuals with Alzheimer's disease (AD) toward other AD patients.

BACKGROUND: The objective of this study was twofold. We assessed whether individuals with Alzheimer's disease (AD) demonstrate higher empathy toward people with the same disorder. We also assessed whether empathy may enhance the recognition of these peoples' faces. METHOD: Twenty-seven mild AD participants and 30 healthy older adults were invited to retain faces depicting either people diagnosed with AD or healthy people. Participants were also invited to rate their empathy toward all faces. RESULTS: Although AD participants reported higher empathy for "AD-labeled" than for "healthy" faces, recognition was similar for both categories of faces. Healthy older adults also reported higher empathy for "AD-labeled" than for "healthy" faces. However, they demonstrated higher recognition for "healthy" than for "AD-labeled" faces. CONCLUSIONS: Although our paper shows no effect of empathy on face recognition in AD, it provides a clinically relevant finding: individuals with mild AD can demonstrate significant empathy toward people with the same medical condition.

Emotional exhaustion and fear of COVID-19 in geriatric facilities during the COVID-19 pandemic.

OBJECTIVE: Since the onset of the COVID-19 pandemic, healthcare workers, especially those employed in hospital settings, have been exposed to a variety of stressors in the workplace. The aim of this study was to explore the Emotional Exhaustion (EE) of workers in geriatric facilities during the COVID-19 crisis. We accordingly sought to investigate the short-term impact of the COVID-19 pandemic in terms of the EE experienced by workers in geriatric facilities, and to examine the manner in which psychosocial conditions and fear of COVID-19 in the workplace have affected EE. METHODS: Surveys were administered in the midst of the COVID-19 crisis (October to December 2020). The study included 118 French healthcare workers with a mean age of 35.61 ± 0.73 recruited in geriatric facilities. We assessed EE, psychosocial conditions (e.g., demands at work, health and well-being, etc.) and fear of COVID-19 in the workplace. RESULTS: The analysis yielded two main outcomes. First, 34.75% workers (41) reported severe levels of EE. Second, demands at work and the fear of COVD-19 increased EE. Health and well-being were, however, demonstrated to protect against EE. DISCUSSION: Furthermore, fear of COVID-19 was shown to contribute significantly to EE healthcare workers in geriatric facilities. It is likely that Covid-19 indirectly contributes to EE by influencing demands at work.

Fear of COVID-19, emotional exhaustion, and care quality experience in nursing home staff during the COVID-19 pandemic.

BACKGROUND: Nursing home staff have been adversely impacted throughout the COVID-19 pandemic, facing difficulties in providing patient care. The aim of this study was to explore health workers' perception regarding their own care quality experience in nursing homes during the COVID-19 pandemic. Amidst the second wave of the pandemic, we investigated the relationships between fear of COVID-19 and care quality experiences in nursing homes with emotional exhaustion (EE) as a mediating role. We hypothesized that EE is associated with fear of COVID-19 and care quality experience among nursing home staff. Furthermore, we predicted that EE would mediate the relationships between fear of COVID-19 and care quality experience. METHODS: During the second wave of COVID-19 (October to December 2020), we administered surveys to a large sample of 129 French nursing home staff with a mean age of 38.47 ± 10.31 who were directly and repeatedly exposed to COVID-19. We assessed their emotional exhaustion (EE) and care quality experience in the workplace via subjective indicators using self-reported scales. RESULTS: In the context of COVID-19, low to severe emotional exhaustion levels were found among nursing home staff, and these levels were associated with care quality experience as well as fear of COVID-19. The groups with low and severe levels of EE reported the highest levels of fear of COVID-19. The groups with moderate and severe levels of EE reported the lowest levels of care quality experience. Lastly, the relationships between fear of COVID-19 and care quality experience were mediated by EE. CONCLUSIONS: The findings made by the present study focused on the role of emotional coping responses to COVID-19. EE was associated positively with fear of COVID-19 and negatively with care quality experience. Furthermore, EE was found to mediate the relationship between fear of COVID-19 and care quality experience. We discuss these findings as they relate to palliative care issues in nursing homes and the manner in which emotional exhaustion ought to be addressed among nursing home staff.

"Who will I be?": The future of the self as described by Alzheimer's disease (AD) patients.

We assessed how Alzheimer's disease (AD) patients would imagine their self in the future. AD patients and healthy controls were asked to generate statements beginning with "I-will-be" to describe how they saw themselves or how they wished to be in the future. These statements were analyzed in terms of four self-dimensions, i.e., physical self, social self, psychological self and self-cessation. The latter was investigated to assess how AD patients processed the idea of their own mortality. Findings demonstrated fewer total "I-will-be" statements in AD participants than in controls, suggesting that the construction of future self-concepts becomes weaker in the disease. Our results also demonstrated fewer statements related to the physical-self, the social-self and the psychological-self, and more statements related to self-cessation in AD participants than in controls. These findings suggest that AD patients are highly preoccupied by the idea of death when thinking about the future of their self.

On Covid-19 and mental health: An observational study on depression, anxiety, and loneliness during the second lockdown in patients with Alzheimer disease.

ABSTRACT: While visiting and socialization restrictions during lockdowns were instituted to cope with the Covid-19 spread and to prolong the life of residents of retirement homes, these measures could have been expected to decrease the quality of life of their residents.We assessed longitudinal effects of the two successive lockdowns, as implemented in France, on mental health (i.e., depression, anxiety, and loneliness) in 62 retirement home residents with Alzheimer disease (AD).Analysis demonstrated higher levels of depression, anxiety, and loneliness during the second lockdown than during the first lockdown.The increased levels of depression, anxiety, and loneliness during the second lockdown can be attributed to the longer duration of the restrictive measures, especially the restriction of visits, that were implemented in retirement homes. In addition, the increased workload of geriatric healthcare workers leading to higher levels of burnout and decreased quality of care may help explain the increased loneliness, depression, and anxiety of retirement home residents with AD, which were observed during the second Covid-19 era lockdown.

The "Sickness" Memory: Can Patients With Alzheimer Disease Remember the Diagnosis Announcement?

BACKGROUND: Diagnosis of Alzheimer disease (AD) can cause substantial psychological distress in patients. We thus assessed how patients with AD remember the announcement of diagnosis. METHODS: We recruited 47 participants with mild AD (26 women; M age=68.89 y, SD=7.37; M years of formal education=9.74, SD=3.00). We invited the participants to remember the moment when their clinicians announced their diagnosis, within 6 months of the event, as well as a control memory, over the same period. We analyzed memory retrieval regarding specificity, as well as the subjective experience of retrieval (ie, regarding mental time travel, visual imagery, emotion and importance). RESULTS: No significant differences were observed between memory of diagnosis and control memory regarding specificity, mental time travel and visual imagery. However, memory of diagnosis triggered a more intense emotional experience and feeling of importance than control memory. DISCUSSION: Retrieval of the diagnosis announcement can activate a strong emotional and personally important experience in patients with AD. When remembering the diagnosis announcement, patients with AD may re-experience some features of that turning point in which they shift from "person" to "patient."

Neuropsychological assessment of patients with alzheimer's Disease in the presence or absence of spouses.

A common question in the neuropsychological testing of patients with Alzheimer's Disease is whether or not patients should be tested in the presence of their spouses. We addressed this issue by assessing the neuropsychological performances of Alzheimer's Disease patients in the presence or absence of spouses. Results showed no significant differences between patients' performances in the presence or absence of spouses on tests assessing general cognitive abilities, episodic memory, working memory, inhibition and flexibility. No significant differences were observed regarding either anxiety or depression in patients when tested alone, compared to when spouses were attending. However, patients demonstrated higher verbal fluency when tested alone compared to when spouses attended. Clinicians may carry out neuropsychological assessment in the presence or absence of spouses, except when assessing verbal fluency. In such cases, clinicians should privilege testing patients alone or, if spouses attend the test, take into account this variable when interpreting patients' performances.

"My sympathetic clinician": perception of sympathy by patients with Alzheimer's disease increases when asked to provide autobiographical memories.

BACKGROUND AND AIMS: Autobiographical memory serves to recall past personal experiences and share them with others, promoting social bonding and communication. In this study, we investigated whether encouraging patients with Alzheimer's disease (AD) to share autobiographical memories during formal neuropsychological testing may boost the patient-clinician relationship, and more specifically, the neuropsychologist's level of sympathy as perceived by patients. METHODS: We invited patients with mild AD to perform neuropsychological testing in two conditions. In one condition, we invited patients to retrieve and share two autobiographical memories after testing, while in a control condition, the testing session ended without asking patients to retrieve and share any autobiographical memories. After the two conditions, patients were invited to rate the neuropsychologist's level of sympathy towards them. RESULTS: Analysis demonstrated that patients perceived a higher level of sympathy when their neuropsychologist invited them to retrieve and share past personal experiences. DISCUSSION: By inviting patients with AD to retrieve past personal experiences, clinicians can promote a sense of sharing, create a social bond and, consequently, enhance the therapeutic relationship. In other words, by inviting patients with AD to share autobiographical memories, clinicians can promote a "social glue" with their patients, boosting mutual sympathy and patients' well-being.

Memories of Falls: Resolved or Unresolved Memories?

BACKGROUND: There is bourgeoning interest in how older adults remember their falls and research in this area has demonstrated how falls can reshape memory retrieval in older adults. We pursued this line of research by assessing whether older adults succeed in integrating memories of falls into their life story. METHODS: We invited older adults to remember their falls and analyzed whether these memories were integrated or non-integrated. RESULTS: Analysis demonstrated no significant differences between the number of integrated and non-integrated memories. Critically, however, higher anxiety and depression was observed in participants who produced non-integrated memories than in those who produced integrated ones. DISCUSSION: The ability to integrate memories of falls in older adults is likely associated with anxiety and depression. Anxiety may result in avoidance of processing of the meaning of falls, and depression may hamper the ability to extract meaning from them, resulting in difficulties for older adults to integrate falls into their life story. Non-integrated memories of falls in older adults may be seen as unresolved memories and deserve special clinical attention.

The eyes of the past: larger pupil size for autobiographical memories retrieved from field perspective.

BACKGROUND: Visual perspective during memory retrieval has mainly been evaluated with methodologies based on introspection and subjective reports. The current study investigates whether visual perspective can be evaluated with a physiological measurement: pupil dilation. METHODS: While their pupil diameter was measured with an eye-tracker, forty-five participants retrieved one memory from a field perspective (i.e., as viewed through our own eyes) and one memory from an observer perspective (i.e., as viewed from a spectator's standpoint). After retrieval, participants rated the emotional intensity of the memories. RESULTS: Analysis demonstrated larger pupils during the retrieval of memories from a field perspective and higher emotional intensity for memories retrieved from a field perspective. DISCUSSION: The larger pupils for memories recalled from a field perspective could, however, not be attributed to their higher emotional intensity. These findings suggest that pupil dilation could be used as a physiological assessment of visual perspective during memory retrieval.

"I Will Be Healthy": Ideal Self in Patients with Alzheimer's Disease.

Background: Within the concept of the self, a distinction can be made between ideal self (i.e., what would like to become) and feared self (i.e., what would not like to become in the future). Objective: We investigated ideal self and feared self in patients with mild Alzheimer's disease (AD). We have also measured these self-related processes in relation to depression and anxiety. Methods: We invited 31 patients with mild AD and 35 control participants to decide whether they would consider the statement (e.g., I will be healthy) as a representation that they would like to acquire (i.e., ideal self) or to avoid (i.e., feared self). Results: Analysis demonstrated that more participants assigned the "I will be healthy" statement to ideal self than to feared self, and this tendency was observed in both AD participants and controls. Less depression and anxiety were observed in participants who have assigned the "I will be healthy" statement to their ideal self compared to those who assigned this statement to their feared self, and this was observed in both AD participant and control groups. Conclusion: Our study demonstrates that AD patients tend to endorse positive health traits and to integrate these traits into their ideal self. AD patients tend to endorse health-related images that are associated with hopes when projecting into their future self. This positive projection into the self may create a motivational force (e.g., aspirations and hopes) to embody the "healthy" self that AD patients desire to be.

High Exhaustion in Geriatric Healthcare Professionals During the COVID-19 Second Lockdown.

BACKGROUND: In a previous study, we assessed burnout in geriatric healthcare workers during the first lockdown that lasted from March to May 2020 in France, in response to the COVID-19 crisis. OBJECTIVE: We carried out a follow-up study to assess burnout in the same population during the second lockdown that was implemented at the end of October 2020. METHODS: We used an online survey to assess burnout in terms of exhaustion and disengagement in a sample of 58 geriatric healthcare workers. RESULTS: We found higher levels of exhaustion, disengagement, and burnout among geriatric healthcare workers during the second than during the first lockdown. We also found high levels of exhaustion but moderate disengagement and burnout during the second lockdown. CONCLUSION: The increased exhaustion, disengagement, and burnout during the second lockdown can be attributed to the increased workload in geriatric facilities throughout this crisis and during the second lockdown due to shortage in staff and increased number of shifts and allocated duties. The high levels of exhaustion reported among geriatric healthcare workers during the second lockdown can reflect their physical fatigue, as well as their feelings of being emotionally overextended and exhausted by their workload.

Hallucinations and Covid-19: Increased Occurrence of Hallucinations in Patients with Alzheimer's Disease During Lockdown.

We investigated the effects of lockdown, as implemented by retirement homes to cope with the spread of Covid-19, on hallucinatory experiences in patients with Alzheimer's disease (AD). The study included 47 patients with AD living in retirement homes and who were already experiencing hallucinations prior to the lockdown. We invited caregivers to rate hallucinatory experiences in these patients during the lockdown, and compared this rating with that provided by the same caregivers prior to the lockdown. Results demonstrated increased hallucinatory experiences in patients with AD during the lockdown, compared with before the lockdown. The decrease in social and physical activities during the lockdown, and especially, the physical separation of residents from family members, might have led to decreased sensory stimulation and increased loneliness, and consequently, to the hallucinatory experiences in patients with AD living in retirement homes during the lockdown. While the restrictive measures were necessary to cope with the spread of Covid-19, these measures have increased hallucinations in patients with AD living in retirement homes, at least in those who were already experiencing hallucinations prior to the lockdown.

Higher Depression of Patients with Alzheimer's Disease During than Before the Lockdown.

We assessed depression in 72 patients with Alzheimer's disease (AD) who live in retirement homes during the COVID-19-related lockdown. We invited caregivers of 72 patients with AD who live in retirement homes to rate depression in the patients both before and during the lockdown. Analysis demonstrated increased depression in the patients during the lockdown. We attribute this increased depression to the restrictive measures on activities, visits, and physical contact between patients with AD and family members during the lockdown.

Cuing Prospective Memory With Smartphone-Based Calendars in Alzheimer's Disease.

OBJECTIVES: We investigated the effect of using smartphone-based calendars (Google and Outlook Calendar) on prospective memory in Alzheimer's disease (AD). METHODS: we recruited two groups of participants with mild AD. In one group, prospective memory was cued by a paper-and-pencil calendar, whereas in the second group prospective memory was cued by a smartphone calendar application. After 2 weeks of training to familiarize the participants with calendar use, we invited participants to perform three prospective events per week (e.g., remembering to go to the grocery store) during a 3-week period. Events were cued either by the paper- or smartphone-based calendar. RESULTS: we observed fewer omissions of prospective events in the smartphone-based calendar group than in the paper-based calendar group. CONCLUSIONS: our study suggests positive effects of smartphone calendar applications on prospective memory in AD.