Cognitive Orientation to daily Occupational Performance (CO-OP) for Older Adults After a Hip Fracture: A Pilot Study.

IMPORTANCE: In-home therapy provides the opportunity for rehabilitation intervention to be completed in the context of the patient's natural environment. However, most studies have focused on the effects of physical exercise, leaving a gap in understanding the effectiveness of a more task-oriented intervention that addresses individual preferences. OBJECTIVE: To assess the feasibility and preliminary efficacy of the Cognitive Orientation to daily Occupational PerformanceTM (CO-OP) approach, delivered at home with older adults after a hip fracture to improve functional outcomes. DESIGN: Single-arm quasi-experimental design. SETTING: Patients' home. PARTICIPANTS: Nine participants (age ≥60 yr) being discharged home from an inpatient rehabilitation ward in a geriatric hospital in a central city in Israel. INTERVENTION: Up to 10 1-hr weekly face-to-face sessions in using the CO-OP approach. OUTCOMES AND MEASURES: The Canadian Occupational Performance Measure was used to measure performance and satisfaction with the patients' level of participation in daily functioning. RESULTS: A 30% recruitment rate, an 81% retention rate, were observed, with 88% of the participants expressing high to very high overall satisfaction with the intervention. Friedman test results indicated statistically significant improvements in occupational performance and satisfaction on trained and untrained goals (p < .01). CONCLUSIONS AND RELEVANCE: The findings suggest that a home-based CO-OP intervention is feasible and potentially beneficial for older adults who are returning home after a hip fracture. What This Article Adds: This study shows that a task-oriented intervention can be effective in helping older adults return home successfully after a hip fracture.

Effectiveness of a tele-rehabilitation intervention to improve performance and reduce morbidity for people post hip fracture - study protocol for a randomized controlled trial.

BACKGROUND: Most surviving hip-fracture patients experience reduced mobility and lose some of their functional ability, which increases the risk of complications and rehospitalization. Post-discharge transitional programs to reduce readmissions and disabilities have shown some success. Telerehabilitation refers to the use of technologies to provide rehabilitation services to people in their homes. Considering the need for long-term follow-up care for people with hip fracture, in-home telerehabilitation could increase independence, decrease hospital stays and reduce the burden for caregivers. The objective of this study is to investigate the effectiveness of an intervention program based on telerehabilitation on activities of daily living (ADL), quality of life (QOL), depression and burden on caregivers compared to face-to-face home visits and usual care of community-dwelling older adults after hip fracture. METHODS/DESIGN: This will be a three-armed randomized control trial (RCT) including pre/post intervention and follow-up. The trial will include 90 older people with hip fractures who will be randomly assigned to a telerehabilitation group (N = 30), face-to-face visits (N = 30) and a control group. The aim of the intervention is to improve the transition from rehabilitation units to community dwelling. It will include 10 videoconferencing/ face-to-face sessions from an occupational therapist in the presence of the primary caregiver. Each session will be utilized to guide the participants to achieve their self-identified goals, focusing on problem-solving for daily life situations and on the ability to implement the discussed strategies for a variety of activities. Outcome measures include Functional Independence Measure (FIM) for evaluation of ADL, SF-12 for evaluation of Health-related QOL, The Geriatric Depression Scale (GDS) and The Zarit Caregiver Burden Scale. Data will be analyzed using Repeated measures MANOVA. DISCUSSION: The current study will enable the cost-effectiveness examination of a suggested rehabilitation service based on available technology. The proposed intervention will increase accessibility of in-home rehabilitation services, improve function and health, and reduce economic burden. TRIAL REGISTRATION: NCT03376750 (12/15/2017).

Alzheimer's "Prevention" vs. "Risk Reduction": Transcending Semantics for Clinical Practice.

The terms "prevention" and "risk reduction" are often used interchangeably in medicine. There is considerable debate, however, over the use of these terms in describing interventions that aim to preserve cognitive health and/or delay disease progression of Alzheimer's disease (AD) for patients seeking clinical care. Furthermore, it is important to distinguish between Alzheimer's disease prevention and Alzheimer's dementia prevention when using these terms. While prior studies have codified research-based criteria for the progressive stages of AD, there are no clear clinical consensus criteria to guide the use of these terms for physicians in practice. A clear understanding of the implications of each term will help guide clinical practice and clinical research. The authors explore the semantics and appropriate use of the terms "prevention" and "risk reduction" as they relate to AD in clinical practice.

D-serine adjuvant treatment alleviates behavioural and motor symptoms in Parkinson's disease.

Parkinson's disease (PD) manifestations include motor symptoms and behavioural deficits that resemble schizophrenia negative symptoms. The N-methyl-D-aspartate subtype of glutamate receptor (NMDAR) represents a novel pharmacological target in PD. D-serine (DSR) allosterically modulates in-vivo NMDAR-mediated neurotransmission and has been shown to improve negative and antipsychotic drug-induced parkinsonian symptoms in schizophrenia patients. This pilot study assessed DSR effects in ten PD patients who completed a 6-wk double-blind, placebo-controlled, crossover adjuvant treatment trial with 30 mg/kg.d DSR. Primary outcome analyses consisted of separate repeated-measures multivariate analyses of variance for Unified Parkinson's Disease Rating Scale (UPDRS), Simpson-Angus Scale for Extrapyramidal Symptoms (SAS), Abnormal Involuntary Movement Scale (AIMS), and Positive and Negative Syndrome Scale (PANSS) scores. DSR treatment was well tolerated and resulted in increased DSR serum levels (p=0.001) and significantly reduced UPDRS (p=0.02), SAS (p=0.009) and PANSS (0.05) total scores. These preliminary findings suggest that DSR treatment may be beneficial in PD. Larger-sized studies with optimized DSR dosages are warranted.

[Creative work of painters with Alzheimer's disease].

Alzheimer's disease is characterized by progressive cognitive and functional decline. Recently, there have been reports in the medical literature on artists who continued to paint while suffering from Alzheimer's. This article describes the changes that occurred in the work of three artists who suffered from Alzheimer's: William Utermohlen, Carolus Horn and Willem de Kooning. In the case of William Utermohlen (1935-2007), Alzheimer's disease was diagnosed at the age of 61. A series of 15 self-portraits that he painted during the years he suffered from Alzheimer's disease provide a rare opportunity to look into the world of an Alzheimer's patient, and testifies to sustained motivation to create, despite severe cognitive impairment. Although Utermohlen's portraits show distortions in proportion and defects in spatial organization that became more evident as the disease progressed, the portraits are characterized by an extraordinary ability to express emotion, as well as by originality: each is a new piece of work, not an attempt to copy a previous painting. Carolus Horn (1921-1992) was diagnosed with Alzheimer's disease at the age of 58. In Horn's paintings, from the time he was diagnosed, there is evidence of distortion in perspective, "primitive" style, lack of individual characteristics in depicting his subjects, more schematic drawing, and a preference for using reds and yellows. In the most advanced stage of the disease Horn was only able to scribble. Despite his cognitive and functional limitations, Horn continued to draw daily, even in the advanced stages of his illness, until shortly before his death. Willem de Kooning's (1904-1997) Alzheimer's was diagnosed in his late eighties. During the following years, he painted more than 300 abstract paintings, which art critics assess as among the finest and most sensitive artistic achievements in contemporary painting. Despite cognitive limitations, de Kooning was able to muster the concentration to continue painting. Common to these three painters was the continuous urge to create, despite considerable cognitive impairment. Their art enables us to have a close look into the world of Alzheimer's sufferers. Analysis of their artwork can help us to understand the type of cognitive impairment caused by ALzheimer's, as well as some neurological aspects of art creation.

Cognitive decline in Alzheimer disease: Impact of spirituality, religiosity, and QOL.

OBJECTIVE: To assess effects of quality of life (QOL), spirituality, and religiosity on rate of progression of cognitive decline in Alzheimer disease (AD). METHODS: In this longitudinal study, we recruited 70 patients with probable AD. The Mini-Mental State Examination was used to monitor the rate of cognitive decline. Religiosity and spirituality were measured using standardized scales that assess spirituality, religiosity, and organizational and private religious practices. We conducted a simultaneous multiple linear regression analysis for factors contributing to rate of cognitive decline. RESULTS: After controlling for baseline level of cognition, age, sex, and education, a slower rate of cognitive decline was associated with higher levels of spirituality (p < 0.05) and private religious practices (p < 0.005). These variables accounted for 17% of the total variance [F(11,58) = 2.24, p < 0.05]. There was no correlation between rate of cognitive decline and QOL. CONCLUSION: Higher levels of spirituality and private religious practices, but not quality of life, are associated with slower progression of Alzheimer disease.

Associative (prosop)agnosia without (apparent) perceptual deficits: a case-study.

In associative agnosia early perceptual processing of faces or objects are considered to be intact, while the ability to access stored semantic information about the individual face or object is impaired. Recent claims, however, have asserted that associative agnosia is also characterized by deficits at the perceptual level, which are too subtle to be detected by current neuropsychological tests. Thus, the impaired identification of famous faces or common objects in associative agnosia stems from difficulties in extracting the minute perceptual details required to identify a face or an object. In the present study, we report the case of a patient DBO with a left occipital infarct, who shows impaired object and famous face recognition. Despite his disability, he exhibits a face inversion effect, and is able to select a famous face from among non-famous distractors. In addition, his performance is normal in an immediate and delayed recognition memory for faces, whose external features were deleted. His deficits in face recognition are apparent only when he is required to name a famous face, or select two faces from among a triad of famous figures based on their semantic relationships (a task which does not require access to names). The nature of his deficits in object perception and recognition are similar to his impairments in the face domain. This pattern of behavior supports the notion that apperceptive and associative agnosia reflect distinct and dissociated deficits, which result from damage to different stages of the face and object recognition process.