The MOMANT study, a caregiver support programme with activities at home for people with dementia: a study protocol of a randomised controlled trial.

BACKGROUND: Because of the expected increase in the number of people with dementia, and the associated social and economic costs, there is an urgent need to develop effective and cost-effective care for people with dementia and their caregivers. The intervention proposed here combines two approaches to caregiver support that have shown to be effective in empowering caregivers, i.e., multiple components for caregiver support and actively engaging caregivers to involve the person with dementia in activities at home. The aim is to investigate whether the intervention is effective in improving quality of life in the caregiver and the person with dementia. A further aim will be to investigate whether this intervention can improve caregivers' feeling of competence, experience of caregiving, and mood. METHODS: The study design is a pragmatic, cluster randomised controlled trial with cost-effectiveness analysis. The study participants are informal caregivers and home-living persons with dementia for whom they care, recruited in various regions in the Netherlands. The trial will compare outcomes in two groups of participants: 85 dyads who receive the intervention, and 85 dyads who receive care as usual. The intervention is a caregiver support training that is manual based and consists of 6 group sessions over 2 months. Training takes place in small groups of caregivers led by a health care professional presented at dementia day care centres. Randomisation occurs at the level of the day care centre. Participants are assessed on the outcome measures at baseline, prior to the intervention, and at 3 and 6 months after baseline. DISCUSSION: The study will provide insight into effectiveness and cost-effectiveness of an intervention that has not previously been evaluated or implemented in the Netherlands. The intervention potentially adds to the effective support options for informal caregivers of people with dementia without greatly increasing the workload for health- or social care professionals. TRIAL REGISTRATION: The trial is registered at the Dutch Trial Register at NTR6643 ; August 22nd, 2017.

The Interrelationship between Insulin-Like Growth Factor 1, Apolipoprotein E ε4, Lifestyle Factors, and the Aging Body and Brain.

Aging is associated with a decrease in body and brain function and with a decline in insulin-like growth factor 1 levels. The observed associations between alterations in insulin-like growth factor 1 levels and cognitive functioning and Mild Cognitive Impairment suggest that altered insulin-like growth factor 1 signaling may accompany Alzheimer's disease or is involved in the pathogenesis of the disease. Recent animal research has suggested a possible association between insulin-like growth factor 1 levels and the Apolipoprotein E ε4 allele, a genetic predisposition to Alzheimer's disease. It is therefore hypothesized that a reduction in insulin-like growth factor 1 signaling may moderate the vulnerability to Alzheimer's disease of human Apolipoprotein E ε4 carriers. We address the impact of age-related decline of insulin-like growth factor 1 levels on physical and brain function in healthy aging and Alzheimer's disease and discuss the links between insulin-like growth factor 1 and the Apolipoprotein E ε4 polymorphism. Furthermore, we discuss lifestyle interventions that may increase insulin-like growth factor 1 serum levels, including physical activity and adherence to a protein rich diet and the possible benefits to the physical fitness and cognitive functioning of the aging population.

Inhomogeneity and anisotropies for motion detection in the monocular visual field of human observers.

Signal-to-noise-ratio (SNR) thresholds were measured for the detection of coherent motion in moving random pixel arrays of constant root-mean-square contrast (35%) and constant average luminance (48 cd/m2) for 8 or 16 directions of motion at 25 positions in the visual field of the right eye. Five observers took part in this perimetric study of motion detection. The 24 eccentric positions were chosen on 8 equally spaced radial lines at the eccentricities 6, 24, and 48 degrees, the 25th position was centred on the fovea. At these positions we analysed the threshold SNR-value as a function of motion direction alpha. A significant modulation of the threshold with alpha is called an anisotropy. Anisotropies were found for low to medium velocities at positions on and near the vertical meridian, where the thresholds proved to be highest for vertical motion directions (up or down). On the horizontal meridian no significant anisotropies were found. Also on the oblique radials anisotropies were found, especially at 225 degrees (lower nasal quadrant of the visual field, upper temporal quadrant of the retina), but these were milder than those on the vertical meridian. The diameter of the stimulus is an important parameter and its influence was explored, albeit incompletely. Also inhomogeneities were found. This is defined as a consistent modulation of the threshold SNR-value with position A, the position along an equi-eccentricity circle (A-inhomogeneity), or with eccentricity E (E-inhomogeneity) or both. A simple acuity-scaling optimized for the nasal retina takes care of most of the E-inhomogeneity, but an A-inhomogeneity stays rather prominent. It too is characterized by higher thresholds near the vertical meridian than near the horizontal meridian. The findings suggest that iso-threshold curves are elliptical or egg-shaped with their long axis on the horizontal meridian and shifted somewhat out of naso-temporal symmetry towards the nasal half of the retinal field. As with the anisotropies the inhomogeneity grows in amplitude for decreasing velocity below medium velocity values of 1-2 pixels/frame, but in contradistinction to the anisotropies it is present and even increases in amplitude for increasing velocities above these medium values of 1-2 pixels/frame as well. The results are discussed in the light of other perimetric studies of motion detection and acuity, in the light of a model postulating the cooperation of groups of velocity-tuned bilocal motion detectors, and in the light of recent ideas on structure and function of primate cortical areas and processing streams.

Recent developments in the neuropsychology and physiology of face processing.

This chapter will review neuropsychological studies of face processing defects. Recent research in this field has been dominated by evidence of preserved face processing in patients who are unaware of these abilities. This phenomenon is referred to as covert recognition and forms a main focus for this review. The second part of the chapter reviews the advances in physiological studies of the brain mechanisms underlying face processing. The relationship between normal perception of faces and information processing at the single cell level is considered. Finally the chapter discusses how the physiological findings relate to the pathology of face processing.