Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility, and Lessons for Implementation.

BACKGROUND: Cognitive stimulation therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, and it has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention but has recently been adapted for online delivery. OBJECTIVE: In this study, we aimed to explore the feasibility and acceptability of online or virtual CST (vCST) delivery in India and Brazil, emphasizing barriers and facilitators to implementation. METHODS: A single-group, multisite, mixed methods, feasibility study was conducted, with nested qualitative interviews. Primary feasibility outcomes were recruitment rate, attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and postintervention measures, including cognition and quality of life, were assessed. Qualitative interviews were conducted with people with dementia, family caregivers, and group and organizational leaders following intervention delivery, and the data were analyzed using the Consolidated Framework for Implementation Research. RESULTS: A total of 17 vCST group sessions with 59 participants were conducted for 7 weeks, with 53% (31/59) of participants attending all 14 sessions. Attrition rate was 7% (4/59), and outcome measure completion rate at follow-up was 68% (40/59). Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders and enabled vital access to services during pandemic restrictions. While online services broadened geographic access, challenges emerged concerning inadequate computer literacy, poor technology access, and establishing interpersonal connections online. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities of daily living, but these results were not statistically significant. CONCLUSIONS: vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic but raised challenges related to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST while emphasizing ongoing development and solutions to address implementation challenges.

Development and acceptability of a brief, evidence-based Dementia Awareness for Caregivers course in low- and middle-income countries.

BACKGROUND: Knowledge of and attitudes towards dementia vary across countries, and for caregivers in low- and middle-income countries (LMICs), access to information can be challenging. There is an urgent need for brief, easily accessible and culturally appropriate educational courses for caregivers of persons with dementia, providing much needed information whilst addressing important psychological concepts such as stigma. METHODS: An international and multidisciplinary team developed Dementia Awareness for Caregivers (DAC) courses in four stages: (1) scoping review and module agreement, (2) development of an International template (DAC-International) containing a standardised process for adding information, (3) development of local DACs using a standardised format and (4) acceptability of courses in Brazil, India and Tanzania. FINDINGS: The DAC-International was developed, comprising three modules: 'What is dementia?'; 'Positive engagement' and 'Caring for someone with dementia'. Three local versions were developed from this (DAC-Brazil, DAC-India and DAC-Tanzania), where additions of country-specific information included prevalent stereotypes and the addition of culturally relevant case studies. An initial field test was conducted in each country (n = 85), which indicated acceptability to participants. CONCLUSIONS: The methods used here resulted in culturally valid and acceptable educational courses for carers of people with dementia. Future work will consist of large-scale, formal evaluations and the development of additional local courses.

Working memory training format in older adults: individual versus group sessions.

Working memory (WM) training has been shown to increase the performance of participants in WM tasks and in other cognitive abilities, but there has been no study comparing directly the impact of training format (individual vs. group) using the same protocol. Therefore, the aim of this study was to compare the efficacy of the Borella et al. three session verbal WM training offered in two different formats on target and transfer tasks. This study was conducted in two waves. In the first wave, participants were randomized into individual training (n = 11) and individual control conditions (n = 15). In the second wave, participants were randomized into group training (n = 16) and group control conditions (n = 17). Training consisted of three sessions of WM exercises and participants in the active control condition responded to questionnaires during the same time. There was significant improvement for both training conditions at post-test and maintenance at follow-up for the target task, other WM tasks, processing speed, and executive functions tasks. The ANOVA results showed that the training gains did not depend on the WM training format. However, the effect size analyses suggested that this intervention can be more effective, at short term and follow-up, when provided individually. To conclude, this study showed that providing this training collectively or individually does not change the training benefits, which increases the possibilities of its use in different contexts.

Verbal working memory training in older adults: an investigation of dose response.

The WM training protocol proposed by Borella et al. found specific and transfer effects among seniors, however, the studies were carried out in the same socio-cultural context and variations in the procedure were never tested. The present study aimed at analyzing the efficacy of Borella et al.'s training, in terms of short and long-term benefits, in a different socio-cultural context (Study 1), and the effect of change in the training's length (duplicating the number of sessions (Study 2). Participants were randomly assigned to a trained group (N = 18 for Study 1, and N = 23 for Study 2) and active control group (N = 28 for Study 1, and N = 27 for Study 2), and evaluated at pre, post-test and six-month follow-up for verbal WM task (criterion task), and for visuospatial and verbal WM, inhibition, processing speed, executive function, and fluid intelligence measures (transfer tasks). The trained groups had higher performance in all tasks when compared with active control groups after training and at 6 month follow-up. The longer training (Study 2) generated similar gains as the original protocol, with some advantage in far transfer tasks at post-test and follow-up. Study limitations include the small sample sizes. In conclusion, this training was effective in a different socio-cultural context and adding three sessions to the protocol did not significantly change training impact.

Art therapy as an adjuvant treatment for depression in elderly women: a randomized controlled trial

Objective: There are few quantitative studies on art therapy for the treatment of depression. The objective of this study was to evaluate if art therapy is beneficial as an adjuvant treatment for depression in the elderly. Methods: A randomized, controlled, single-blind study was carried out in a sample of elderly women with major depressive disorder (MDD) stable on pharmacotherapy. The experimental group (EG) was assigned to 20 weekly art therapy sessions (90 min/session). The control group (CG) was not subjected to any adjuvant intervention. Patients were evaluated at baseline and after 20 weeks, using the Geriatric Depression Scale (GDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and cognitive measures. Results: Logistic regression analysis adjusted for age revealed that women in EG (n=31) had significant improvement in GDS (p = 0.007), BDI (p = 0.025), and BAI (p = 0.032) scores as compared with controls (n=25). No difference was found in the cognitive measures. Conclusion: Art therapy as an adjunctive treatment for MDD in the elderly can improve depressive and anxiety symptoms. Clinical trial registration: RBR-2YXY7Z

Art therapy as an adjuvant treatment for depression in elderly women: a randomized controlled trial.

OBJECTIVE: There are few quantitative studies on art therapy for the treatment of depression. The objective of this study was to evaluate if art therapy is beneficial as an adjuvant treatment for depression in the elderly. METHODS: A randomized, controlled, single-blind study was carried out in a sample of elderly women with major depressive disorder (MDD) stable on pharmacotherapy. The experimental group (EG) was assigned to 20 weekly art therapy sessions (90 min/session). The control group (CG) was not subjected to any adjuvant intervention. Patients were evaluated at baseline and after 20 weeks, using the Geriatric Depression Scale (GDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and cognitive measures. RESULTS: Logistic regression analysis adjusted for age revealed that women in EG (n=31) had significant improvement in GDS (p = 0.007), BDI (p = 0.025), and BAI (p = 0.032) scores as compared with controls (n=25). No difference was found in the cognitive measures. CONCLUSION: Art therapy as an adjunctive treatment for MDD in the elderly can improve depressive and anxiety symptoms. CLINICAL TRIAL REGISTRATION: RBR-2YXY7Z.

Categorization Working Memory Span Task: Validation study of two Brazilian alternate versions.

BACKGROUND: The Categorization Working Memory Span Task (CWMS task) is a complex working memory (WM) span test that has been used previously to assess age and individual differences in WM as well as the relationship between WM and complex aspects of cognition such as listening comprehension. Two alternate versions of the task have been developed to be used as outcome variables in WM training protocol, which mirrors the task involved in the CWMS task. OBJECTIVES: (1) To translate and adapt the CWMS task for Brazilian Portuguese; (2) to test the equivalence of its 2 alternate versions; (3) to examine temporal stability; (4) to examine the influence of age and schooling on CWMS task; (5) to establish its relationship with other tests of WM. METHODS: Eighty-one older adults completed version A, and 86 completed version B of the CWMS task. After 6 months, a subsample (n = 85) completed the same version of the task. RESULTS: Versions A and B of the task generated comparable scores. Both versions had adequate temporal stability, which was higher for the CWMS total recall, which is the classical variable in this task to represent WM performance, when compared to the other variables generated by the test. The CWMS task variables were moderately correlated with schooling and other cognitive tests (Mini Mental State Examination, Letter-Number Sequencing, Spatial Span Backward, Digit Span Forward). CONCLUSIONS: The 2 versions of the CWMS task were equivalent and stable temporally. The task was influenced by schooling and global cognition.

Multidisciplinary rehabilitation program: effects of a multimodal intervention for patients with Alzheimer’s disease and cognitive impairment without dementia

Abstract Background Non-pharmalogical interventions represent an important complement to standard pharmalogical treatment in dementia. Objective This study aims to evaluate the effects of a multidisciplinary rehabilitation program on cognitive ability, quality of life and depression symptoms in patients with Alzheimer’s disease (AD) and cognitive impairment without dementia (CIND). Methods Ninety-seven older adults were recruited to the present study. Of these, 70 patients had mild AD and were allocated into experimental (n = 54) or control (n = 16) groups. Two additional active comparison groups were constituted with patients with moderate AD (n = 13) or with CIND (n = 14) who also received the intervention. The multidisciplinary rehabilitation program lasted for 12 weeks and was composed by sessions of memory training, recreational activities, verbal expression and writing, physical therapy and physical training, delivered in two weekly 6-hour sessions. Results As compared to controls, mild AD patients who received the intervention had improvements in cognition (p = 0.021) and quality of life (p = 0.003), along with a reduction in depressive symptoms (p < 0.001). As compared to baseline, CIND patients displayed at the end of the intervention improvements in cognition (p = 0.005) and depressive symptoms (p = 0.011). No such benefits were found among patients with moderate AD.Discussion: This multidisciplinary rehabilitation program was beneficial for patients with mild AD and CIND. However, patients with moderate dementia did not benefit from the intervention.

Subjective memory and strategy use in mild cognitive impairment and healthy aging

Limited information is available about subjective memory and strategy use in seniors with mild cognitive impairment (MCI). We investigated whether differences exist in the perception of changes in memory, perceived frequency of forgetting, overall memory evaluation, and strategy use between seniors with MCI and unimpaired older adults. The study included 56 participants, aged 60 years and older, including 28 normal controls (NC) and 28 MCI patients. The participants completed the Short Cognitive Performance Test, the Story and Grocery list recall tasks, the 15-item Geriatric Depression Scale, the Memory Complaint Questionnaire for the perception of changes in episodic memory, the McNair Frequency of Forgetting Questionnaire, and a single question that evaluated overall memory. The Bousfield semantic clustering measure was calculated to assess semantic clustering for list recall. The number of underlined words during story encoding was calculated to assess strategy use. Participants with MCI had significantly worse scores on Story and Grocery list recall, semantic clustering, and overall memory evaluation. No differences were found in the number of underlined words. List recall was significantly correlated with semantic clustering in both groups (NC: r = .58, p = .001; MCI: r = .57, p = .002). Participants with MCI appeared to be less efficacious when using memory strategies, which may be associated with poor memory performance.

Effects of a multidisciplinary cognitive rehabilitation program for patients with mild Alzheimer's disease.

OBJECTIVE: To evaluate the effects of a multidisciplinary rehabilitation program on cognition, quality of life, and neuropsychiatry symptoms in patients with mild Alzheimer's disease. METHOD: The present study was a single-blind, controlled study that was conducted at a university-based day-hospital memory facility. The study included 25 Alzheimer's patients and their caregivers and involved a 12-week stimulation and psychoeducational program. The comparison group consisted of 16 Alzheimer's patients in waiting lists for future intervention. INTERVENTION: Group sessions were provided by a multiprofessional team and included memory training, computer-assisted cognitive stimulation, expressive activities (painting, verbal expression, writing), physiotherapy, and physical training. Treatment was administered twice a week during 6.5-h gatherings. MEASUREMENTS: The assessment battery comprised the following tests: Mini-Mental State Examination, Short Cognitive Test, Quality of Life in Alzheimer's disease, Neuropsychiatric Inventory, and Geriatric Depression Scale. Test scores were evaluated at baseline and the end of the study by raters who were blinded to the group assignments. RESULTS: Measurements of global cognitive function and performance on attention tasks indicated that patients in the experimental group remained stable, whereas controls displayed mild but significant worsening. The intervention was associated with reduced depression symptoms for patients and caregivers and decreased neuropsychiatric symptoms in Alzheimer's subjects. The treatment was also beneficial for the patients' quality of life. CONCLUSION: This multimodal rehabilitation program was associated with cognitive stability and significant improvements in the quality of life for Alzheimer's patients. We also observed a significant decrease in depressive symptoms and caregiver burden. These results support the notion that structured nonpharmacological interventions can yield adjunct and clinically relevant benefits in dementia treatment.

Effects of a multidisciplinar cognitive rehabilitation program for patients with mild Alzheimer's disease

OBJECTIVE: To evaluate the effects of a multidisciplinary rehabilitation program on cognition, quality of life, and neuropsychiatry symptoms in patients with mild Alzheimer's disease. METHOD: The present study was a single-blind, controlled study that was conducted at a university-based day-hospital memory facility. The study included 25 Alzheimer's patients and their caregivers and involved a 12-week stimulation and psychoeducational program. The comparison group consisted of 16 Alzheimer's patients in waiting lists for future intervention. INTERVENTION: Group sessions were provided by a multiprofessional team and included memory training, computer-assisted cognitive stimulation, expressive activities (painting, verbal expression, writing), physiotherapy, and physical training. Treatment was administered twice a week during 6.5-h gatherings. MEASUREMENTS: The assessment battery comprised the following tests: Mini-Mental State Examination, Short Cognitive Test, Quality of Life in Alzheimer's disease, Neuropsychiatric Inventory, and Geriatric Depression Scale. Test scores were evaluated at baseline and the end of the study by raters who were blinded to the group assignments. RESULTS: Measurements of global cognitive function and performance on attention tasks indicated that patients in the experimental group remained stable, whereas controls displayed mild but significant worsening. The intervention was associated with reduced depression symptoms for patients and caregivers and decreased neuropsychiatric symptoms in Alzheimer's subjects. The treatment was also beneficial for the patients' quality of life. CONCLUSION: This multimodal rehabilitation program was associated with cognitive stability and significant improvements in the quality of life for Alzheimer's patients. We also observed a significant decrease in depressive symptoms and caregiver burden. These results support the notion that structured nonpharmacological interventions can yield adjunct and clinically relevant benefits in dementia treatment.

Treino cognitivo em idosos com Comprometimento Cognitivo Leve: impacto no desempenho cognitivo e funcional / Cognitive training in older adults with Mild Cognitive Impairment: Impact on cognitive and functional performance

Aging is associated with cognitive decline, yet this does not prevent older adults from finding ways to compensate for age-related deficits. Earlier studies have shown that cognitively unimpaired older adults can benefit from training programs. The efficacy of cognitive interventions among older adults without dementia but with cognitive decline (mild cognitive impairment, MCI) has not yet been widely tested. Objectives: To evaluate the impact of 8-session cognitive training on the cognitive and functional performance of older adults with MCI. Methods: 16 older adults diagnosed with MCI received cognitive training (18 participated as controls). All participants were assessed pre and post intervention using the Short Cognitive Test (SKT), Direct Assessment of Functional Scale Revised (DAFS-R), Geriatric Depression Scale (GDS), and Clock Drawing Test (CDT). Results: A significant improvement was observed in the study group between pre and post-test in attention (SKT), time orientation, shopping skills and dealing with finances (DAFS-R) along with reduced depressive symptoms (GDS). Conclusion: These results indicate the importance of non-pharmacological interventions for older adults with MCI to help compensate for cognitive decline.

O envelhecimento está associado ao declínio de algumas funções cognitivas, entretanto, este fato não impede que a pessoa idosa encontre formas de compensar déficits. Estudos anteriores documentaram que a pessoa idosa sem declínio cognitivo pode beneficiar-se de programas de treino. A eficácia de intervenções cognitivas junto à população idosa sem demência mas com alterações cognitivas (comprometimento cognitivo leve, CCL) ainda não foi testada amplamente. Objetivos: Avaliar o impacto de treino cognitivo de 8 sessões na funcionalidade e desempenho cognitivo em idosos com CCL. Métodos: 16 idosos com CCL receberam treino cognitivo e 18 participaram como grupo controle; pacientes e controles foram avaliados antes e depois da intervenção com o Short Cognitive Test (SKT), Direct Assessment of Funcional Scale Revised (DAFS-R), Escala de Depressão Geriátrica (GDS) e o Teste do Desenho do Relógio (TDR). Resultados: Foi observada melhora significante no grupo experimental do pré para o pós-teste no desempenho em atenção (SKT), orientação temporal, habilidade para fazer compras e lidar com dinheiro (DAFS-R) e diminuição nos sintomas depressivos (GDS). Conclusões: Estes resultados destacam a importância da intervenção não-farmacológica em idosos com CCL para compensar déficits cognitivos.

Cognitive training in older adults with Mild Cognitive Impairment: Impact on cognitive and functional performance.

Aging is associated with cognitive decline, yet this does not prevent older adults from finding ways to compensate for age-related deficits. Earlier studies have shown that cognitively unimpaired older adults can benefit from training programs. The efficacy of cognitive interventions among older adults without dementia but with cognitive decline (mild cognitive impairment, MCI) has not yet been widely tested. OBJECTIVES: To evaluate the impact of 8-session cognitive training on the cognitive and functional performance of older adults with MCI. METHODS: 16 older adults diagnosed with MCI received cognitive training (18 participated as controls). All participants were assessed pre and post intervention using the Short Cognitive Test (SKT), Direct Assessment of Functional Scale Revised (DAFS-R), Geriatric Depression Scale (GDS), and Clock Drawing Test (CDT). RESULTS: A significant improvement was observed in the study group between pre and post-test in attention (SKT), time orientation, shopping skills and dealing with finances (DAFS-R) along with reduced depressive symptoms (GDS). CONCLUSION: These results indicate the importance of non-pharmacological interventions for older adults with MCI to help compensate for cognitive decline.

O envelhecimento está associado ao declínio de algumas funções cognitivas, entretanto, este fato não impede que a pessoa idosa encontre formas de compensar déficits. Estudos anteriores documentaram que a pessoa idosa sem declínio cognitivo pode beneficiar-se de programas de treino. A eficácia de intervenções cognitivas junto à população idosa sem demência mas com alterações cognitivas (comprometimento cognitivo leve, CCL) ainda não foi testada amplamente. OBJETIVOS: Avaliar o impacto de treino cognitivo de 8 sessões na funcionalidade e desempenho cognitivo em idosos com CCL. MÉTODOS: 16 idosos com CCL receberam treino cognitivo e 18 participaram como grupo controle; pacientes e controles foram avaliados antes e depois da intervenção com o Short Cognitive Test (SKT), Direct Assessment of Funcional Scale Revised (DAFS-R), Escala de Depressão Geriátrica (GDS) e o Teste do Desenho do Relógio (TDR). RESULTADOS: Foi observada melhora significante no grupo experimental do pré para o pós-teste no desempenho em atenção (SKT), orientação temporal, habilidade para fazer compras e lidar com dinheiro (DAFS-R) e diminuição nos sintomas depressivos (GDS). CONCLUSÕES: Estes resultados destacam a importância da intervenção não-farmacológica em idosos com CCL para compensar déficits cognitivos.

Spreading of HIV-1 subtype G and envB/gagG recombinant strains among injecting drug users in Lisbon, Portugal.

We have evaluated the genetic diversity of HIV-1 strains infecting injecting drug users (IDUs) in Lisbon, Portugal. Heteroduplex mobility assay and/or phylogenetic analysis revealed that env (C2V3C3 or gp41) subtype B is present in 63.7% of the 135 viral samples studied, followed by subtypes G (23.7%), A (6.7%), F (5.2%), and D (0.7%). Similar analysis of gag (p24/p7) performed on 91 of the specimens demonstrated that 49.5% of the infections were caused by subtype G viruses; other gag subtypes identified were B (39.5%), F (3.3%), A and D (1.1.% each), and the recombinant circulating form CRF02_AG (5.5%). Discordant env/gag sub-types were detected in 34.1% of the strains and may reflect the presence of dual infections and/or recombinant viruses. The presumptive B/G recombinant form was highly predominant (21 of 31). The genetic pattern of HIV-1 subtype B and G strains is suggestive of multiple introductions and recombination episodes and of a longstanding presence of both subtypes in the country. C2V3C3 amino acid sequences from IDU-derived subtype G viruses presented highly significant signatures, which distinguish the variants from this transmission group. The unusually high prevalence of subtype G sequences (34.1%), independent of the geographic origin of the infected individuals, makes this IDU HIV-1 epidemic unique.