An intergenerational programme delays health impairment in nursing home residents: the Duplo project.

PURPOSE: To analyse whether an intergenerational programme in which students interacted with institutionalised older persons had any impact on the older persons' functional status. METHODS: Each academic year, a group of older adults living in nursing homes were divided into two arms. For the next four months, the first group received daily visits from a group of students during which they followed a pre-established activity plan, whilst the other arm proceeded with their normal activity. After 4 months, the groups crossed over, and the second arm received the student visits, whilst the first group returned to their normal activity. A battery of tests was performed at inception, crossover and the end of the second period. The tests explored mobility (Timed Up-and-Go), cognition (Mini-Mental Examination), executive function (Frontal Assessment Battery) and mood (Geriatric Depression Scale). A dichotomous aggregate "significant impairment" variable was deemed to be present when there was at least a 20% loss of function (compared to the value at the beginning of the period) in any of the aforementioned tests. RESULTS: The study included 289 older adults who visited with 91 students. Subjects in the active phase had a lower incidence of significant impairment than those in the control phase (O.R. 0.90, p < 0.01). There were no significant differences in the individual variables. CONCLUSION: An intergenerational project with students visiting older adults in nursing homes had a protective effect, delaying functional decay in older adults.

Cerebral Microbleeds in Advanced Dementia: Clinical and Pathological Correlates.

OBJECTIVE: We conducted a longitudinal study to explore the clinical and pathological correlates of cerebral microbleeds (CMBs) in institutionalized patients with dementia. METHODS: Clinical and magnetic resonance imaging (MRI) data were extracted from 182 nursing home patients (mean age [standard deviation]: 81.3 [6.9], 78.0% female, and 83.4% moderate to severe dementia), which were divided according to the CMBs number and location. One-year follow-up data were obtained from 153 patients, and postmortem pathological diagnosis was available in 40 patients. RESULTS: Cerebral microbleeds were observed in 42.9% of patients and were associated with MRI ischemic lesions ( P < .0005). In the adjusted analysis, lobar CMB predicted worsening of parkinsonism (standardized ß: 0.43) and gait (standardized ß: 0.24). A pathological diagnosis of Alzheimer's disease was less frequent in the brains of patients with lobar and deep CMB (33.3% vs 85.3%; P < .05). CONCLUSION: Cerebral microbleeds were linked to cerebrovascular disease and predicted motor deterioration in institutionalized people with advanced dementia.

Pattern of and risk factors for brain microbleeds in neurodegenerative dementia.

OBJECTIVE: A cross-sectional study was conducted to describe the prevalence, locations, and risk factors for brain microbleeds (BMBs) in neurodegenerative dementia. METHODS: The database of the Alzheimer Center Reina Sofía Foundation was searched, BMBs were described, and the potential associations of BMBs were investigated using univariate statistics. RESULTS: A total of 148 patients (age 81.6 [standard deviation 6.7], 79.1% female) were studied. Prevalence of BMBs was 44.6%. A group of patients with unusually high (ie, ≥4) number of BMBs were identified, which displayed higher number of vascular risk factors and vascular diseases. Brain microbleeds were also associated with ischemic lesions in the basal ganglia (r = .39), clinical diagnosis of Alzheimer's disease (AD) and cerebrovascular disease (r = .33), cortical infarction (r = .20), and antiaggregant or anticoagulant treatment duration (r = .20). CONCLUSIONS: Brain microbleeds are associated with vascular burden and AD diagnosis in old patients with neurodegenerative dementia. More research is warranted regarding the mechanisms and potential clinical implications of these results.

Motor effects of radio electric asymmetric conveyer in Alzheimer's disease: results from a cross-over trial.

We conducted a randomized, cross-over trial to investigate the feasibility, safety, and motor effects of brain stimulation with radio electric asymmetric conveyer (REAC) technique in patients with Alzheimer's disease (AD). Neuropostural optimization (NPO) and sham protocol were administered to 60 patients from the nursing home and day care units of the Alzheimer Center Reina Sofía Foundation. The mean age was 84.1 (SD 7.9) years and 86.7% of the subjects were female. Motor measures were collected at baseline (T1), immediately (T2), seven (T3), and 11 days (T4) after treatment and, following cross-over, immediately (T5), seven (T6), and 11 (T7) days after treatment. Close safety surveillance was conducted from seven days before T1 to the end of the study (T7), with total study duration of 35 days. Wilcoxon test was utilized in the efficacy analysis, considering T1 and T5 as independent baseline assessments and using a threshold of p < 0.05 (corrected) for statistical significance. The NPO protocol was easily administered and well accepted by the participants. Axial movements improved at T3 and T4 after NPO and at T2 after sham NPO, but no significant effects were observed in axial movements in the second phase of the trial. The effects of NPO in gait performance were not consistent. There were six falls between T2 and T7, but only two of them occurred in patients who had received NPO. In light of safety and feasibility of REAC, a trial with the more intense neuropsycho-physical optimization protocol is warranted.