Japan-Multimodal Intervention Trial for the Prevention of Dementia: A randomized controlled trial.

INTRODUCTION: We examined the efficacy of a multidomain intervention in preventing cognitive decline among Japanese older adults with mild cognitive impairment (MCI). METHODS: Participants aged 65-85 years with MCI were randomized into intervention (management of vascular risk factors, exercise, nutritional counseling, and cognitive training) and control groups. The primary outcome was changes in the cognitive composite score over a period of 18 months. RESULTS: Of 531 participants, 406 completed the trial. The between-group difference in composite score changes was 0.047 (95% CI: -0.029 to 0.124). Secondary analyses indicated positive impacts of interventions on several secondary health outcomes. The interventions appeared to be particularly effective for individuals with high attendance during exercise sessions and those with the apolipoprotein E ε4 allele and elevated plasma glial fibrillary acidic protein levels. DISCUSSION: The multidomain intervention showed no efficacy in preventing cognitive decline. Further research on more efficient strategies and suitable target populations is required. HIGHLIGHTS: This trial evaluated the efficacy of multidomain intervention in individuals with MCI. The trial did not show a significant difference in preplanned cognitive outcomes. Interventions had positive effects on a wide range of secondary health outcomes. Those with adequate adherence or high risk of dementia benefited from interventions.

Association between workplace interpersonal relationships and psychological distress among care workers at elder care facilities.

BACKGROUND: As the number of older people requiring care continues to increase across the globe, maintaining care workers' mental health is an important task for all countries. This study examines the association between interpersonal relationships at work and psychological distress among care workers at elder care facilities in Japan. METHODS: This study was a secondary data analysis of cross-sectional data. There were 406 participants who were analyzed. Questions consisted of demographic variables, psychological distress, interpersonal problems in the workplace, and intention to improve interpersonal relationships. Psychological distress was evaluated using the Japanese version of the K6 scale. Factors related to psychological distress were identified by logistic regression analysis. RESULTS: Prevalence of psychological distress was 53.2%. Care workers experiencing interpersonal problems in the workplace were 5.95 (95% CI: 3.82-9.43) times more likely to experience psychological distress than care workers without such problems. Moreover, those who displayed an intention to improve their interpersonal relationships were 0.33 times (95% CI: 0.15-0.71) less likely to experience psychological distress than those who did not. CONCLUSIONS: This study found there is a strong association between workplace interpersonal relationships and psychological distress among care workers at elder care facilities. Therefore, experiencing interpersonal problems in the workplace may be a risk factor for psychological distress, and displaying an intention to improve one's interpersonal relationships may attenuate psychological distress.

Relationship between turnover intention and workplace personal relations among care workers employed by elder care facilities.

BACKGROUND: This study focuses on care workers at elder care facilities to examine what factors (including workplace personal relations) influence turnover intention and to what extent. Based on this analysis, the study discusses the content of workplace personal relations problems in qualitative terms. METHODS: The study targeted care workers at elder care facilities. There were 406 participants with no missing data who were analyzed. The survey period ranged from September to November 2021. Questions consisted of basic attributes, turnover intention, problems with workplace personal relations, content of personal relation problems, and psychological distress. RESULTS: Female care workers were 2.25 times more likely than male care workers to have turnover intention. Care workers with workplace personal relation problems were 1.97 times more likely than those without these problems to have high turnover intention. Moreover, with regard to psychological distress, the ratio increased to 4.99 times. The following six categories were extracted from the text data on workplace personal relation problems: insufficient communication, bullying, sense of unfair workload, different attitudes to care work, difficulty in guidance for subordinates/new staff, and labelling. CONCLUSIONS: Gender, workplace personal relation problems, and psychological distress have shown to affect care workers' turnover intentions. To prevent care worker turnover, future studies should focus on the development and impact of strategies to improve workplace personal relations specific to care workers, targeting the six factors identified in this study.

Correlation Between Subjective Happiness and Pleasant Activities at Workplace in Nursing Staff for Older Individuals in Japan.

The purpose of this study was to investigate the correlations between nursing staff's mental health, number of years worked, night shifts performed, and pleasant activities at the workplace. One hundred forty-three subjects who had no missing data were analyzed. Questions consisted of basic attributes, subjective happiness scale (SHS), and pleasant activities conducted at the workplace. Denouements of SHS indicated a significant trend for the main effect, with more pleasant activities in the high SHS group than the low SHS group. The interaction was significant, with fewer pleasant activities in participants in the low SHS group who worked the night shift compared with those who worked the night shift regardless of work experience. The outcomes of this study suggest that it is essential to expand the repertoire of pleasant activities at the workplace to increase the subjective happiness of nursing staff for older individuals.

Effects of a lifestyle development program designed to reduce the risk factors for cognitive decline on the mental health of elderly individuals.

BACKGROUND: The incidence of Alzheimer's disease (AD) along with depression is high in the elderly. In the present study, a program that allows the elderly individuals to voluntarily manage and develop lifestyles that may reduce the risk factors for cognitive decline was applied to the participants to evaluate its effect on the mental health of these individuals. METHODS: The participants were randomly assigned to an intervention group and a control group. The program was conducted during 7 months in the intervention group, and it had seven times of group activities, performed once a month for about 1 h, and individual activities to reduce the risk factors for cognitive decline, performed every day. To evaluate the effects of the program on the mental health of the participants, the Geriatric Depression Scale (GDS) and Philadelphia Geriatric Center Morale Scale (PGC) were used. These two scales were applied twice to the intervention and control groups. RESULTS: The GDS score revealed no change in the score in the intervention group before and after the 7-month program implementation; however, in the control group, the score was significantly higher after program implementation than that before. The PGC score revealed no change in the intervention group before and after 7-month program implementation; however, in the control group, the score was significantly lower after program implementation than that before. Additionally, it revealed no change in the GDS score in the depression-prone control group before and after 7-month program implementation; however, in the depression-prone intervention group, the GDS score was significantly lower after program implementation than that before. CONCLUSIONS: The intervention program that allows the elderly individuals to voluntarily manage and develop lifestyles that may reduce the risk factors for cognitive decline is expected to maintain mental health in elderly individuals.

Analyzing the chance of developing dementia among geriatric people: a cross-sectional pilot study in Bangladesh.

AIM: Alzheimer's disease is the most common form of dementia, representing 60-80% of cases, and ageing is the primary risk factor for the development of Alzheimer's disease. The objective of this study was to examine the chance of developing dementia (i.e. mild cognitive impairment (MCI), Alzheimer's disease) among geriatric people in Bangladesh. METHODS: This study included 390 adult citizens of Bangladesh (age range: 60-70 years). The Takeda Three Colors Combination (TTCC) test was used to detect the prevalence of MCI and mild dementia among the subjects, and then the Clinical Dementia Rating was used to determine the level of dementia. RESULTS: The subjects who were aged 60-65 years included 154 with MCI, 76 with mild dementia, 1 with moderate dementia, 4 with severe dementia, and 29 without dementia. The subjects who were aged 66-70 years included 75 with MCI, 36 with mild dementia, 0 with moderate dementia, 2 with severe dementia, and 13 without dementia. The sensitivity of the TTCC was 75% and 58% for the mild dementia and MCI groups, respectively, and the specificity was 52%. The odds ratio of incorrect responses to the TTCC was 3.42 (95% confidence interval: 1.63-7.21) for subjects with mild dementia compared those without dementia. However, the TTCC outcomes revealed no significant differences between the MCI and non-dementia groups. The results showed no significant associations between cognitive decline/developing dementia and social status/occupation. CONCLUSION: The outcomes of this study indicated that most of the subjects had MCI or mild dementia and were farmers aged 60-65 years.

The Takeda three colors combination test: a screening test for detection of very mild Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) is the most common type of dementia and is prevalent worldwide. It is expected that AD, for which aging is a risk factor, will increase in the future. Because early detection of AD has become increasingly important, promoting demand for screening tests with adequate sensitivity. In this study, we examined the usefulness of the Takeda Three Colors Combination Test (TTCC) for screening of the very mild AD and amnestic mild cognitive impairment (aMCI). METHODS: 154 senior persons participated in the research: 55 with very mild AD, 45 with aMCI, and 54 control group. The TTCC, which was a colored cards configuration memory task, was examined for sensitivity and specificity. RESULTS: The sensitivity of the TTCC was 76% and 47% for the very mild AD and aMCI groups, and the specificity was 83%. Conducting TTCC (including instruction and evaluation) was accomplished within 2 minutes for all subjects. CONCLUSION: The TTCC is useful screening test for early detection of AD. Furthermore, administration time is short and requires no special training or skills. Thus, we believe the TTCC shows great potential for use as an AD screening test by a general practitioner in communities worldwide.

Factors Related to Turnover and Intention to Leave the Care Working Profession in Japan: A Review.

Globally, the elderly population is growing rapidly. The number of elderly people requiring nursing care is expected to increase along with the elderly population. However, the high turnover rate of care workers has caused a labor shortage, which in turn has encouraged further turnover, creating a vicious cycle. Preventing turnover is an important issue not only for the physical and mental health of care workers but also for the quality of nursing care. In particular, Japan has emerged as the world's first super-aged society, experiencing an increase in the number of elderly people requiring nursing care and a shortage of care workers. This review summarizes the research on factors influencing care worker turnover and intent to leave the profession in Japan. Additionally, workplace interpersonal problems have been shown to be consistently associated with care worker turnover or intention to leave in previous studies that were reviewed.

Development of the Workplace Interpersonal Problems Scale for Care Workers (WIPS) and examination of its reliability and validity.

Introduction: The turnover rate of care workers has remained high by global standards, with previous studies showing an association between workplace interpersonal relations and care worker turnover and turnover intentions. This study details the development of the Workplace Interpersonal Problems Scale for Care Workers (WIPS) and examines its reliability and validity according to the COSMIN guidelines. Methods: A total of 476 care workers employed by elder care facilities participated in the study. This study examined the reliability and validity of the WIPS after its development. Reliability was evaluated using Cronbach's α, test reliability with the standard error of measurement, and test-retest reliability with the intraclass correlation coefficient. Content validity, construct validity, and structural validity were examined to evaluate validity. Results: Both total and subscale scores of the WIPS had a Cronbach's α coefficient >0.75 and high test-retest reliability (intraclass correlation coefficient, 0.75). Content validity analysis showed the item-content validity index of ≥0.90 for all WIPS items, confirming 100% of the hypotheses for testing construct validity. Confirmatory factor analysis showed an acceptable fit for the hypothesized six-factor construct (CFI = 0.92, TLI = 0.91, RMSEA = 0.07, SRMR = 0.05). Conclusions: The WIPS was found to be a valid and reliable instrument. With the growth of the elderly population worldwide, we believe that the WIPS will be a useful quantitative measure to assess workplace interpersonal problems affecting care workers in various aspects.

Commitment profiles among nurses: combinations of organizational commitment forms and work engagement, psychological distress, and turnover intention.

To clarify the combined effect of the sub-factors of organizational commitment, this study examined the relationships between organizational commitment profiles and work engagement, psychological distress, and turnover intention among nurses. A cross-sectional survey was conducted; 455 nurses (38 men and 417 women) were included in the statistical analysis. We extracted six clusters through k-means cluster analysis and applied a one-way analysis of variance and χ2 test for work engagement, psychological distress, and turnover intention. Consequently, significant differences were found in work engagement and turnover intention (both p<0.05), and no significant difference was found in psychological distress. These results indicate the formation of affective and normative commitment among nurses in working energetically or preventing turnover. Additionally, no negative effects related to increases in continuance commitment were identified in this study.

Development of a Neuropsychological Test to Evaluate Cognitive Flexibility.

BACKGROUND: Cognitive flexibility is also referred to as set-shifting and is considered to be an important activity of the frontal lobe. The objective of this study was to produce a Cognitive Flexibility Test (CFT) that can evaluate cognitive flexibility in a short time and in a simple manner and to verify the usefulness of the test. METHODS: The CFT, Mini Mental State Examination (MMSE), Verbal Fluency Test (VFT), and Geriatric Depression Scale 15 (GDS-15) were implemented among a total of 94 elderly people who live at home. An "A" version of CFT (CFT-A), which asked about the possible uses of a plastic bottle other than drinking and a "B" version (CFT-B), which asked about the possible uses of a ballpoint pen other than writing, were produced. RESULTS: In the case of CFT-A, after adjusting the number of years of education, a significant correlation was found between CFT-A and the variables age, VFT, and MMSE. As for CFT-B, after adjusting the number of years of education, it was found to have a significant correlation with age and VFT. The number of responses for CFT-A and CFT-B were significantly lower than that of VFT. The number of responses for CFT-B was significantly lower than that of CFT-A. CONCLUSION: The CFT-A may be useful as a neuropsychological test to evaluate cognitive flexibility among elderly people that can be implemented easily in a short time.

The Effect of Nurses' Work-Life Balance on Work Engagement: The Adjustment Effect of Affective Commitment.

BACKGROUND: This study aimed to examine the effects of nurses' work-life balance (WLB), job demands and resources, and organizational attachment on their work engagement (WE). The second aim was to shed light on whether the relationships among WLB, job demands, resources, and WE are modulated by organizational attachment. METHODS: In total, 425 nurses working in a university hospital responded to the questionnaire. The primary statistical analysis method was hierarchical multiple regression with WE as the dependent variable. RESULTS: In the model in which all variables were applied, affective commitment (AC) (ß = 0.41), family-to-work positive spillover (ß = 0.25), and number of children (ß = 0.13) were found to have a significant association with WE. Family-to-work negative spillover (FWNS) and AC had significant interaction effects. The result suggests that when AC was low, WE tended to decline further due to FWNS; however, when AC was high, WE did not change due to the effect of FWNS. CONCLUSION: These results confirmed that to improve nurses' WE, hospital organizations should implement initiatives to facilitate WLB that considers nurses' household roles. Furthermore, high organizational attachment buffered the home's negative influence on work, thereby helping nurses work energetically.

Effects of a Classroom-Based Stress Management Program by Cognitive Reconstruction for Elementary School Students.

BACKGROUND: The present study evaluates the effects of a classroom-based universal program for stress management among elementary school students. METHODS: The participating children (aged 11-12 years) were assigned to either an intervention (n = 172) or a control group (n = 100). The program involved one 45-minute session during school hours. The program taught students about cognitive distortions and trained them using cognitive reconstruction. Cognitive distortions were characterized so that children could easily understand them. Students were asked to complete the Children's Stress Response Test, comprised of five questions about self-efficacy about cognitive reconstruction before and after the program, to assess the program's effects. RESULTS: The results as observed in the intervention group were as follows: (a) stress responses decreased, (b) self-efficacy in the awareness about one's feelings and thinking improved, (c) understanding how thinking affects feelings was prompted, (d) self-efficacy to review one's thinking improved when they felt uncomfortable, and (e) self-efficacy to change one's negative thinking to adaptive thinking improved. CONCLUSION: These results suggest that the program was useful for reducing stress responses and improving self-efficacy in cognitive reconstruction among children.

The relationship between cognitive distortion, depressive symptoms, and social adaptation: A survey in Japan.

BACKGROUND: In the treatment of depression, improvements in both clinical symptoms and social adaptation are important. Previous studies have shown that cognitive distortion and depressive symptoms are mutually related, and that depressive symptoms and social adaptation are related to each other. However, it is unknown how these three factors interrelate. Therefore, this study examined the relationship between cognitive distortion, depressive symptoms, and social adaptation. METHODS: The final analyzed sample consisted of 430 employees of a manufacturing company in Japan (74.2% male, 24.7% female, 1.2% unknown). Participants completed the Worker's Cognitive Distortion Scale (WCDS), Beck Depression Inventory-Second Edition (BDI-II), and Social Adaptation Self-Evaluation Scale (SASS). The WCDS was further divided into two subscales: self-contained cognitive distortion (WCDS-S) and environment-dependent cognitive distortion (WCDS-E). We used a covariance structure analysis for the main analysis and examined the relationship between these three variables' scores. RESULTS: The results revealed that both the WCDS-S and WCDS-E affected social adaptation indirectly via depressive symptoms, and that the WCDS-S additionally affected social adaptation directly. It was further revealed that the WCDS-S exerted a greater effect on depressive symptoms than the WCDS-E. LIMITATIONS: The participants were healthy cases. As such, one must be cautious about applying the results of healthy cases to clinical cases. CONCLUSIONS: This study indicates that cognitive distortion affects social adaptation directly and that it is indirectly mediated by depressive symptoms. Thus, professionals are required to attempt to treat depressive symptoms and improve social adaptation by considering that interventions in cognitive distortion may be effective.

A program of exercise, brain training, and lecture to prevent cognitive decline.

OBJECTIVE: We examined the benefits of a community-based program combining physical exercise, cognitive training, and education on dementia and lifestyle habits. METHODS: This crossover open-label trial included 141 community-dwelling elderly people with suspected mild cognitive decline (MCD). Subjects were assigned to a 6-month intervention-first/6-month observation-second (INT-OBS) group or an OBS-INT group. The 6-month intervention consisted of 2 h of physical exercise, cognitive training, and classroom study or rest once weekly. Primary outcome was change in Touch Panel-type Dementia Assessment Scale (TDAS) score. RESULTS: TDAS score improved significantly during the intervention period compared with the observation period for all subjects (P < 0.05). Some physical functions also improved significantly during the intervention period compared with the observation period in the OBS-INT group (P < 0.05). INTERPRETATION: This community-based program improved both cognitive and physical function in elderly people with suspected MCD.

The Effectiveness of Training Programs on the Fidelity of Neuropsychological Tests.

BACKGROUND: There will probably be an exponential increase in the number of seniors suffering from dementia, as aging is the greatest risk factor for this disease. Therefore, neuropsychological tests to assessing dementia are likely to play an increasingly important role for medical services in Japan. This study developed and evaluated the usefulness of a training program on neuropsychological tests aimed at promoting the understanding of testers with regard to the cognitive functions and communication required in the neuropsychological testing process. METHODS: The subjects of this study comprised 20 individuals engaged in administrating neuropsychological tests at the Japan-Multidomain Intervention Trial for Prevention of Dementia in Older Adults with Diabetes. A four-hour training session was held. The first part of the training program focused on "cognitive functions and communication;" the second addressed "neuropsychological tests." As the main evaluation criteria, a fidelity checklist was created with 14 items designed to measure success or failure with regard to important and easily mistakable aspects of implementing each neuropsychological test. They were conducted three times: before, immediately after, and six months after the training. RESULTS: The main effect of time was significant for the "fidelity" score. The effect size was large at η2 = 0.69. A simple main effect test using the Bonferroni method revealed significant differences between the pre-training and post-training values and between the pre-training and six-month point values. However, no significant differences were found in self-efficacy scores before, immediately after, and six months after the training. CONCLUSION: This outcome indicates that the fidelity of the subjects to neuropsychological tests increased as a result of the training program, and that this improvement was maintained through the six-month period following the program. Moreover, the large effect size suggests that the training program may be effective in facilitating the mastery of neuropsychological tests in testers.

Autophagy and Alzheimer's Disease: From Molecular Mechanisms to Therapeutic Implications.

Alzheimer's disease (AD) is the most common cause of progressive dementia in the elderly. It is characterized by a progressive and irreversible loss of cognitive abilities and formation of senile plaques, composed mainly of amyloid ß (Aß), and neurofibrillary tangles (NFTs), composed of tau protein, in the hippocampus and cortex of afflicted humans. In brains of AD patients the metabolism of Aß is dysregulated, which leads to the accumulation and aggregation of Aß. Metabolism of Aß and tau proteins is crucially influenced by autophagy. Autophagy is a lysosome-dependent, homeostatic process, in which organelles and proteins are degraded and recycled into energy. Thus, dysfunction of autophagy is suggested to lead to the accretion of noxious proteins in the AD brain. In the present review, we describe the process of autophagy and its importance in AD. Additionally, we discuss mechanisms and genes linking autophagy and AD, i.e., the mTOR pathway, neuroinflammation, endocannabinoid system, ATG7, BCL2, BECN1, CDK5, CLU, CTSD, FOXO1, GFAP, ITPR1, MAPT, PSEN1, SNCA, UBQLN1, and UCHL1. We also present pharmacological agents acting via modulation of autophagy that may show promise in AD therapy. This review updates our knowledge on autophagy mechanisms proposing novel therapeutic targets for the treatment of AD.

Spectrum of Disease and Prescription Pattern for Outpatients with Neurological Disorders: An Empirical Pilot Study in Bangladesh.

BACKGROUND: Neurological disorders represent one of the most prominent causes of morbidity and mortality that adversely affect the lifestyle of patients and a major percentage of these diseases exists in developing countries. PURPOSE: The objective of this study was to examine the prevalence and prescription pattern for outpatients with neurological disorders in Bangladesh. METHODS: The study was conducted on 1,684 patients in 6 hospitals (National Institute of Neurosciences and Hospital, Dhaka Medical College and Hospital, Bangabandhu Sheikh Mujib Medical University, Shaheed Suhrawardy Medical College, Sir Salimullah Medical College, and Apollo Hospitals Dhaka) of the Dhaka City from March 2014 to June 2015. Data were collected through a predesigned questionnaire from the patients that contain information about gender, age, marital status, occupation, residential status, affected disease, self-medicated medicines, and prescribed medicines. RESULTS: Out of 1,684 patients, 28.38% patients were aged 51-60 years and male, 57.19% predominance. The study exposed headache and migraine for 29.75% patients, followed by stroke for 23.93% patients and seizure for 7.07% patients. Genetic reason for the neurological disorders was seen only among 12.35% patients. In this study, 16.98% patients had been affected by neurological disorders for more than 2 years and 19% of patients for less than 6 months. Most extensively prescribed medicines were multivitamins and multiminerals used by 17.89% of patients followed by nonsteroidal anti-inflammatory drugs and other analgesic by 14.84%; afterwards antiulcerants were used by 12.62%, subsequently anticoagulants were used by 11.61% followed by antihyperlipidemic medicines by 10.26% and antiepileptic drugs by 8.08% of patients. The crucial reasons for the selection of prescribed medicines were the confidence that patients had with the physician's prescribed medicines, which was shown for 40.97% patients and knowledge of the medicines was reported for 35.04% patients. The period of prescribed medicine usage was 1-3 months for 39.73% patients and 3-6 months for 29.16% patients. The patient's compliance for prescribed medicines was satisfactory for 34.56% patients, good for 28.15% patients, and side effects were reported for 23.22% patients. CONCLUSION: In Bangladesh, it is not surprising to note that neurological diseases are more prevalent than other different diseases among different age groups and genders. Headache and migraine, stroke and seizure are most frequently encountered neurological disorders here. Treatment procedure of these disorders is not quite suitable due to the anomalies of health care management systems. Appropriate management of the health care system, especially the placement of hospital and community pharmacy can overcome the existing inconsistencies as well as increase the knowledge, awareness, and perception of the patients about health and neurological disorders.

Factors Affecting Intention to Undergo Dementia Screening.

BACKGROUND: In the present study, we focused on the main perception-related factors that affect people's intention to undergo dementia screening. METHODS: The 344 subjects that answered all the survey questions were included in the analysis. Data on the following variables were collected: Basic attributes such as age, sex, years of education, and number of people in the household; degree of intention to undergo dementia screening; degree of awareness of the seriousness of the consequences of dementia; degree of awareness that the person may someday develop dementia; degree of awareness of their ability to prevent dementia; availability of social support; degree of knowledge of lifestyle habits that can prevent dementia; role in the community and purpose in life. RESULTS: There were 110 people in the strong intention group and 234 people in the weak intention group. On univariate analysis, awareness of seriousness, awareness of morbidity, preventability, and knowledge of preventative lifestyle were statistically significant at a significance level of 5%, and these variables tended to be higher in the strong intention group as compared to that in the weak intention group. These were entered in the logistic regression analysis as the explanatory variables, and intention to undergo screening was entered as the objective variable. The results indicated that awareness of seriousness and knowledge of preventative lifestyle had significant influence on intention to undergo screening. CONCLUSION: The above results suggested that to increase the intention to undergo dementia screening, psychoeducation that encourages people to understand the serious consequences of dementia, efforts to spread awareness of the risk factors for dementia, and promotion of lifestyle factors that are preventative may be effective.