Are Protective Activities and Limitations in Practical Skills of Daily Living Associated with the Cognitive Performance of People with Mild Cognitive Impairment? Baseline Results from the BrainFit-Nutrition Study.

Limitations in daily living have not yet been described adequately for mild cognitive impairment (MCI). In this study, we investigated first, time spent on protective activities (social, mental, and physical) and second, limitations in practical skills of daily living, both for people with MCI. We used baseline data from 270 individuals who participated in the randomized controlled trial BrainFit-Nutrition. The Montreal Cognitive Assessment (MoCA) was used to identify people with MCI. Participants were asked how much time they spent engaged in social, mental, and physical activities each week. Furthermore, the Bayer-ADL scale was used to quantify deficits in activities of daily living (ADLs). Regarding protection, the number of hours spent engaged in the three activity areas was significantly correlated with the cognitive performance in people with MCI. Social activities were positively associated with current cognitive performance. Concerning the limitations in practical skills of daily living, older and more cognitively impaired individuals were affected. Memory and orientation appear to be among the first practical skills of daily living that become impaired in people with MCI. Treatment recommendations for people with MCI include an increase in social, mental, and physical activities as well as the promotion of a healthy lifestyle.

Laying the foundation for an ICF core set for community dwelling older adults in primary care: an expert survey.

BACKGROUND: A holistic biopsychosocial model focused on functioning in individual contexts (environment, task) is better suited to meet the needs of older patients than disease only based models. The International Classification of Functioning, Disability and Health (ICF) is the official standard for describing functional health. As the ICF is too detailed to be used in practice, brief core sets have been developed. OBJECTIVE: This study aimed to identify relevant aspects of functioning for older primary care patients from the perspective of healthcare professionals in Germany. MATERIAL AND METHODS: An internet-based cross-sectional expert survey was conducted in preparation for the development of an ICF core set for community-dwelling patients aged 75 years and older. Open-ended questions to identify the most important aspects of functioning and disability in old age were used. Responses were analyzed based on a content analysis approach to identify relevant concepts in the care of the target population. These concepts were then linked to ICF categories according to established linking rules. RESULTS: A total of 63 experts participated in this survey. Across all responses, 2240 meaningful concepts were identified. A total of 75 ICF categories (4 first level categories, 67 second level categories, 4 code combinations) were identified by at least 5% of respondents and will thus be considered as candidate categories for the final ICF core set. Most of concepts were associated with the environmental factors component. The most frequently identified categories were immediate family and family relationships. CONCLUSION: This survey provides a list of relevant ICF categories from the experts' perspective and together with other preparatory studies will be used for developing an ICF core set for community-dwelling older adults in primary care.

Vitamin B-Can it prevent cognitive decline? A systematic review and meta-analysis.

BACKGROUND: Development of cognitive decline represents substantial issues in today's society, steadily gaining importance with increasing life expectancy. One potential approach to preventing cognitive decline is to lower homocysteine by administering vitamin B. In this systematic review and meta-analysis, we address this topic and investigate whether oral supplementation of vitamin B can successfully prevent cognitive decline in cognitively unimpaired individuals. METHODS: A computerized systematic literature search was conducted using the electronic databases PubMed, Embase, and the Cochrane Library. Eligibility criteria included oral supplementation with vitamin B (B1, B6, folic acid, and B12) and the absence of cognitive impairment. A meta-analysis was conducted with "global cognition" as the primary outcome of this review. Secondary outcomes were changes in cognitive function in other cognitive domains reported in the included studies. Risk of bias was assessed according to the Cochrane Risk of Bias tool and the GRADE approach to establish the overall certainty of the evidence. RESULTS: The meta-analysis did not yield a significant overall effect of supplementation with vitamin B on cognitive function (Z = 0.87; p = 0.39; SMD, 0.02; 95% CI, - 0.034, 0.08). A sensitivity analysis focusing on specific risk factors did not alter this result. Some studies reported isolated significant effects of the intervention on secondary outcomes. However, these findings were outnumbered by the number of cognitive tests that did not yield significant effects. DISCUSSION: We found no overall evidence that oral vitamin B supplementation prevented cognitive decline. The isolated significant effects that were reported could be attributed to methodological issues. The results of this review do not provide evidence that population groups with certain risk factors would profit more from the intervention than others. Our findings do not apply to forms of administration other than oral supplementation nor do they offer information regarding the treatment of cognitively impaired individuals via the administration of vitamin B. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017071692.

From board to bedside - training the communication competences of medical students with role plays.

BACKGROUND: Role plays and standardized patients are often used in medical education and have proven to be effective tools for enhancing the communication skills of medical students. Most course concepts need additional time and teaching staff, and there are only a few studies about role plays in the preclinical segment. METHODS: We developed a highly consolidated concept for the curricular course of 2nd-year medical students, including ten role plays about five subjects: anamnesis, shared decision making, prevention, breaking bad news, and so-called "difficult interactions". Before the course, all students were asked about their expectations and attitudes toward the course. After the course, all students rated the course, their individual learning progress, whether their expectations had been fulfilled, and re-evaluated their attitudes. Questionnaires were self-report measures and had a quantitative and a short qualitative section and were analyzed with descriptive statistics. Group differences (sex, age, role played) were evaluated with t tests at a Bonferonni-corrected significance level of p = .03 and the non-parametric U-tests. RESULTS: Implementing this practical course concept is possible without incurring additional costs. This paper not only shows how that can be done but also provides 5 examples of role scripts for different training subjects. The course concept was highly appreciated by the students. More than 75% felt that they had learned important communication techniques and would be better able to handle difficult situations. Playing the doctor's role was felt to be more useful than playing the patient's role. Women admitted a higher degree of shyness in the beginning and gave higher ratings to their learning progress than men. Students' most frequent wish in the qualitative analysis was to be able to play the doctor's role at least once. The students' answers showed a differentiated pattern, thus suggesting that the influence of social desirability was minimal. CONCLUSIONS: Practical skills can be taught successfully in the preclinical stage of medical education even without an increase in resources. The course concept described in this article provides an effective means by which to do so.