Kundalini Yoga Intervention Increases Hippocampal Volume in Older Adults: A Pilot Randomized Controlled Trial.

Background: Among a rapidly aging population, there is increased need for neuroprotective interventions promoting healthy neurological aging. Mind-body interventions, such as Kundalini yoga, are actively being explored as accessible means to encourage healthy aging. However, little remains known about the neurobiological effects of Kundalini yoga. Aims: This pilot randomized-controlled trial (RCT) examined the potential neuroprotective effects of Kundalini yoga in older adults. Methods: We conducted an RCT with 11 healthy meditation-naïve older adults. Participants were randomized to a Kundalini yoga or psychoeducation intervention. Structural magnetic resonance imaging data were obtained at baseline and 12-week follow-up. The primary outcome measure was gray matter volume of the bilateral hippocampi and bilateral posterior cingulate cortex. Results: We found significant right hippocampal volume increases specific to the Kundalini yoga group (P = 0.034, ηp 2 = 0.408). Conclusions: These findings provide initial neurobiological support for the neuroprotective effects of Kundalini yoga.

Mindfulness-based cognitive therapy vs. a health enhancement program for the treatment of late-life depression: Study protocol for a multi-site randomized controlled trial.

Background: Late-life depression (LLD) affects up to 18% of older adults and has been linked to elevated dementia risk. Mindfulness-based cognitive therapy (MBCT) holds promise for treating symptoms of depression and ameliorating cognitive deficits in older adults. While preliminary findings are promising, a definitive RCT investigating its effects on late life depression and cognition have not yet been conducted. We present a protocol describing a multi-site blinded randomized controlled trial, comparing the effects of MBCT and of an active control, a Health Enhancement Program (HEP), on depressive symptoms, executive functioning, and brain biomarkers of LLD, among several other exploratory outcomes. Methods: Two-hundred and thirteen (n = 213) patients with LLD will be recruited at various centers in Montreal, QC, Canada. Participants will undergo stratified randomization to either MBCT or HEP intervention groups. We will assess changes in (1) depression severity using the Hamilton Depression Rating Scale (HAM-D17), (2) processing speed and executive functioning, (3) brain biomarkers of LLD (hippocampal volume, default network resting-state functional connectivity and executive network resting-state functional connectivity), and (4) other exploratory physiological and mood-based measures, at baseline (0 weeks), post intervention (8 weeks), and 26 weeks after baseline. Discussion: The proposed study will assess the clinical potential of MBCT to improve symptoms of depression, as well as examine its impact on cognitive impairments and neurobiological markers, and thus inform its use as a promising adjunct in the treatment of LLD. Clinical trial registration: www.ClinicalTrials.gov, identifier: NCT05366088.

The Rationale and Design of Behavioral Interventions for Management of Agitation in Dementia in a Multi-Site Clinical Trial.

BACKGROUND: Agitation and aggression are common in patients with Alzheimer's disease and related dementias and pose a significant burden on patients, caregivers, and the healthcare systems. Guidelines recommend personalized behavioral interventions as the first-line treatment; however, these interventions are often underutilized. The Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov Identifier # NCT0367220) is a multisite randomized controlled trial comparing an Integrated Care Pathway, that includes a sequential pharmacological algorithm and structured behavioral interventions, with treatment-as-usual to treat agitation in dementia in long-term care and inpatient settings. OBJECTIVE: To describe the rationale and design of structured behavioral interventions in the StaN study. METHODS: Structured behavioral interventions are designed and implemented based on the following considerations: 1) personalization, 2) evidence base, 3) dose and duration, 4) measurement-based care, and 5) environmental factors and feasibility. RESULTS: The process to design behavioral interventions for each individual starts with a comprehensive assessment, followed by personalized, evidence-based interventions delivered in a standardized manner with ongoing monitoring of global clinical status. Measurement-based care is used to tailor the interventions and integrate them with pharmacotherapy. CONCLUSION: Individualized behavioral interventions in patients with dementia may be challenging to design and implement. Here we describe a process to design and implement individualized and structured behavioral interventions in the context of a multisite trial in long-term care and inpatient settings. This process can inform the design of behavioral interventions in future trials and in clinical settings for the treatment of agitation in dementia.

Category-specific verb-semantic deficits in Alzheimer's disease: Evidence from static and dynamic action naming.

We investigated the representation and breakdown of verb knowledge employing different syntactic and semantic classes of verbs in a group of individuals with probable Alzheimer's Disease (pAD). In an action naming task with coloured photographs (Fiez & Tranel, 1997. Standardized stimuli and procedures for investigating the retrieval of lexical and conceptual knowledge for action. Memory and Cognition, 25(4), 543-569. https://doi.org/10.3758/BF03201129), pAD individuals were impaired for naming actions compared to objects. Verb tense was also affected, with simple-past (e.g., chopped) being more difficult to name than the gerundial form (e.g., chopping). Employing action-naming with short movies depicting events and states, we contrasted three verb classes based on their hypothetical structural and semantic/conceptual properties: argument structure, thematic structure, and conceptual templates. The three classes were: causatives (peel), verbs of perception (hear), and verbs of motion (run) Overall, results suggest that individuals with pAD are selectively impaired for verb tense and thematic assignment, but not conceptual-template complexity. Methodologically, we also show that dynamic scenes are more ecologically valid than static scenes to probe verb knowledge in AD.

Connecting During COVID-19: A Protocol of a Volunteer-Based Telehealth Program for Supporting Older Adults' Health.

Introduction: Social-distancing due to COVID-19 has led to social isolation, stress, and mental health issues in older adults, while overwhelming healthcare systems worldwide. Telehealth involving phone calls by trained volunteers is understudied and may be a low-cost, scalable, and valuable preventive tool for mental health. In this context, from patient participatory volunteer initiatives, we have adapted and developed an innovative volunteer-based telehealth intervention program for older adults (TIP-OA). Methods and analysis: To evaluate TIP-OA, we are conducting a mixed-methods longitudinal observational study. Participants: TIP-OA clients are older adults (age ≥ 60) recruited in Montreal, Quebec. Intervention: TIP-OA volunteers make weekly friendly phone calls to seniors to check in, form connections, provide information about COVID-19, and connect clients to community resources as needed. Measurements: Perceived stress, fear surrounding COVID-19, depression, and anxiety will be assessed at baseline, and at 4- and 8-weeks. Semi-structured interviews and focus groups will be conducted to assess the experiences of clients, volunteers, and stakeholders. Results: As of October 15th, 2020, 150 volunteers have been trained to provide TIP-OA to 305 older clients. We will consecutively select 200 clients receiving TIP-OA for quantitative data collection, plus 16 volunteers and 8 clinicians for focus groups, and 15 volunteers, 10 stakeholders, and 25 clients for semi-structured interviews. Discussion: During COVID-19, healthcare professionals' decreased availability and increased needs related to geriatric mental health are expected. If successful and scalable, volunteer-based TIP-OA may help prevent and improve mental health concerns, improve community participation, and decrease healthcare utilization. Clinical Trial Registration: ClinicalTrials.gov NCT04523610; https://clinicaltrials.gov/ct2/show/NCT04523610?term=NCT04523610&draw=2&rank=1.

Mind-Body Interventions in Late-Life Mental Illnesses and Cognitive Disorders: A Narrative Review.

BACKGROUND: Current pharmacological treatments and psychotherapeutic approaches often have adverse effects or are ineffective in late-life cognitive and mental illnesses. Mind-body interventions offer a holistic approach and are of interest because of potential patient acceptability and scalability. OBJECTIVE: To synthesize current evidence on mind-body interventions in treating or preventing mental illnesses and cognitive disorders in older adults. SEARCH STRATEGY: A search was conducted using Ovid MEDLINE, EMBASE, and PsycINFO articles published from 1993 to 2017. SELECTION CRITERIA: 1) Randomized controlled trials, 2) involving older adults (>60 years old), 3) suffering from mental illness or cognitive decline, 4) comparing mind-body interventions with a control group. Mind-body interventions included: imagery, meditation, prayer, autogenic training, tai chi & variants, and yoga. Control group included: health education, other non-pharmacological interventions, treatment as usual, or no treatment at all. DATA COLLECTION AND ANALYSIS: Data included number of patients, age, psychiatric diagnoses, type of intervention, frequency andduration, control conditions, outcomes measures and treatment results. RESULTS: 3916 articles were reviewed and ten met inclusion criteria. Six were on Tai Chi and four assessed meditation-based therapies. Clinically significant improvement in depressive and anxiety symptoms were reported, as well as improvement insomedomains of cognition and reduced risk of cognitive deterioration. CONCLUSION: There is increasing evidence that mind-body interventions may potentially be useful in the treatment or prevention of geriatric mental illnesses and cognitive disorders. There are important methodological limitations of the current literature such as small sample sizes, heterogeneous study populations, and varying clinical outcomes.

Anosognosia predicts default mode network hypometabolism and clinical progression to dementia.

OBJECTIVE: To identify the pathophysiologic mechanisms and clinical significance of anosognosia for cognitive decline in mild cognitive impairment. METHODS: We stratified 468 patients with amnestic mild cognitive impairment into intact and impaired awareness groups, determined by the discrepancy between the patient and the informant score on the Everyday Cognition questionnaire. Voxel-based linear regression models evaluated the associations between self-awareness status and baseline ß-amyloid load, measured by [18F]florbetapir, and the relationships between awareness status and regional brain glucose metabolism measured by [18F]fluorodeoxyglucose at baseline and at 24-month follow-up. Multivariate logistic regression tested the association of awareness status with conversion from amnestic mild cognitive impairment to dementia. RESULTS: We found that participants with impaired awareness had lower [18F]fluorodeoxyglucose uptake and increased [18F]florbetapir uptake in the posterior cingulate cortex at baseline. In addition, impaired awareness in mild cognitive impairment predicted [18F]fluorodeoxyglucose hypometabolism in the posterior cingulate cortex, left basal forebrain, bilateral medial temporal lobes, and right lateral temporal lobe over 24 months. Furthermore, participants with impaired awareness had a nearly 3-fold increase in likelihood of conversion to dementia within a 2-year time frame. CONCLUSIONS: Our results suggest that anosognosia is linked to Alzheimer disease pathophysiology in vulnerable structures, and predicts subsequent hypometabolism in the default mode network, accompanied by an increased risk of progression to dementia. This highlights the importance of assessing awareness of cognitive decline in the clinical evaluation and management of individuals with amnestic mild cognitive impairment.

Cognitive reserve in a cross-cultural population: the case of Italian emigrants in Montreal.

BACKGROUND: Cognitive reserve could be defined as the accumulation of experiences, abilities, knowledge and changes that occur throughout the lifespan. One of the most difficult changes in life is the experience of emigrating to a foreign country. AIMS: The present investigation aimed to compare the cognitive reserve of two paired groups of elderly: Italians living in Italy and Italians who in adult age (around 20 years) emigrated to Montreal. Both groups attended the same years of school, in Italy. METHODS: Cognitive reserve was measured in the two groups by a structured and standardised questionnaire, the cognitive reserve questionnaire. RESULTS: Cognitive reserve showed to be significantly higher in the Italian-Canadian individuals (i.e. Italians who emigrated). CONCLUSIONS: Emigration might act as an environmental factor that enriches people's lifestyle and reflects itself in the amount of their cognitive reserve.