Randomized trial of individual reminiscence therapy for older adults with cognitive impairment: a 3-month responder analysis. / Ensayo aleatorio de terapia de reminiscencia individual para adultos mayores con deterioro cognitivo: un análisis de respuesta de tres meses.

INTRODUCTION: Non-pharmacological intervention options, including individual reminiscence therapy (iRT), have been effective in improving cognitive functioning, mood, and quality of life (QoL) in persons with neurocognitive disorders (NCD). OBJECTIVES: A 13-week randomized trial intervention utilizing iRT was conducted on older adults with NCD. We explored predictors of participants with positive and non-positive intervention responses using responder analysis, an analytic strategy that focuses on contributors to intervention response. PATIENTS AND METHODS: Re-analysis of a published single-blind, multicentre, randomised controlled trial on 251 older adult residents with NCD from residential facilities across Portugal. Participants received 13 weeks of biweekly iRT (26 sessions) or treatment/programming as usual. Outcomes included global cognition (Minimental State Examination), memory (MAT), executive functioning (FAB), depressive symptoms (GDS-15), and QoL (QoL-AD). RESULTS: There were more responders in the intervention than the control group on all five criteria, with significant differences for cognition (p = 0.001; f = 0.202; NNT = 5) and memory (p = 0.004; f = 0.184; NNT = 6). At baseline, intervention responders vs non-responders had: higher QoL-AD scores (30.23 vs 25.57; p < 0.001; d = -0.774) for cognition; lower FAB scores (1.41 vs -2.12; p < 0.001; d = 0.928) for executive functioning; higher GDS-15 scores for the depressive symptoms (7.57 vs 4.91; p < 0.001; d = -0.845), and for QoL (6.81 vs 5.33; p = 0.013; d = -0.443). CONCLUSIONS: The iRT intervention showed high response rates for cognition and memory. Those with worse executive dysfunction, mood, and QoL, benefitted most from the intervention for those respective outcomes. Therefore, the presented iRT has beneficial effects for people with NCD, with mood and QoL as important influential factors.

TITLE: Ensayo aleatorio de terapia de reminiscencia individual para adultos mayores con deterioro cognitivo: un análisis de respuesta de tres meses.Introducción. La terapia de reminiscencia individual (iTR) ha demostrado mejorar la cognición, el estado de ánimo y la calidad de vida (CdV) de personas con trastornos neurocognitivos (TNC). Objetivo. Se exploraron los predictores de la respuesta positiva a la iTR utilizando el análisis de respuesta, una estrategia analítica de los factores que contribuyen a una respuesta a la intervención. Pacientes y métodos. Reanálisis de un ensayo controlado aleatorizado de 251 adultos mayores portugueses con TNC. Los participantes recibieron dos sesiones de iTR durante 13 semanas (26 sesiones) o el tratamiento habitual. Las variables analizadas fueron la cognición global (Minimental State Examination), la memoria (test de alteración de la memoria), el funcionamiento ejecutivo ­batería de evaluación frontal (FAB)­, los síntomas depresivos ­escala de depresión geriátrica-15 (GDS-15)­ y la CdV ­escala de calidad de vida en la enfermedad de Alzheimer (QOL-AD)­. Resultados. Hubo más respondedores en el grupo de intervención que en el de control en los cinco criterios, con diferencias significativas para cognición (p = 0,001; f = 0,202; número necesario para tratar = 5) y memoria (p = 0,004; f = 0,184; número necesario para tratar = 6). En la línea de base, los respondedores tenían: puntuaciones más altas de QOL-AD (30,23 frente a 25,57; p menor de 0,001; d = ­0,774) para la cognición; puntuaciones FAB más bajas (1,41 frente a ­2,12; p menor de 0,001; d = 0,928) para el funcionamiento ejecutivo; y mayores puntuaciones en la GDS-15 para los síntomas depresivos (7,57 frente a 4,91; p menor de 0,001; d = ­0,845) y para la CdV (6,81 frente a 5,33; p = 0,013; d = ­0,443). Conclusiones. La iTR mostró altas tasas de respuesta para la cognición y la memoria. Los que tienen peor función ejecutiva, estado de ánimo y CdV se beneficiaron más de la intervención para esas respectivas variables. La iTR tiene efectos beneficiosos en los TNC, con el estado de ánimo y la CdV como factores influyentes.

Ensayo aleatorio de terapia de reminiscencia individual para adultos mayores con deterioro cognitivo: un análisis de respuesta de tres meses / Randomized trial of individual reminiscence therapy for older adults with cognitive impairment: a 3-month responder analysis

Introducción: La terapia de reminiscencia individual (iTR) ha demostrado mejorar la cognición, el estado de ánimo y la calidad de vida (CdV) de personas con trastornos neurocognitivos (TNC). Objetivo: Se exploraron los predictores de la respuesta positiva a la iTR utilizando el análisis de respuesta, una estrategia analítica de los factores que contribuyen a una respuesta a la intervención. Pacientes y métodos: Reanálisis de un ensayo controlado aleatorizado de 251 adultos mayores portugueses con TNC. Los participantes recibieron dos sesiones de iTR durante 13 semanas (26 sesiones) o el tratamiento habitual. Las variables analizadas fueron la cognición global (Minimental State Examination), la memoria (test de alteración de la memoria), el funcionamiento ejecutivo –batería de evaluación frontal (FAB)–, los síntomas depresivos –escala de depresión geriátrica-15 (GDS-15)– y la CdV –escala de calidad de vida en la enfermedad de Alzheimer (QOL-AD)–. Resultados: Hubo más respondedores en el grupo de intervención que en el de control en los cinco criterios, con diferencias significativas para cognición (p = 0,001; f = 0,202; número necesario para tratar = 5) y memoria (p = 0,004; f = 0,184; número necesario para tratar = 6). En la línea de base, los respondedores tenían: puntuaciones más altas de QOL-AD (30,23 frente a 25,57; p < 0,001; d = –0,774) para la cognición; puntuaciones FAB más bajas (1,41 frente a –2,12; p < 0,001; d = 0,928) para el funcionamiento ejecutivo; y mayores puntuaciones en la GDS-15 para los síntomas depresivos (7,57 frente a 4,91; p < 0,001; d = –0,845) y para la CdV (6,81 frente a 5,33; p = 0,013; d = –0,443). Conclusiones: La iTR mostró altas tasas de respuesta para la cognición y la memoria. Los que tienen peor función ejecutiva, estado de ánimo y CdV se beneficiaron más de la intervención para esas respectivas variables. La iTR tiene efectos beneficiosos en los TNC, con el estado de ánimo y la CdV como factores influyentes.(AU)

Introduction: Non-pharmacological intervention options, including individual reminiscence therapy (iRT), have been effective in improving cognitive functioning, mood, and quality of life (QoL) in persons with neurocognitive disorders (NCD). Objectives: A 13-week randomized trial intervention utilizing iRT was conducted on older adults with NCD. We explored predictors of participants with positive and non-positive intervention responses using responder analysis, an analytic strategy that focuses on contributors to intervention response. Patients and methods: Re-analysis of a published single-blind, multicentre, randomised controlled trial on 251 older adult residents with NCD from residential facilities across Portugal. Participants received 13 weeks of biweekly iRT (26 sessions) or treatment/programming as usual. Outcomes included global cognition (Minimental State Examination), memory (MAT), executive functioning (FAB), depressive symptoms (GDS-15), and QoL (QoL-AD). Results: There were more responders in the intervention than the control group on all five criteria, with significant differences for cognition (p = 0.001; f = 0.202; NNT = 5) and memory (p = 0.004; f = 0.184; NNT = 6). At baseline, intervention responders vs non-responders had: higher QoL-AD scores (30.23 vs 25.57; p < 0.001; d = –0.774) for cognition; lower FAB scores (1.41 vs –2.12; p < 0.001; d = 0.928) for executive functioning; higher GDS-15 scores for the depressive symptoms (7.57 vs 4.91; p < 0.001; d = –0.845), and for QoL (6.81 vs 5.33; p = 0.013; d = –0.443). Conclusions: The iRT intervention showed high response rates for cognition and memory. Those with worse executive dysfunction, mood, and QoL, benefitted most from the intervention for those respective outcomes. Therefore, the presented iRT has beneficial effects for people with NCD, with mood and QoL as important influential factors.(AU)

Pilot study on the effectiveness of Reminiscence Therapy on cognition, depressive symptoms, and quality of life in nursing home residents.

AIM: This study aimed to assess the effectiveness of the group Reminiscence Therapy (RT) on cognition, depressive symptoms, and quality of life (QOL) in older adults recruited in nursing homes. METHODS: A pilot study with a one-group pretest-posttest design was conducted between September 2017 and March 2018 in five nursing homes from central Portugal. A comprehensive RT program (Core program followed by a Follow-up program) was provided to clinically stable volunteers aged 65 years or more, who did not have severe cognitive impairment. RESULTS: From the 50 older adults (32 women and 18 men, with mean age of 83.32±7.76, and mean education level of 5.48±4.05) considered eligible to participate in the study, 35 (mean age: 84.17±7.46, mean education level of 6.14±4.49) completed the Core Program and 28 completed the Follow-up Program (mean age: 84.25±7.66, mean education level of 6.18±4.57). Based on the Wilcoxon Test, it was observed that the participants' cognitive performance did not change during the two RT programs. No significant changes were confirmed in relation to depressive symptomatology and QOL. CONCLUSION: Although no statistically significant improvements of the older adults' cognitive function, depressive symptomatology, and quality of life were found, the stabilization of such outcomes are relevant from a clinical viewpoint. Further studies are necessary to confirm these findings.

An Interregional, Transdisciplinary and Good Practice-Based Approach for Frailty: the Mind&Gait Project.

Social facilities such residential structures and day-centres increasingly seek integrated, structured, adapted, creative, dynamic and economic strategies to prevent frailty. The arising need of an aged and frail population requires innovative interventions and products to prevent cognitive and physical decline. The interregional MIND&GAIT project aims to promote independent living in frail older adults by improving cognition and gait ability by using assistive products. This transdisciplinary strategy within a 24-months period expects as project' deliverables: i) a structured and good practice-based combined intervention (CI) consisting of a cognitive stimulation programme and a physical exercise programme; ii) an auto-blocking mechanism for rolling walkers with biofeedback acquisition (ABMRW); iii) a randomized clinical trial to assess CI' effectiveness; and iv) a web-platform to be used as a repository that will support and disseminate the intervention materials, covering the action-line of translational research. Positive benefits are expected in prevention and maintenance of frail older adults' capacities. Preliminary results showed positive effects on the improvement of cognitive and physical functions, functionality and depressive symptomatology. The interregional geographical coverage induced by MIND&GAIT underlines the potential replicability of the project extension to the community in the Centro and Alentejo regions of Portugal. MIND&GAIT network supports actions and provides learning opportunities and emergence of locally-embedded support systems towards social innovation for older adults.

Cognitive Stimulation in Older Adults: An Innovative Good Practice Supporting Successful Aging and Self-Care.

The project Cognitive Stimulation in Older Adults: Intervention on Cognitive Frailty and Promotion of Self-Care (in brief the ECOG project) arises in a context of worldwide demographic aging, and is fostered by the need to provide a sustainable solution to the progressive increase in the prevalence of age-related cognitive impairment. The main goal of the ECOG project is to promote active citizenship in old age through the empowerment for autonomy and self-care. Namely, the ECOG team is working on the development of evidence-based programs and tools that promote gains in health in cognitively frail and cognitively impaired older adults from the community. It is also working on the transfer of ECOG products to the practice of health and social care, promoting active involvement of geriatric care institutions in the implementation of the ECOG programs and tools, and ensuring appropriate training of professionals. Finally, the ECOG team is deploying a digital platform to reach out to the broadest audience possible and support the remote access and scaling up of the ECOG products. The impacts expected at an individual level include improvements in cognition, functionality, and autonomy of older adults, with simultaneous reduction of depressive symptomatology, and increase in quality of life of both person cared and his/her caregiver. Regarding societal gains, we anticipate an increase in life expectancy and significant postponement of institutionalization associated with geriatric problems. We also believe that the wide implementation of the ECOG products will reduce the costs of interventions for cognitively impaired citizens, contributing to sustainability and efficiency of health systems.

A Study Protocol for Development and Validation of a Clinical Prediction Model for Frailty (ModulEn): a new European Commitment to Tackling Frailty.

There is a growing need to implement and evaluate the technological solutions that allow the early detection of age-related frailty and enable assessment of the predictive values of frailty components. The broad use of these solutions may ensure an efficient and sustainable response of health and social care systems to the challenges related to demographic aging. In this paper, we present the protocol of the ModulEn study that aims to develop and validate a predictive model for frailty. For this purpose, the sample composed by older adults aged 65-80 years and recruited from the community will be invited to use an electronic device ACM Kronowise® 2.0. This device allows proactive and continuous monitoring of circadian health, physical activity, and sleep and eating habits. It will be used during a period of seven to ten days. The participants will also be given the questionnaires evaluating the variables of interest, including frailty level, as well as their experience and satisfaction with the device use. Data provided from these two sources will be combined and the relevant associations will be identified. In our view, the implications of this study' findings for clinical practice include the possibility to develop and validate tools for timely prevention of frailty progress. In the long term, the ModulEn may contribute to the critical reduction of frailty burden in Europe.

The Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Ageing.

Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs.

CROSS-CULTURAL VALIDATION OF THE PORTUGUESE VERSION OF THE EDUCATIONAL NEEDS ASSESSMENT TOOL (PortENAT).

OBJECTIVES: To undertake a cross-cultural adaptation and validation of the educational needs assessment tool (ENAT) into Portuguese. METHODS: The first phase of this research (cross-cultural adaptation) utilised a well-established translation method comprising five sequential steps: forward-translation, synthesis of translations, back-translation, expert committee and field-testing of the adapted version. The second phase involved collecting data from 123 patients and subjecting them to Rasch analysis for validity testing including cross-cultural invariance. RESULTS: The translation and field-testing phase went smoothly giving rise to minor adjustments in the phrasing of some items. The preliminary analysis of the 39 items, revealed some deviations from the model with the overall item-person interaction fit statistics 2(df) = 56.025 (39), p = 0.038. Significant item-item correlations caused artificial inflation of the internal consistency, therefore violating the model assumption of local independence of items. To correct this, all locally dependent items were then grouped into their respective domains, creating a 7 testlet-scale which demonstrated a good fit to the Rasch model, 2(df) = 2.625 (7), p = 0.917 and internal consistency PSI = 0.975. Analysis of the pooled (Portuguese and the English) data revealed cross-cultural DIF, requiring adjustments in two testlets: 'treatments' and 'support' which ensured cross-cultural equivalence. CONCLUSIONS: This study confirms the Portuguese ENAT is a robust unidimensional tool with which to assess the educational needs of Portuguese people with RA. Cross-cultural adjustments are required only if the data from Portugal and the UK are pooled or compared. The tool is now available for use in clinical practice and research.