Exploration of eye movement desensitization and reprocessing in treating posttraumatic stress-disorder in patients with acquired brain injury: a retrospective case series.

Background: Posttraumatic stress disorder (PTSD) is prevalent in people with acquired brain injury (ABI). Despite the established efficacy of eye movement desensitization and reprocessing (EMDR) for PTSD in general, evaluation studies on EMDR in ABI patients with PTSD are limited.Objective: The aim of this study is to explore clinical features, treatment characteristics, feasibility and first indications of efficacy of EMDR in adult ABI patients with PTSD.Method: This retrospective consecutive case series included ABI patients, who received at least one session of EMDR for PTSD between January 2013 and September 2020. PTSD symptoms were measured using the Impact of Event Scale (IES) pre- and post-treatment. Affective distress was measured using the Subjective Units of Distress (SUD) pre- and post-treatment of the first target.Results: Sixteen ABI patients (median age 46 years, 50% males), with predominantly moderate or severe TBI (50%) or stroke (25%) were included. Treatment duration was a median of seven sessions. Post-treatment IES scores were significantly lower than pre-treatment scores (p < .001). In 81% of the cases there was an individual statistically and clinically relevant change in IES score. Mean SUD scores of the first target were significantly lower at the end of treatment compared to scores at the start of treatment (p < .001). In 88% of the patients full desensitization to a SUD of 0-1 of the first target was accomplished. Only few adjustments to the standard EMDR protocol were necessary.Conclusions: Findings suggest that EMDR is a feasible, well tolerated and potentially effective treatment for PTSD in ABI patients. For clinical practice in working with ABI patients, it is advised to consider EMDR as a treatment option.

This retrospective consecutive case series (N = 16) explores clinical features, treatment characteristics, feasibility and first indications of efficacy of eye movement desensitization and reprocessing (EMDR) in adult patients with acquired brain injury (ABI) and Posttraumatic stress disorder (PTSD).The results suggest that EMDR is a feasible and potentially efficacious treatment for PTSD in ABI patients, as patients demonstrated statistically and clinically significant large sized reductions in PTSD-symptoms after EMDR treatment.For clinical practice in working with ABI patients, we advise to consider EMDR as a treatment option.

Nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual.

PURPOSE: To examine whether nurse-led stroke aftercare is beneficial for long-term psychosocial outcome of community-dwelling persons with stroke. MATERIALS AND METHODS: Comparative effectiveness research design in which a prospective stroke aftercare cohort (n = 87) was compared to care-as-usual (n = 363) at six- and 12-months post stroke. Changes over time in cognitive and emotional problems experienced in daily life, fatigue and stroke impact on daily life were examined for stroke aftercare only. Multilevel modelling was used to compare stroke aftercare to care-as-usual concerning anxiety and depression symptoms, social participation and quality of life, over time. RESULTS: Sample characteristics did not differ between cohorts except for stroke type and on average, more severe stroke in the stroke aftercare cohort (p < 0.05). Following stroke aftercare, anxiety and emotional problems decreased significantly (p < 0.05), whereas care-as-usual remained stable over time in terms of anxiety. No significant changes over time were observed on the other outcome domains. CONCLUSIONS: Nurse-led stroke aftercare showed to be beneficial for emotional well-being in comparison to care-as-usual. Providing psychoeducation and emotional support seem effective elements but adding other therapeutic elements such as self-management strategies might increase the effectiveness of nurse-led stroke aftercare.Implications for rehabilitationRoutine stroke follow-up care should pay attention to psychosocial and emotional outcome in a systematic manner, in addition to secondary prevention.Healthcare professionals such as (specialized) nurses are needed to appropriately address the hidden cognitive and emotional consequences of stroke.Providing psychoeducation and emotional support in stroke aftercare diminish insecurities and worries in community-dwelling persons with stroke, leading to better outcomes.

Efficacy of amantadine on behavioural problems due to acquired brain injury: A systematic review.

Objectives: To systematically review literature on efficacy of amantadine on behavior (irritability/aggression/agitation, emotional lability, apathy, impairment of executive functioning), participation, quality-of-life (QoL), and safety, in patients with acquired brain injury (ABI). Amantadine is widely used clinically, so comprehensive information on efficacy, participation, QoL and safety is relevant. Methods: We used PRISMA Guidelines. We searched PubMed/EMBASE/CINAHL (last search 28-8-2018) Two independent reviewers performed selection and data-extraction. Quality of studies was assessed, using CONSORT and Quality Assessment Tool for Quantitative Studies (QATFQS). Results: Eleven out of 500 studies were included. Of five RCTs, two reported significant effects on irritability/aggression, and one no effect. One RCT on cognition no effect. One prospective cohort study showed a significant effect on executive functioning. One retrospective study was inconclusive. One single-case experimental design (SCED) study reported significant effect on apathy and three case-reports indicated effects on behavior. QoL and societal participation were not measured. No safety issues emerged. Conclusion: Amantadine may be efficacious on irritability and aggression after ABI. Amantadine is a safe drug in the presence of adequate creatinine clearance. Future studies should use designs, suitable for the heterogeneous ABI population, like randomized SCEDs, and should include the effect on societal participation and QoL.

[Prevalence and manifestations of aggression in adult patients with acquired brain injury: a review]. / Prevalentie en uitingsvormen van agressie bij volwassen patiënten met niet-aangeboren hersenletsel: een literatuuroverzicht.

BACKGROUND: Aggression after acquired brain injury has a major impact on daily functioning for the patient, their family, and caregivers.
AIM: To present the prevalence and manifestations of aggression in patients with different types of brain injury.
METHOD: Systematic search of the literature in PubMed, Psycinfo and Embase.
RESULTS: Fourty-one studies were included in which 15 different outcome measures for aggression were used. The prevalence of agitation ranged between 4.0%-93.9% (median 35.8%), of aggression between 3.7%-88.0% (median 35.3%) and of hostility between 4.0%-45.7% (median 9.1%). Prevalence rates were highest in patients with traumatic brain injury. Verbal aggression occurred more frequently (median 33.0%, 14.0%-70.0%) than physical aggression (median 11.5%, 1.5%-33.8%), but manifestations of aggression were only examined in ten studies.
CONCLUSION: Aggression is a common behavioral problem after brain injury. The prevalence varies and depends on the type of brain injury, the specific target behavior and the outcome measure. It is recommended to reach consensus on definitions and outcome measures.

An Experience Sampling Method Intervention for Dementia Caregivers: Results of a Randomized Controlled Trial.

OBJECTIVE: Ecological momentary interventions integrated with real-life assessments using the experience sampling method (ESM) could be promising to effectively support dementia caregivers in daily life. This study reports on the effectiveness of the ESM-based intervention "Partner in Sight." DESIGN, SETTING, PARTICIPANTS: A randomized controlled trial with 76 dementia caregivers was performed. Participants were randomly assigned to the intervention group ("Partner in Sight": ESM self-monitoring and personalized feedback), the pseudo-intervention group (ESM self-monitoring without feedback), or the control group (usual care). MEASUREMENTS: Effects were evaluated pre- and postintervention and at 2-month follow-up. Primary outcomes were retrospective measures of caregiver sense of competence and mastery. Secondary outcomes were retrospective measures of depression, anxiety, and perceived stress. Complementary ESM measures of positive and negative affect were collected pre- and postintervention. RESULTS: Both the experimental and pseudo-experimental groups showed an increase in retrospective sense of competence and a decrease in perceived stress at 2-month follow-up. At postintervention, the experimental group showed a decrease in momentary negative affect compared with the pseudo-experimental and control groups. No effects were found for retrospective mastery, depression, anxiety, and momentary positive affect. CONCLUSIONS: ESM interventions could be an important asset for increasing caregiver resources and could help caregivers to better adapt and manage difficult situations and to protect against negative emotions.

Dealing with daily challenges in dementia (deal-id study): an experience sampling study to assess caregiver functioning in the flow of daily life.

OBJECTIVE: Accurate assessment of caregiver functioning is of great importance to gain better insight into daily caregiver functioning and to prevent high levels of burden. The experience sampling methodology (ESM) is an innovative approach to assess subjective experiences and behavior within daily life. In this study, the feasibility of the ESM in spousal caregivers of people with dementia was examined, and the usability of ESM data for clinical and scientific practice was demonstrated. METHODS: Thirty-one caregivers collected ESM data for six consecutive days using an electronic ESM device that generated ten random alerts per day. After each alert, short reports of the caregiver's current mood state and context were collected. Feasibility was assessed by examining compliance and subjective experiences with the ESM. Usability was described using group and individual ESM data. RESULTS: Participants on average completed 78.8% of the reports. One participant completed less than 33% of the reports and was excluded from data analyses. Participants considered the ESM device to be a user-friendly device in which they could accurately describe their feelings and experiences. The ESM was not experienced as too burdensome. Zooming in on the ESM data, personalized patterns of mood and contextual factors were revealed. CONCLUSIONS: The ESM is a feasible method to assess caregiver functioning. In addition to standard retrospective measurements, it offers new opportunities to gain more insight into the daily lives of people with dementia and their caregivers. It also provides new possibilities to tailor caregiver support interventions to the specific needs of the caregiver. Copyright © 2016 John Wiley & Sons, Ltd.

[Cognitive impairment in patients with COPD: a review]. / Cognitieve beperkingen bij patiënten met COPD: een overzicht.

COPD (Chronic Obstructive Pulmonary Disease) is a respiratory disease characterized by progressive and largely irreversible airway limitation and extrapulmonary problems. The prevalence of COPD increases with age. Mental health problems, including cognitive capacity limitations, occur frequently. Patients with COPD may have problems with cognitive functioning, either globally or in single cognitive domains, such as information processing, attention and concentration, memory, executive functioning and self-regulation. Possible causes are hypoxemia, hypercapnia, exacerbations and decreased physical activity. Cognitive problems in these patients may be related to structural brain abnormalities, such as gray matter pathologic changes and the loss of white matter integrity. Because of the negative impact on health and daily life, it is important to assess cognitive functioning in patients with COPD in order to optimize patient-oriented treatment and to reduce personal discomfort, hospital admissions and mortality.

[Patients with brain injury in a psychiatric setting; assessment of health care needs and received care]. / Klinische patiënten met niet-aangeboren hersenletsel in de ggz; inventarisatie van zorgbehoeftes en ontvangen zorg.

BACKGROUND: In some Dutch mental health care organisations specific neuropsychiatric departments have been developed for patients with brain injury. AIM: To identify the characteristics of patients with brain injury who form a specific population in mental health care and to determine whether such patients require either specialised care or a special type of care. METHOD: A cross-sectional analysis of typical brain injury inpatients was performed. We noted the age and gender of these patients and recorded any previous periods of inpatient care. We listed patients' impairments, the diagnoses they had been given and the treatment they had received. This inventory formed the basis of our conclusions. RESULTS: The typical clinical patient with brain injury in this setting was a male of 51 years or older, most probably affected by a stroke or traumatic brain injury, admitted for a period of 6 months, many years after the incident. He was mostly referred from home or hospital by a physician and was expected to return home again. A combination of cognitive and psychiatric impairments was often found. Physically the patient had no or only mild disabilities, but societal participation was low and many cognitive-affective disorders were seen. Treatment was relatively infrequent and mostly directed at daily activities. The most frequent diagnosis was & lquo;cognitive deficits not otherwise specified'. Irritability, agitation, apathy and depression were frequent symptoms. CONCLUSION: This inventory suggests that brain injury patients in a mental health care setting need special care which is not available in other health care settings.

Cognitive functioning in healthy older adults aged 64-81: a cohort study into the effects of age, sex, and education.

The objective of this study was to determine a possible differential effect of age, education, and sex on cognitive speed, verbal memory, executive functioning, and verbal fluency in healthy older adults. A group of 578 healthy participants in the age range of 64-81 was recruited from a large population study of healthy adults (Maastricht Aging Study). Even in healthy individuals in this restricted age range, there is a clear, age-related decrease in performance on executive functioning, verbal fluency, verbal memory, and cognitive speed tasks. The capacity to inhibit information is affected most. Education had a substantial effect on cognitive functioning: participants with a middle or high level of education performed better on cognitive tests than did participants with a low level of education. Women performed better than men on verbal memory tasks. Therefore, education and sex must be taken into account when examining an older individual's cognitive performance.

Does cognitive function in older adults with hearing impairment improve by hearing aid use?

In the present study, the effects of hearing aid use by hearing-impaired older individuals on different aspects of cognitive function, such as memory, attention, executive functioning, and processing speed, were investigated. Fifty-six participants (mean age = 72.5) who were fitted with hearing aids were compared with 46 control participants (mean age = 74.5) with an equivalent hearing impairment, but who were not fitted with a hearing aid. After a dual baseline measurement and fitting of the hearing aids, all participants were assessed again with neurocognitive tests after 12 months. While the participants with hearing aids had improved aided hearing thresholds, they did not demonstrate an improved performance on the cognitive tests compared to the controls. Thus improved hearing did not improve cognitive functioning. These findings may suggest that hearing aid use only restores impairments at the level of the sensory organ, but does not affect the central nervous system and, as a consequence, cognitive functioning.

The seven minute screen: a neurocognitive screening test highly sensitive to various types of dementia.

BACKGROUND: The seven minute screen (7MS) is a compilation of the temporal orientation test, enhanced cued recall, clock drawing, and verbal fluency. It has been shown to be useful for detecting Alzheimer's disease in a population of patients with memory complaints. OBJECTIVE: To assess the predictive validity of the 7MS for various types of dementia, and the influence of depression and other psychiatric conditions on 7MS scores. SETTING: Multicentre: secondary referral sites across the Netherlands. SUBJECTS: 542 patients with various types of dementia or depression, together with 45 healthy controls. RESULTS: Alzheimer's disease was diagnosed in 177 patients, other types of dementia in 164. The sensitivity of the 7MS for Alzheimer's disease was 92.9% with a specificity of 93.5%. For other types of dementia the sensitivity was 89.4% and the specificity 93.5%. Cognitive abnormalities were found in 71% of the patients with depression (n = 31). The mean (SD) duration of administration of the 7MS was 12.4 (4.6) minutes, range 8 to 22, depending on dementia severity. CONCLUSIONS: The 7MS is a useful screening tool for discriminating patients with dementia from cognitively intact patients. This not only applies to Alzheimer's disease but also to other types of dementia. Specificity with respect to depression was lower for the 7MS than for the MMSE.

Engaged lifestyle and cognitive function in middle and old-aged, non-demented persons: a reciprocal association?

Some studies have shown that cognitive function is positively affected by an engaged and active lifestyle. However, a recent study found evidence for an opposite causal direction, i.e., persons with good cognitive function more often start to engage in leisure-time activities. Here, we longitudinally examine the causal direction of the association between an engaged lifestyle and cognitive function in middle and old-aged Dutch men and women. The participants in the prospective cohort study "Maastricht Aging Study" (MAAS) were recruited from a register of 15 family practices in the South of the Netherlands. There were 830 non-demented men and women, aged 49 to 81 in 1993-1995 (baseline phase). They were re-examined three years later (follow-up phase). During both phases, all persons reported on their participation in mental, social, and physical activities. Six separate neuropsychological tests, including the Mini-Mental State Examination, were used to define cognitive function at baseline and follow-up. All three activities measured were negatively related to cognitive decline between both phases. Effects were moderate, but consistent. Persons participating in all three activities were particularly protected against longitudinal decline. Furthermore, persons with the best baseline cognitive performance were more likely to increase their number of activities during follow-up compared with persons with the poorest scores. In summary, an engaged lifestyle and cognitive function mutually influence each other in middle and old aged, non-demented persons. This reciprocal association is characterized by simultaneous positive effects of leisure-time activities and good cognitive function on cognitive function and leisure-time activities, respectively. This reciprocal association may create a self-reinforcing, beneficial or adverse life-course in middle and old age.

Diagnosis of preclinical Alzheimer's disease in a clinical setting.

INTRODUCTION: The aim of the study was to investigate whether the preclinical stage of Alzheimer's disease (AD) can be diagnosed in a clinical setting. To this end we investigated whether subjects with preclinical AD could be differentiated from subjects with nonprogressive mild cognitive impairment and from subjects with very mild AD-type dementia. METHODS: Twenty-three subjects with preclinical AD, 44 subjects with nonprogressive mild cognitive impairment, and 25 subjects with very mild AD-type dementia were selected from a memory clinic population. Variables that were used to differentiate the groups were demographic variables, the Mini-Mental State Examination score, performance on cognitive tests, measures of functional impairment, and measures of noncognitive symptomatology. RESULTS: Age and the scores for the delayed recall task could best discriminate between subjects with preclinical AD and subjects with nonprogressive mild cognitive impairment. The overall accuracy was 87%. The score on the Global Deterioration Scale and a measure of intelligence could best discriminate between subjects with preclinical AD and subjects with very mild AD-type dementia. The overall accuracy was 85%. CONCLUSIONS: Subjects with preclinical AD can be distinguished from subjects with nonprogressive mild cognitive impairment and from subjects with very mild AD-type dementia. This means that preclinical AD is a diagnostic entity for which clinical criteria should be developed.

The influence of soy-derived phosphatidylserine on cognition in age-associated memory impairment.

Phosphatidylserine (PS) is a phospholipid widely sold as a nutritional supplement. PS has been claimed to enhance neuronal membrane function and hence cognitive function, especially in the elderly. We report the results of a clinical trial of soybean-derived PS (S-PS) in aging subjects with memory complaints. Subjects were 120 elderly (> 57 years) of both sexes who fulfilled the more stringent criteria for age-associated memory impairment (AAMI); some also fulfilled the criteria for age-associated cognitive decline. Subjects were allocated at random to one of the three treatment groups: placebo, 300mg S-PS daily, or 600mg S-PS daily. Assessments were carried out at baseline, after 6 and 12 weeks of treatment, and after a wash-out period of 3 weeks. Tests of learning and memory, choice reaction time, planning and attentional functions were administered at each assessment. Delayed recall and recognition of a previously learned word list comprised the primary outcome measures. No significant differences were found in any of the outcome variables between the treatment groups. There were also no significant interactions between treatment and 'severity of memory complaints'. In conclusion, a daily supplement of S-PS does not affect memory or other cognitive functions in older individuals with memory complaints.

Pesticide exposure and risk of mild cognitive dysfunction.

Little is known about the adverse effects of substances, such as pesticides and metals, on the development of mild cognitive dysfunction (MCD). Cross-sectional and prospective data from the Maastricht Aging Study were used to find out the potential neurotoxicity of particular substances. Exposure to pesticides, for example by arable farmers and gardeners, was associated with increased risks of MCD. Exposure to metals and organic solvents was not associated with MCD. Our findings might reflect subtle changes in brain function among people exposed to pesticides.

Distinction between preclinical Alzheimer's disease and depression.

OBJECTIVE: To assess the prevalence of depression in subjects with preclinical Alzheimer's disease (AD) and to investigate the possibility of differentiating subjects with preclinical AD and depression from subjects with depression-related cognitive impairment. DESIGN: A prospective, observational cohort study. SETTING: An outpatient memory clinic of a university-affiliated hospital. PARTICIPANTS: Nondemented subjects with cognitive impairment older than 55 years (n = 111) without neurological or somatic causes for the cognitive impairment. MEASUREMENTS: At baseline, data were collected on patient characteristics, the severity of depression, and cognitive functioning. The course of the cognitive impairment and the presence of dementia were assessed after 2 and 5 years. RESULTS: Twenty-five subjects had preclinical dementia with Alzheimer's type dementia at follow-up. Sixty percent of these subjects (n = 15) were depressed at baseline. Subjects with depression and preclinical AD had at baseline a poorer performance on the cognitive tasks and were older than the subjects with depression-related cognitive impairment. Logistic regression with backward step selection selected age and memory performance as the best predictors for Alzheimer's type dementia in the depressed subjects. The specificity of these predictors for the diagnosis of future Alzheimer's type dementia in depressed subjects was 94%, sensitivity was 90%, positive predictive value was 90%, and negative predictive value was 94%. CONCLUSIONS: Depression is common in preclinical AD. Depressed subjects with preclinical AD can be accurately differentiated from subjects with depression-related cognitive impairment by age and the severity of the memory impairment. Research that aims to investigate preclinical AD should not exclude a priori subjects with depression inasmuch as preclinical AD is often accompanied by depression.

Course of objective memory impairment in non-demented subjects attending a memory clinic and predictors of outcome.

The aim of the study was to investigate the course of objective memory impairment in non-demented subjects who attended a memory clinic and to test predictors of outcome. Non-demented subjects (N=74) were included when they were older than 40 years and had a baseline score on the delayed recall of a word learning test below the tenth percentile. Subjects with memory impairment due to known somatic or neurological causes were excluded. The subjects were reassessed after 2 and 5 years. At the 5-year follow-up, 42% of the subjects had no memory impairment, 19% of the subjects had memory impairment without dementia, and 39% of the subjects had Alzheimer type dementia (AD). Predictors at baseline of reversible memory impairment in a multivariate analysis were age, scores on the MMSE and delayed recall, and the degree of functional impairment. Predictors at baseline of AD in a multivariate analysis were age and the score on the MMSE. The apolipoprotein E genotype and the presence of depression at baseline were not predictors of outcome. The positive predictive value was 72% for reversible memory impairment and 81% for AD. Memory impairment is often reversible and therefore its presence alone is not sufficient to consider subjects as preclinically demented. Predictive accuracy can be increased by including simple measures such as age, the scores on the MMSE and delayed recall, and the degree of functional impairment.

How ageing and social factors affect memory.

OBJECTIVES: To explore the relationships between lifestyle and memory, and determine whether social factors influence memory. METHODS: the relationship between memory and lifestyle was examined in 497 adults aged 25-80 years, using the Mectamemory in Adulthood questionnaire. We asked about sports activity and perceived activity, participation in voluntary organizations and social contacts. RESULTS: Activity and frequent contact with friends and family were related to higher memory capacity scores. Those with higher capacity scores were also younger, had better health and a stronger internal locus of control. In contrast, people with higher anxiety scores had more symptoms and less education, and were more externally oriented. CONCLUSIONS: people who consider themselves socially and physically active also consider their memory capacity to be good and are less anxious about their memory than less socially and physically active people. Perceived memory change appears to be predominantly influenced by ageing, whereas memory capacity and memory anxiety are more influenced by social factors.

Lithium induced cognitive side-effects in bipolar disorder: a qualitative analysis and implications for daily practice.

Qualitative analysis of the literature on cognitive side-effects of lithium in patients with a bipolar disorder identified four of 17 studies that fulfilled criteria of adequate methodological quality. Analysis of these four studies showed that lithium had a negative effect on memory and speed of information processing, often without subjective complaints or awareness of mental slowness. The consequences of these findings for daily practice are discussed, in particular with respect to driving performance. When neurocognitive complaints or deficits are present, lithium plasma level, thyroid functions and degree of mood disturbance should be assessed. In cases where all these parameters are within normal limits and neurocognitive complaints still persist, dose reduction of lithium, thyroid hormone addition, prescription of a slow release preparation or replacement of lithium by another moodstabiliser should be considered. Guidelines are suggested with respect to further neuropsychological screening.