Night-to-night variation in sleep associates with day-to-day variation in vigilance, cognition, memory, and behavioral problems in Alzheimer's disease.

Introduction: Sleep disturbances are commonly reported in people living with Alzheimer's disease (AD), but it is currently unknown whether night-to-night variation in sleep predicts day-to-day variation in vigilance, cognition, mood, and behavior (daytime measures). Methods: Subjective and objective sleep and daytime measures were collected daily for 2 weeks in 15 participants with mild AD, eight participants with mild cognitive impairment (MCI), and 22 participants with no cognitive impairment (NCI). Associations between daytime measures and four principal components of sleep (duration, quality, continuity, and latency) were quantified using mixed-model regression. Results: Sleepiness, alertness, contentedness, everyday memory errors, serial subtraction, and behavioral problems were predicted by at least one of the components of sleep, and in particular sleep duration and continuity. Associations between variations in sleep and daytime measures were linear or quadratic and often different between participants with AD and those with NCI. Discussion: These findings imply that daytime functioning in people with AD may be improved by interventions that target sleep continuity.

Dementia awareness, beliefs and barriers among family caregivers in Pakistan.

OBJECTIVES: Dementia research and services in Pakistan are limited. The following was explored in experiences of family caregivers of people with dementia in Pakistan: (a) to determine whether culture and religion play a role in caregiving; (b) to draw insights on how family caregivers cope, what barriers they face and what help they would be willing to accept and (c) to determine how these findings could be used to raise awareness and influence public policies in improving the lives of families living with dementia. METHODS: The experiences of family caregivers of people with dementia in Pakistan were explored via semi-structured interviews (10 in Lahore; 10 in Karachi). This was part of a larger qualitative study conducted about dementia in Pakistan. Caregivers interviewed were aged 35-80 (14 female). Most caregivers in the study were educated and affluent. Interviews were conducted in Urdu, translated into English and thematically analysed. RESULTS: Five themes emerged: knowledge and awareness; stigma; importance of religion and duty to care; use of day care centres and home-help; and barriers. A lack of dementia awareness exists in Pakistan. The religious duty to care for family influenced caregiving decisions. Day care centres and home-help were accessed and viewed positively. The caregivers also wanted extracurricular activities for people with dementia, support groups for caregivers and better training for healthcare staff. Novel findings included that caregivers felt that dementia should not be stigmatised, and awareness should be raised in Pakistan via TV, radio and social media, but not inside mosques. DISCUSSION: Additional research is necessary to determine if positive views of day care centres and home-help exist more widely. Attitudes and experiences regarding stigma may be different for caregivers of people with more advanced dementia. We recommend raising dementia awareness, allocating more funds to dementia services and an emphasis on home-based care.

Experiences of People With Dementia in Pakistan: Help-Seeking, Understanding, Stigma, and Religion.

BACKGROUND AND OBJECTIVES: The prevalence of dementia will increase in low- and middle-income countries like Pakistan. Specialist dementia services are rare in Pakistan. Public awareness of dementia is low, and norms about family care can lead to stigma. Religion plays a role in caregiving, but the interaction between dementia and Islam is less clear. RESEARCH DESIGN AND METHODS: Qualitative interviews were carried out with 20 people with dementia in Karachi and Lahore. Interviews were conducted in Urdu, translated to English, and respondents' views on help-seeking experiences, understanding of diagnosis, stigma, and religion were analyzed thematically. RESULTS: Although some people with dementia understood what dementia is, others did not. This finding shows a more positive perspective on diagnosis in Pakistan than previously thought. Help-seeking was facilitated by social and financial capital, and clinical practice. Stigma was more common within the family than in the community. Dementia symptoms had a serious impact on religious obligations such as daily prayers. Participants were unaware that dementia exempts them from certain religious obligations. DISCUSSION AND IMPLICATIONS: Understanding of dementia was incomplete despite all participants having a formal diagnosis. Pathways to help-seeking need to be more widely accessible. Clarification is needed about exemption from religious obligations due to cognitive impairment, and policy makers would benefit from engaging with community and religious leaders on this topic. The study is novel in identifying the interaction between dementia symptoms and Islamic obligatory daily prayers, and how this causes distress among people living with dementia and family caregivers.

Social networks and loneliness in people with Alzheimer's dementia.

OBJECTIVES: Modifiable lifestyle risk factors are of great interest in the prevention and management of Alzheimer's disease (AD). Loneliness and social networks may influence onset of AD, but little is known about this relationship in people with AD. The current study aimed to explore the relationship between loneliness and social networks (social measures) and cognitive and psychopathology decline (AD outcomes) in people with AD. METHODS: Ninety-three participants with mild to moderate AD were recruited from memory clinics, in a cross-sectional study. Social networks (measured by the Lubben Social Network Scale-6), feelings of loneliness (measured by De Jong Loneliness Scale), cognition (measured by the Standardized Mini-Mental State Examination), and psychopathology (measured by the Neuropsychiatric Inventory) were assessed in an interview setting. Two multiple regressions with bootstrap were conducted on cognition and psychopathology as outcome variables. Family and friends subsets of social networks and loneliness were entered as predictors and age, gender, and depression as covariates. RESULTS: The friendship subset of social networks was significantly related to cognition (independent of age, gender, depression, loneliness, and family subset of social network): B = 0.284, P = 0.01. Neither loneliness nor social networks predicted psychopathology (Ps > 0.05). CONCLUSIONS: Maintaining or developing a close friendship network could be beneficial for cognition in people with AD. Alternatively, greater dementia severity may lead to fewer friends. More research on the direction of this relationship in people with AD is needed.

Is Sleep Disruption a Risk Factor for Alzheimer's Disease?

Sleep disturbances are routinely encountered in Alzheimer's disease (AD) and affect about 25-40% of patients in the mild-to-moderate stages of the disease. In many, sleep pathology may represent a symptom of the underlying neurodegeneration. However, a history of sleep disruption occurring years prior to onset of cognitive symptoms could represent a potential risk factor for AD. The aim of the present narrative review was to evaluate current evidence linking sleep disturbances with AD development and to understand the mechanisms that may contribute to this. Although the mechanisms by which poor sleep may contribute to AD genesis is not fully understood, emerging evidence linking disturbances in the sleep wake cycle with Aß deposition is shedding light on the relationship between sleep pathology and the subsequent development of AD. Aß burden appears to be enhanced by sleep-wake cycle disruptions and is suspected as being an important mechanism by which sleep disruptions contribute in AD development. Other mechanisms triggered by sleep disruption may also be involved in AD development, such as brain hypoxia, oxidative stress, circadian activity rhythms disturbances, overexpression of orexins, and blood-brain barrier impairment. Further understanding of the link between sleep disturbances and future development of AD is still needed before sleep disturbances are clearly marked as a preventable risk factor for AD. In these circumstances, early lifestyle interventions to help increase the quantity and quality of sleep may have a favorable outcome on decreasing the incidence of AD and this needs to be investigated further.

Can verbal instruction enhance the recall of an everyday task and promote error-monitoring in people with dementia of the Alzheimer-type?

People with dementia of the Alzheimer-type (DAT) have difficulties with performing everyday tasks, and error awareness is poor. Here we investigate whether recall of actions and error monitoring in everyday task performance improved when they instructed another person on how to make tea. In this situation, both visual and motor cues are present, and attention is sustained by the requirement to keep instructing. The data were drawn from a longitudinal study recording performance in four participants with DAT, filmed regularly for five years in their own homes, completing three tea-making conditions: performed-recall (they made tea themselves); instructed-recall (they instructed the experimenter on how to make tea); and verbal-recall (they described how to make tea). Accomplishment scores (percentage of task they correctly recalled), errors and error-monitoring were coded. Task accomplishment was comparable in the performed-recall and instructed-recall conditions, but both were significantly better than task accomplishment in the verbal-recall condition. Third person instruction did not improve error-monitoring. This study has implications for everyday task rehabilitation for people with DAT.

Narratives of traumatic birth: Quality and changes over time.

Childbirth is a highly emotive event that can involve complications. Around 1% of births in the United Kingdom involve life-threatening complications to the mother (Waterstone, Bewley, & Wolfe, 2001) and 0.8% result in stillbirth or perinatal death (Confidential Enquiry into Maternal and Child Health [CEMACH], 2009). A review found that 3.1% of women report posttraumatic stress disorder (PTSD) after birth (Grekin & O'Hara, 2014). The aim of this study was to examine whether narrative characteristics of traumatic birth were specific to women with PTSD or observed in all women who experience a highly emotive and potentially traumatic birth. Parturient women were matched for birth events, but either had severe PTSD symptoms (n = 22) or no, or very low, PTSD symptoms (n = 22). Women were interviewed about the birth 3 and 6 months postpartum, and their birth narratives were examined for content, coherence, and cognitive and perceptual processing. Results showed birth narratives became shorter and more coherent over time. Consistent with PTSD literature, birth memories were more likely to be recalled and involuntarily triggered in women with PTSD symptoms. However, women with PTSD symptoms had more coherent narratives, used more causal and fewer tentative words. These latter findings are inconsistent with research finding that PTSD is associated with fragmented or incoherent memories but are consistent with the view that highly emotive events result in improved memory (e.g., Berntsen, Willert, & Rubin, 2003). Possible reasons for this are discussed.

Error-monitoring in an everyday task in people with Alzheimer-type dementia: observations over five years of performance decline.

Research suggests that, although everyday action errors increase significantly with dementia progression, accomplishment of the task remains high, even in severe dementia. We used archive observational data charting progressive decline in everyday task performance to explore error-monitoring over a 5-year period in four people with dementia. None of the participants showed effective error-monitoring during their execution of their established tea-making routine: Over 5 years and into more severe stages of dementia, errors increased, but there was no reactive increase from our participants in error-monitoring. Training to error-monitor routine tasks may be an appropriate target for further study.

Age-related changes in error monitoring of an everyday task.

The process of checking in an everyday task to ensure error prevention/error correction, has not been systematically documented in relation to everyday action errors. This is surprising, given that studies of everyday task performance in people with dementia suggest poor error monitoring (error detection/correction). The present study documented age-related changes in errors and error monitoring behaviors, including the novel variable of checking (verbal/non-verbal gestures indicating active task monitoring), in an everyday task. In a 2 × 2 mixed-subjects design (n = 57), young and older adults performed a tea-making task under standard and dual-task conditions. Error rates were similar across age-groups and conditions. The dual-task condition reduced verbal checking and increased microslips (initiation and termination of an error before the error is completed) for both age-groups, when compared to the standard condition. In the standard condition, older adults engaged in more verbal checks than young adults, but this was not associated with improved task accuracy. Thus, both age-groups do engage in checking during an everyday task, but this checking had little impact on task accuracy. Consequently, checking may not be a necessary part of performance accuracy. Future studies should investigate whether enhanced awareness would make monitoring more effective.