How non-drug interventions affect the quality of life of patients suffering from progressive cognitive decline and their main caregiver.

BACKGROUND: In the absence of cure for age-related neurodegenerative diseases, non-drug interventions (NDIs) represent useful options. Quality of life (QOL) is a multidimensional concept progressively affected by cognitive decline. How single or multiple NDIs impact QOL is unknown. RESULTS: We found no significant effect of multiple over single NDI on QOL. Socio-demographic variables influenced patients' (age, gender, caregivers' occupational status, management of patients' financial affairs) and caregivers' (gender, occupational status, patients' severity of cognitive decline) QOL. When dyads interrupted interventions after 6 months, their QOL was lower and caregivers' anxiety, depression and physical symptoms were higher at the end of the study. CONCLUSIONS: While the type and number of interventions do not appear to be critical, the continuity of adapted interventions in the long-term might be important for maintaining QOL of patients and caregivers. METHODS: This is a multicenter (7 Swiss Memory Clinics), quasi-experimental, one-year follow-up study including 148 subjects (mild cognitive impairment or mild dementia patients and their caregivers). Primary outcome was the effect of multiple vs single NDIs on QOL. Secondary outcome included NDIs effect on patients' cognitive impairment and functional autonomy, caregivers' burden, severity of patients' neuropsychiatric symptoms and dyads' anxiety and depression.

[Cognitive impairment and non-medical interventions: quality of life of patients and their caregivers]. / Troubles cognitifs et interventions non médicamenteuses†: qualité de vie des patients et de leurs proches.

In the absence of curative pharmaceutical treatment for evolving cognitive impairment, non-drug interventions are key components in patients' and caregivers' care. These interventions, when combined and adapted to the needs of the patient and the caregiver, allow for maintaining functional autonomy, decreasing caregiver burden and, possibly, slowing down cognitive decline. An on-going study in Suisse Romande (INDID-MCI-QOL) assesses the effect of the number and type of interventions conducted over a year on the evolution of physical, psychological and cognitive health in this population.

Les interventions non médicamenteuses sont des outils clés dans la prise en charge des patients atteints de troubles cognitifs évolutifs et de leurs proches aidants, en l'absence de traitement médicamenteux curatif. Ces interventions, lorsqu'elles sont combinées et adaptées aux besoins du patient et du proche aidant, permettent un meilleur maintien de l'autonomie, une diminution du sentiment de fardeau et pourraient même aider à ralentir le déclin cognitif. Une étude en cours en Suisse romande (INDID-MCI-QOL) évalue l'effet à un an du nombre et du type d'interventions non médicamenteuses effectuées sur l'évolution de la santé physique, cognitive et psychologique de cette population.

Specific activation of the paralemniscal pathway during nociception.

Two main neuronal pathways connect facial whiskers to the somatosensory cortex in rodents: (i) the lemniscal pathway, which originates in the brainstem principal trigeminal nucleus and is relayed in the ventroposterior thalamic nucleus and (ii) the paralemniscal pathway, originating in the spinal trigeminal nucleus and relayed in the posterior thalamic nucleus. While lemniscal neurons are readily activated by whisker contacts, the contribution of paralemniscal neurons to perception is less clear. Here, we functionally investigated these pathways by manipulating input from the whisker pad in freely moving mice. We report that while lemniscal neurons readily respond to neonatal infraorbital nerve sectioning or whisker contacts in vivo, paralemniscal neurons do not detectably respond to these environmental changes. However, the paralemniscal pathway is specifically activated upon noxious stimulation of the whisker pad. These findings reveal a nociceptive function for paralemniscal neurons in vivo that may critically inform context-specific behaviour during environmental exploration.