Reliability and Validity of the Geriatric Depression Scale in a Sample of Portuguese Older Adults with Mild-to-Moderate Cognitive Impairment.

Although the Geriatric Depression Scale (GDS) is a well-established instrument for the assessment of depressive symptoms in older adults, this has not been validated specifically for Portuguese older adults with cognitive impairment. The objective of this study was to analyze the psychometric properties of two Portuguese versions of the GDS (GDS-27 and GDS-15) in a sample of Portuguese older adults with mild-to-moderate cognitive impairment. Clinicians assessed for major depressive disorder and cognitive functioning in 117 participants with mild-to-moderate cognitive decline (76.9% female, Mage = 83.66 years). The internal consistency of GDS-27 and GDS-15 were 0.874 and 0.812, respectively. There was a significant correlation between GDS-27 and GDS-15 with the Beck Depression Inventory-II (GDS-27: rho = 0.738, p < 0.001; GDS-15: rho = 0.760, p < 0.001), suggesting good validity. A cutoff point of 15/16 in GDS-27 and 8/9 in GDS-15 resulted in the identification of persons with depression (GDS-27: sensitivity 100%, specificity 63%; GDS-15: sensitivity 90%, specificity 62%). Overall, the GDS-27 and GDS-15 are reliable and valid instruments for the assessment of depression in Portuguese-speaking older adults with cognitive impairment.

Effectiveness of a year-long individual cognitive stimulation program in Portuguese older adults with cognitive impairment.

Cognitive stimulation is a recommended therapy with positive effects on the cognitive performance of older adults with neurocognitive disorders. However, there are few one-on-one, long-term interventions applied by professionals. The aim of the present study was to determine the effectiveness of 47-week individual cognitive stimulation (iCS) interventions on cognition, mood, instrumental activities of daily living, and quality of life in older adults, with neurocognitive disorders using a single-blind, randomized, parallel two-arm RCT. A sample of 59 older adults with neurocognitive disorders (predominantly Alzheimer's disease), who were non-institutionalized but socially vulnerable, was selected. The intervention group (n = 30) received 47 iCS weekly sessions. The control group (n = 29) maintained their baseline treatments. Outcomes were global cognitive function, cognitive impairment, mood, instrumental activities of daily living, and self-reported quality of life. All participants were assessed at baseline, 25 weeks, and 50 weeks. The results showed a significant effect of the intervention on MMSE, MoCA, GDS-15. Individual cognitive stimulation may have beneficial effects on the cognitive function and mood of older adults with cognitive impairment.

Home-Based Individualized Cognitive Stimulation (iCS) Therapy in Portuguese Psychiatric Patients: A Randomized Controlled Trial.

Cognitive difficulties are common in people with mental health issues, including psychotic disorders, although this population may have difficulty accessing treatments due to various challenges, including transportation, remembering appointments, or discomfort in crowded or unfamiliar places. Home-based services can be crucial and effective for reaching populations with accessibility issues; one home-based intervention technique is individual cognitive stimulation (iCS), which has been shown to be an effective strategy to target and improve cognitive functioning in various samples. Using a previously established Portuguese iCS protocol, based on an initial brief cognitive assessment and the subsequent administration of cognitive stimulation materials and reflection exercises, the current randomized controlled trial explored the effectiveness of the iCS intervention on participants in Portugal with psychotic disorders. Outcome tools included measures of cognition, depression, quality of life, and functional abilities at baseline, the completion of the intervention, and post-intervention follow-up. With two well-matched groups at baseline, the results revealed significant improvements in the intervention group on cognitive functioning, depression, quality of life, and, more modestly, functional activities. These results offer an important contribution to the field of iCS protocols, in an effort to enhance the lives and well-being of various clinical populations, including those with psychotic disorders.

Impact of confinement measures due to the COVID-19 pandemic on people living with dementia and their caregivers in Spain.

The COVID-19 pandemic has particularly affected people living with dementia (PLWD) and their caregivers, who have seen their access to social support services and opportunities for socialisation limited. The objective of the study was to explore the impact of COVID-19 on PLWD and their caregivers in Spain. An online survey was conducted between November 27, 2020, and January 19, 2021, that explored compliance with prevention guidelines, changes at the family level and in access to social support services. Instruments were included to estimate levels of anxiety and depression. The survey was answered by 229 people (161 current caregivers, 54 former caregivers, 13 formal caregivers and 1 person with dementia). Analysis of the current and former caregivers showed that they felt well informed, although they find it difficult for PLWD to comply with prevention guidelines. The use of social support services was reduced and the difficulty of access to social and health services increased, there was a negative impact on the economic situation and family relationships, with an increase in perceived overload. In addition, caregivers of PLWD scored above the cut-off points in the tests used to assess depression and anxiety, although the results of the multiple regression analysis do not allow us to conclude that the loss of resources influences the anxiety and depression scores. The negative impact of the pandemic on caregivers of PLWD is verified. It is necessary to adapt social support services and design strategies to maintain the provision of support to these vulnerable groups.

Multicenter randomized controlled trial of the effects of individual reminiscence therapy on cognition, depression and quality of life: Analysis of a sample of older adults with Alzheimer's disease and vascular dementia.

Objective: To determine the effectiveness of a 13-week individual reminiscence therapy (RT) intervention on cognition, memory, executive function, mood, and quality of life of people with Alzheimer's disease and vascular dementia. Method: Non-protocolized analysis using data from a larger multicenter, single-blind, randomized, parallel two-arm RCT of RT for people with neurocognitive disorders. A sample of 148 people with probable Alzheimer's disease or vascular dementia attending 23 Portuguese institutions providing care and support services for older adults were selected. Intervention group (n = 74) received 26 individual RT sessions, twice a week for 13 weeks. Control group (n = 74) maintained their treatment as usual. Outcomes were global cognitive function (MMSE), memory (MAT), executive function (FAB), mood (GDS-15), and self-reported quality of life (QoL-AD). All participants were assessed at baseline (T0) and 15 weeks later (T1). Results: The results showed a significant effect of the intervention on global cognition (Group X Time interaction F(1, 128) = 10.542, p = .001, ηp2 = .076), memory (F(1,128) = 9.881, p = .002, ηp2 = .072), and quality of life (F(1,128) = 0.181, p = .671, ηp2 = .001), with medium effect sizes. A small effect on executive function (F(1,127) = 11.118, p = .001, ηp2 = .080) was also found. No effects were found on depressive symptoms (F(1,128) = 0.181, p = .671, ηp2 = .001). Conclusion: Individual RT may have beneficial effects on cognition and quality of life of people with Alzheimer's disease or vascular dementia.

Effectiveness of a Randomized Controlled Trial of Individual Reminiscence Therapy on Cognition, Mood and Quality of Life in Azorean Older Adults with Neurocognitive Disorders.

Reminiscence therapy (RT) is a form of cognitive stimulation therapy that incorporates discussion of past activities, events, and experiences to stimulate individual memories; it has had some success in treating persons with neurocognitive disorders. This research aims to evaluate the ability of individual RT, using a simple reminiscence format, to improve the overall cognitive function, memory, executive functions, emotional status, and quality of life in older adults with neurocognitive disorders who received social care and support services. A multicenter randomized controlled trial was completed in the Azores archipelago (an independent region of Portugal) using repeated measures (pre-intervention, post-intervention, and follow-up). The intervention group underwent individual RT sessions, twice weekly for 13 weeks, while the control group completed regular activities administered as part of their program. Results did not reveal any significant differences between the intervention and control groups. While results did not reveal significant effects, a number of historical and contextual factors are considered as possible explanations for the lack of effects-namely, data collection occurring during the COVID-19 global pandemic, participant cohort effects, and therapist heterogeneity.

Multicentre randomised controlled trial about the effect of individual reminiscence therapy in older adults with neurocognitive disorders.

OBJECTIVES: To evaluate the effectiveness of a 13-week individual reminiscence therapy (RT) intervention to improve the overall cognitive function, memory, executive function, mood and quality of life (QoL) of people with neurocognitive disorders. METHODS: A single-blind, multicentre, randomised parallel two-arm controlled trial recruited 251 people with neurocognitive disorders attending 24 institutions providing care and support services for older adults in Portugal. The primary outcome measure was cognitive function (Mini-Mental State Examination [MMSE]). Secondary outcomes were memory (Memory Alteration Test [MAT]), executive function (Frontal Assessment Battery [FAB]), mood (Geriatric Depression Scale-15 [GDS-15]) and self-reported QoL-Alzheimer's disease AD). Participants in the intervention group (n = 131) received 26 individual RT sessions, twice a week, over the course of 13 weeks. Participants in the control group (n = 120) maintained their treatment as usual. RESULTS: Intention-to-treat analysis showed that, at endpoint assessment, the intervention group had significantly improved in relation to the control group in MMSE (mean difference 1.84, 95% CI [0.80, 2.89], p = .001, d = .44), MAT (mean difference 2.82, 95% CI [0.72, 4.91], p = .009, d = .34) and QoL-AD (mean difference 1.78, 95% CI [0.17, 3.39], p = .031, d = .28). Non-significant improvements were found on FAB (mean difference 0.74, 95% CI [-0.04, 1.52], p = .062, d = .24) and GDS-15 (mean difference -0.63, 95% CI [-1.45, 0.19], p = .130, d = .19). CONCLUSIONS: For people with neurocognitive disorders attending social care and support services, the individual RT designed for this trial should be considered an intervention with the potential to improve cognition, memory and QoL.

Protocolo de intervenção individual baseado na terapia de reminiscência em idosos com perturbação neurocognitiva / Individual intervention protocol based on reminiscence therapy for older people with neurocognitive disorders / Protocolo de intervención individual basado en la terapia de reminiscencia en personas mayores con trastornos neurocognitivos

Enquadramento: A literatura sugere que a terapia de reminiscência (TR) é uma das terapias não-farmacológicas com melhores evidências na população idosa com perturbação neurocognitiva (PNC), permitindo estimular a neuroplasticidade e a reserva cognitiva, podendo ter um efeito protetor na pessoa com PNC. Objetivo: Apresentar de forma pormenorizada a estrutura e o conteúdo de um protocolo de intervenção em idosos com PNC, baseado na TR individual. Metodologia: Identificação das fases preliminares ao desenho do protocolo de intervenção. Resultados: Protocolo de intervenção individual baseado na TR, em formato misto, composto por 26 sessões, com frequência bissemanal e com duração aproximada de 50 minutos por sessão, administrado por terapeutas treinados. Conclusão: O programa de TR individual pormenorizado permite uma implementação e replicabilidade adequada, podendo contribuir para atenuar a progressão da PNC.

Background: The literature suggests that reminiscence therapy (RT) is one of the non-pharmacological treatments with better evidence for older people with neurocognitive disorders (NCD). RT stimulates neuroplasticity and cognitive reserve, and it may have a protective effect on the person with NCD. Objective: To describe in detail the structure and contents of an individual RT intervention protocol applied to older people with NCD. Methodology: Identification of the phases prior to the design of the intervention protocol. Results: Individual RT intervention protocol, in a mixed format, consisting of 26 sessions, twice a week, of approximately 50 minutes each, conducted by trained therapists. Conclusion: The detailed individual RT program can be adequately implemented and replicated, and it may delay the progression of NCD.

Marco contextual: La literatura sugiere que la terapia de reminiscencia (TR) es una de las terapias no farmacológicas con mejores resultados en la población anciana con trastorno neurocognitivo (PNC, en portugués), pues permite la estimulación de la neuroplasticidad y la reserva cognitiva, y puede tener un efecto protector en la persona con PNC. Objetivo: Presentar de forma pormenorizada la estructura y el contenido de un protocolo de intervención para personas mayores con PNC, basado en la TR individual. Metodología: Identificación de las fases preliminares al diseño del protocolo de intervención. Resultados: Protocolo de intervención individual basado en la TR, en formato mixto, compuesto por 26 sesiones, con una frecuencia quincenal y una duración aproximada de 50 minutos por sesión, administrado por terapeutas capacitados. Conclusión: El programa de TR individual pormenorizado permite una implementación y una replicabilidad adecuadas, y puede contribuir a suavizar el progreso de la PNC.

Effects of Dog-Assisted Therapy on Social Behaviors and Emotional Expressions: A Single-Case Experimental Design in 3 People With Dementia.

This study examined the effects of dog-assisted therapy (DAT) on social behaviors, emotional manifestations, and experience during the activity of 3 people with dementia residing in a specialized dementia unit. The study used an A-B-A-B withdrawal single-case experimental design with two 5-session phases, baseline and DAT, replicating the same activities in each phase. The sessions were recorded and 2 independent coders quantified the frequency of social behaviors along with an assessment of the emotional manifestations and experience during the activity. Comparing with baseline sessions, DAT sessions showed an increase in prosocial behaviors (leans, looks, and verbalizations) and a significant impact on emotional manifestations with heightened pleasure. Dog-assisted therapy sessions also led to a better experience, with higher participation, pleasure, and relationship with others, together with lower rejection and displeasure than in the baseline sessions. Dog-assisted therapy seems to be a nonpharmacological therapy with potential to improve quality of life of people with dementia through promoting social behaviors and positive emotional manifestations.

A pilot study on the impact of a pottery workshop on the well-being of people with dementia.

OBJECTIVE: This study seeks to assess the impact of a pottery workshop as a creative arts programme and discover the extent to which people with dementia taking part in an artistic and creative activity engage with it, experience a feeling of well-being, and improve their mood state. In addition, the study will seek to answer the question of whether taking part in a programme of creative activities improves the self-esteem of people with dementia. METHOD: The research used an uncontrolled, repeated measures design. Thirty users of the National Reference Centre for Alzheimer's and Dementia care in Salamanca (Spain) in a moderate to advanced stage of dementia (Global Deterioration Scale 4, 5, or 6) were divided into five intervention groups that received ten 45-minute sessions in which they were helped by facilitators to make different ceramic pieces. The participants were assessed before and after the intervention with a self-esteem scale, and they rated their mood before and after the sessions on a graphic scale. During the art sessions, two observers recorded the presence of multiple indicators of well-being. RESULTS: The intervention was found to have a significant impact on mood and self-esteem that was independent of the participants' Global Deterioration Scale. Regarding the tool used to observe well-being, the participants scored highly in the domains of sustained attention, pleasure, self-esteem, and normalcy, with low scores in negative affect and sadness. CONCLUSIONS: Pottery may be a highly suitable activity for people with dementia, as they may enjoy both the activity and the creative process, with it triggering a positive mood during the sessions, providing psychological well-being and reinforcing their self-esteem.

Síntomas disejecutivos y reflejos frontales en pacientes con enfermedad de Alzheimer / Dysexecutive symptoms and frontal reflexes in patients with Alzheimer disease

INTRODUCCIÓN. La enfermedad de Alzheimer, supone la primera causa de demencia y produce múltiples alteraciones cognitivas como la afectación de las funciones ejecutivas. Esos pacientes presentan síntomas disejecutivos y alteración en los reflejos de liberación frontal, aunque se desconoce si están afectados en función del grado de severidad de la demencia. OBJETIVO. Determinar si existe una relación entre los Síntomas Disejecutivos y los Reflejos de Liberación Frontal en pacientes con enfermedad de Alzheimer. MATERIALES Y MÉTODOS. Se realizó un estudio descriptivo, retrospectivo; se analizaron 23 pacientes con demencia tipo Alzheimer del Centro de Referencia Estatal de Atención a Personas con Enfermedad de Alzheimer, durante el periodo 2013-2014. Los datos fueron obtenidos mediante el cuestionario disejecutivo, y analizados mediante la prueba X2 y la U de Mann-Whitney. RESULTADOS. Las edades de los participantes oscilaron entre 55 y 90 años. La media de puntuaciones según el cuestionario disejecutivo, arrojó un valor de 21,69. En la planificación se observó diferencias significativas entre los pacientes con Alzheimer leve y moderado (p=0,020); así como, entre la fase leve y la moderadamente grave (p=0,014). En la conciencia social resultó similar entre la etapa leve y la moderada (p=0,036). CONCLUSIÓN. Los reflejos de liberación frontal y los síntomas disejecutivos estuvieron afectados, pero no se evidenció relación entre estos y el grado de severidad de enfermedad de Alzheimer. Se refutó la hipótesis que, a mayor grado de severidad, mayor afectación disejecutiva y de los reflejos de liberación frontal.

INTRODUCTION. Alzheimer's disease is the leading cause of dementia and produces multiple cognitive disorders such as the involvement of executive functions. These patients present with dysexecutive symptoms and impaired frontal release reflexes, although it is unknown whether they are affected depending on the severity of the dementia. OBJECTIVE. To determine if there is a relationship between the Dissecutive Symptoms and the Frontal Release Reflexes in patients with Alzheimer's disease. MATERIALS AND METHODS. A descriptive, retrospective study was carried out; 23 patients with Alzheimer's dementia from the State Reference Center for Care for People with Alzheimer's Disease were analyzed during the 2013-2014 period. The data were obtained through the dissertation questionnaire, and analyzed using the X2 test and the Mann-Whitney U test. RESULTS. The ages of the participants ranged from 55 to 90 years. The average of scores according to the executive questionnaire showed a value of 21,69. In the planning, significant differences were observed between patients with mild and moderate Alzheimer's disease (p = 0.020); as well as between the mild and moderately severe phase (p = 0.014). In social consciousness it was similar between the mild and moderate stages (p = 0.036). CONCLUSION. Frontal release reflexes and dissecting symptoms were affected, but no relationship between them and the severity of Alzheimer's disease was evident. The hypothesis was refuted that, to a greater degree of severity, greater disejecutiva involvement and frontal release reflexes.

Tratamiento no farmacológico en demencias: efectividad de los animales robóticos / Non-pharmacological treatment of dementia: effectiveness of robotic animals

El Centro de Referencia Estatal de atención a personas con enfermedad de Alzheimer y otras demencias (CREA) cuenta con un programa de terapias no farmacológicas (TNF) al que se van incorporando intervenciones novedosas, adaptándonos a los cambios sociales y tecnológicos. Una de las TNF que más interés ha generado en los últimos años es la Roboterapia, el uso de robots sociales con forma de animal. Numerosos estudios han mostrado que la roboterapia tiene beneficios en las áreas social, afectiva, fisiológica y comportamental, pudiendo repercutir en la calidad de vida de la persona con demencia. A este respecto desde el CREA se han realizado recientemente dos estudios: el primero de ellos para valorar la eficacia de la foca robótica Paro en la reducción de los síntomas psicológicos o conductuales y mejora de la calidad de vida; mientras que el segundo consistió en una comparación de las respuestas generadas por Paro o un cachorro de perro

The National Reference Centre for Alzheimer's and Dementia care (CREA) has a program of non-pharmacological therapies (NPT) to which new interventions are incorporated, adapting to social and technological changes. Robotherapy, the use of social robots in the form of animals, is a NPT that has attracted great interest in recent years. Numerous studies have shown that robotherapy has benefits in the social, affective, physiological and behavioural areas, and can have an impact on the quality of life of the person with dementia. In this regard, two studies have been carried out recently by CREA: the first of them to assess the effectiveness of the Paro robotic seal in reducing psychological or behavioural symptoms and improving quality of life; while the second consisted of a comparison of the responses generated by Paro or a puppy dog

Propiedades psicométricas del Profile of Mood States (POMS) en personas con demencia y su aplicación en la evaluación de los efectos de la danza creativa terapéutica / Psychometric properties of Profile of Mood States (POMS) in people with dementia and its application in the evaluation of the effects of therapeutic creative dance

Introducción. Existe una creciente necesidad de estudios científicos e instrumentos que permitan evaluar los efectos en el plano afectivo de algunas terapias no farmacológicas para personas con demencia, como la danza creativa terapéutica. Objetivos. Determinar la validez y fiabilidad del Profile of Mood States (POMS) en personas con demencia y analizar las posibles diferencias en las puntuaciones de los participantes antes y después de sesiones de danza creativa terapéutica. Pacientes y métodos. El POMS se administró a 36 personas con demencia antes y después de cuatro sesiones grupales de danza creativa terapéutica. Para comprobar la validez de constructo se administraron dos cuestionarios autoinformados (PANAS y STAXI-2). Resultados. El POMS presentó una buena consistencia interna para cada factor y excelente para la escala total. La estabilidad temporal fue media-alta. Los resultados de validez convergente apoyan la validez de constructo. Después de las sesiones de danza creativa terapéutica, los factores tensión, depresión y confusión del POMS se redujeron, mientras que el factor vigor aumentó significativamente. No hubo ningún efecto sobre la fatiga y la cólera. Conclusiones. Se ha demostrado la validez y fiabilidad del POMS en una población con demencia. La danza creativa terapéutica puede ofrecer beneficios emocionales para personas con demencia

Introduction. There is a growing need for scientific studies and tools that allow the evaluation of the effects at an affective level of some non-pharmacological therapies for people with dementia such as the creative therapeutic dance. Aims. To explore the validity and reliability of the Profile of Mood States (POMS) in people with dementia and to analyse the possible differences in the scores of the participants before and after sessions of creative therapeutic dance. Patients and methods. POMS was administered to 36 people with dementia before and after four group sessions of creative therapeutic dance. To verify the construct validity, PANAS and STAXI-2 were also administered. Results. The POMS presented a good internal consistency for each factor and an excellent one for the total scale. The temporal stability was medium-high. Convergent validity results support construct validity. After the creative therapeutic dance sessions, POMS factors tension, depression and confusion were reduced, while vigour increased significantly. There was noeffect on fatigue and anger.Conclusions. The validity and reliability of POMS have been demonstrated in a population with dementia. Creative therapeutic dance can offer emotional benefits for people with dementia

[Emotion and recognition memory: the discrimination of negative information as an adaptive process]. / Emoción y memoria de reconocimiento: la discriminación de la información negativa como un proceso adaptativo.

We studied the effect of emotion generated by IAPS (International Affective Picture System) pictures on incidental recognition of these pictures for short retention periods (15 min). Memorization distraction tasks and reaction time tasks were used together with short exposure times (2 seconds per picture) in order to prevent a high recognition rate that would impede testing for the effect of emotion on discrimination parameters (A´) and response bias (B´´D) (ceiling effect). We used 80 pictures representing the medium and high levels of two-dimensional emotional space. The results showed greater discrimination and a more conservative response style to unpleasant and medium arousal level pictures. These pictures produced higher confidence and lower response times in the recognition phase. The results can be explained by the negative content of the pictures and activation level effects on attentional processing and memory, and can be interpreted as a phenomenon that is evolutionarily adaptive.

Emoción y memoria de reconocimiento: la discriminación de la información negativa como un proceso adaptativo / Emotion and recognition memory: The discrimination of negative information as an adaptive process

Se estudió el efecto de la emoción generada a través de fotografías del IAPS (International Affective Picture System) sobre el reconocimiento incidental de dichas fotografías con períodos de retención cortos (15 min). Se utilizaron tareas distractoras de memorización y tiempo de reacción, junto a tiempos de exposición breves (2 segundos por fotografía), con el fin de evitar que la elevada tasa de reconocimiento presente en este tipo de trabajos impida comprobar el efecto de la emoción sobre los parámetros de discriminación (A´) y sesgo de respuesta (B´´D) (efecto techo). Para este fin se utilizaron 80 fotografías representativas de los niveles medio y alto del espacio afectivo bidimensional. Los resultados informan de una mayor discriminación y un estilo de respuesta más conservador para las fotografías desagradables y las de arousal medio. Para este tipo de fotografías se obtuvo una mayor confianza y menores tiempos de respuesta en la fase de reconocimiento. Los resultados pueden explicarse por los efectos que el contenido negativo y el nivel de activación de las fotografías tienen sobre el procesamiento atencional y la memoria, e interpretarse como un fenómeno que resulta adaptativo evolutivamente (AU)

We studied the effect of emotion generated by IAPS (International Affective Picture System) pictures on incidental recognition of these pictures for short retention periods (15 min). Memorization distraction tasks and reaction time tasks were used together with short exposure times (2 seconds per picture) in order to prevent a high recognition rate that would impede testing for the effect of emotion on discrimination parameters (A´) and response bias (B´´D) (ceiling effect). We used 80 pictures representing the medium and high levels of two-dimensional emotional space. The results showed greater discrimination and a more conservative response style to unpleasant and medium arousal level pictures. These pictures produced higher confidence and lower response times in the recognition phase. The results can be explained by the negative content of the pictures and activation level effects on attentional processing and memory, and can be interpreted as a phenomenon that is evolutionarily adaptive (AU)