Usability study and pilot validation of a computer-based emotion recognition test for older adults with Alzheimer's disease and amnestic mild cognitive impairment.

OBJECTIVES: This study aimed to carry out a pilot validation of Affect-GRADIOR, a computer-based emotion recognition test, with older adults. The study evaluated its usability, reliability and validity for the screening of people with Alzheimer´s disease (AD) and amnestic mild cognitive impairment (aMCI). METHODS: The test was administered to 212 participants (76.37 ± 6.20 years) classified into three groups (healthy controls, n = 69; AD, n = 84; and aMCI, n = 59) on the basis of detailed neurological, neuropsychological, laboratory and neuro-imaging evidence. Data on usability were collected by means of a questionnaire and automated evaluation. RESULTS: The validated test comprised 53 stimuli and 7 practice items (one per emotion). Participants reported that Affect-GRADIOR was accessible and user-friendly. It had high internal consistency (ordinal Cronbach's α = 0.96). Test-retest reliability correlations were significant and robust (r = 0.840, p < 0.001). Exploratory factor analysis supported a seven-factor model of the emotions assessed (neutral expression, happiness, surprise, disgust, sadness, anger and fear). Receiver operating characteristic curve analyses suggested that the test discriminated healthy older adults from AD and aMCI cases. Correct answer score improved MMSE predictive power from 0.547 to 0.560 (Cox & Snell R2, p = 0.012), and Affect-GRADIOR speed of processing score improved MMSE predictive power from 0.547 to 0.563 (Cox & Snell R2, p = 0.010). CONCLUSIONS: Affect-GRADIOR is a valid instrument for the assessment of the facial recognition of emotions in older adults with and without cognitive impairment.

ELECTRONIC DEVICES FOR COGNITIVE IMPAIRMENT SCREENING: A SYSTEMATIC LITERATURE REVIEW.

OBJECTIVES: The reduction in cognitive decline depends on timely diagnosis. The aim of this systematic review was to analyze the current available information and communication technologies-based instruments for cognitive decline early screening and detection in terms of usability, validity, and reliability. METHODS: Electronic searches identified 1,785 articles of which thirty-four met the inclusion criteria and were grouped according to their main purpose into test batteries, measures of isolated tasks, behavioral measures, and diagnostic tools. RESULTS: Thirty one instruments were analyzed. Fifty-two percent were personal computer based, 26 percent tablet, 13 percent laptop, and 1 was mobile phone based. The most common input method was touchscreen (48 percent). The instruments were validated with a total of 4,307 participants: 2,146 were healthy older adults (M = 73.59; SD = 5.12), 1,104 had dementia (M = 74.65; SD = 3.98) and 1,057 mild cognitive impairment (M = 74.84; SD = 4.46). Only 6 percent were administered at home, 19 percent reported outcomes about usability, and 22 percent about understandability. The methodological quality of the studies was good, the weakest methodological area being usability. Most of the instruments obtained acceptable values of specificity and sensitivity. CONCLUSIONS: It is necessary to create home delivered instruments and to include usability studies in their design. Involvement of people with cognitive decline in all phases of the development process is of great importance to obtain valuable and user-friendly products. It would be advisable for researchers to make an effort to provide cutoff points for their instruments.

Rehabilitación del reconocimiento de emociones combinada con estimulación cognitiva para personas con enfermedad de Alzheimer. Eficacia sobre aspectos cognitivos y funcionales / Emotion recognition rehabilitation combined with cognitive stimulation for people with Alzheimer’s disease. Efficacy for cognition and functional aspects

Introducción. Se han encontrado déficits en el reconocimiento de emociones en personas con enfermedad de Alzheimer (EA), pero no se ha informado de ningún tratamiento rehabilitador de esta capacidad en esta población. Objetivo. Evaluar la eficacia de un tratamiento combinado de rehabilitación del reconocimiento de emociones (RRE) y estimulación cognitiva (EsC) sobre las funciones cognitivas, el estado de ánimo, la anosognosia, la capacidad funcional y el reconocimiento de emociones de personas con EA. Sujetos y métodos. En un diseño cuasi experimental, 36 pacientes con EA fueron asignados a tres condiciones: un grupo experimental, que recibió 20 sesiones de RRE y 20 sesiones de EsC; un grupo control, que recibió 40 sesiones de EsC, y un grupo que recibió tratamiento usual (GTU). Resultados. Completaron el estudio 32 pacientes, con una edad media de 77,53 ± 5,43 años. Se observó mejoría en el Minimental State Examination en su versión de 30 ítems (F = 5,10; p = 0,013) y en la de 35 (F = 4,16; p = 0,026), reconocimiento de afectos (Z = -2,81; p = 0,005) y actividades básicas de la vida diaria (Z = -2,27; p = 0,018) a favor del grupo experimental. El grupo que recibió tratamiento usual empeoró en depresión (Z = -1,99; p = 0,048), apatía (Z = -2,30; p = 0,022) y anosognosia (Z = -2,19; p = 0,028). Conclusiones. El tratamiento combinado de RRE y EsC fue más eficaz que la EsC y que el tratamiento usual. Es la primera vez que se informa de un tratamiento rehabilitador del reconocimiento de emociones en personas con EA (AU)

Introduction. The ability to recognize facial emotional expression is essential for social interactions and adapting to the environment. Emotion recognition is impaired in people with Alzheimer’s disease (AD), thus rehabilitation of these skills has the potential to elicit significant benefits. Aim. To assess the efficacy of a combined treatment of rehabilitation of emotion recognition (RER) and cognitive stimulation (CS) for people with AD, due to its potential implications for more effective psychosocial interventions. Subjects and methods. 36 patients were assigned to one of three experimental conditions: an experimental group (EG) that received 20 sessions of RER and 20 sessions of CS; a control group (CG) that received 40 sessions of CS, and a treatment as usual group (TAU). Results. 32 patients completed the treatment (77.53 ± 5.43 years). Significant differences were found in MMSE30 (F = 5.10; p = 0.013), MMSE35 (F = 4.16; p = 0.026), affect recognition (Z = -2.81; p = 0.005) and basic activities of daily living (Z = -2.27; p = 0.018) favouring the efficacy of the combined treatment. The TAU group showed a decline in depression (Z = -1.99; p = 0.048), apathy (Z = -2.30; p = 0.022) and anosognosia (Z = -2.19; p = 0.028). Conclusions. The combined treatment of RER + CS was more effective than TAU and CS alone for the treatment of patients with AD. This is the first study about the rehabilitation of affect recognition in AD (AU)

Intervenciones online para cuidadores de personas con demencia: revisión sistemática / Online interventions for caregivers of people with dementia: a systematic review

Introducción. La población de edad avanzada está creciendo debido al aumento de la esperanza de vida, lo que lleva a un incremento de personas con enfermedades crónicas, como la demencia. La mayoría de la población que sufre esta enfermedad es atendida por cuidadores informales, quienes juegan un papel muy importante en el cumplimiento de las necesidades, favoreciendo que puedan seguir viviendo en su ambiente. Internet se presenta como una herramienta de apoyo a los programas de psicoeducación que mejore la accesibilidad de los mismos, estableciéndose, en la actualidad, como un recurso interactivo para la formación de pacientes con enfermedades agudas y crónicas así como a sus cuidadores. Población y método. Mediante una búsqueda bibliográfica en las bases de datos Pubmed, PsyINFO, Scopus, SciELO y Psicodoc, se revisaron sistemáticamente los estudios relativos a intervenciones basadas en internet para cuidadores informales de personas con demencia o deterioro cognitivo. Resultados. En conjunto, los estudios indican una mejoría significativa tras la intervención psicoeducativa. Concretamente, la mejora del bienestar de los cuidadores se aprecia en las medidas de autoeficacia, ansiedad y depresión. Conclusiones. Las intervenciones online constituyen una estrategia prometedora para la intervención de cuidadores de personas con demencia. Serían convenientes mayores estudios aleatorizados, que evalúen tanto los motivos de falta de adherencia a la intervención como estudios de usabilidad de los diversos programas de software empleados (AU)

Introduction. The elderly population is growing driven by the increase in life expectancy, which in turn entails an increase in the number of people with chronic diseases such as dementia. The vast majority of people suffering from this illness is assisted by informal caregivers, who play a key role in fulfilling the patients’ needs, promoting the possibility for people with dementia to live in their home environment. The Internet as a support tool in psychoeducational programs can significantly improve accessibility of them, becoming a currently consolidated interactive resource for the training of patients with acute and chronic diseases, and their caregivers. Population and method. A literature search of the Pubmed, PsyINFO, Scopus, SciELO and Psicodoc databases was performed to systematically review those studies related to web-based interventions for informal caregivers of people with dementia or cognitive impairment. Results. On balance, the studies show a significant improvement after the psychoeducational intervention. Specifically, the improvement in caregivers’ wellbeing can be observed in the measures for self-efficacy, anxiety and depression. Conclusions. Online interventions are a promising strategy for the care of people with dementia. It would be advisable to perform further randomized trials to assess the reasons for lack of adherence to intervention, as well as usability studies to test the different software programs used (AU)

The Efficacy of Emotion Recognition Rehabilitation for People with Alzheimer's Disease.

BACKGROUND: The ability to recognize emotional expression is essential for social interactions, adapting to the environment, and quality of life. Emotion recognition is impaired in people with Alzheimer's disease (AD), thus rehabilitation of these skills has the potential to elicit significant benefits. OBJECTIVE: This study sought to establish whether emotion recognition capacity could be rehabilitated in people with AD. METHODS: Thirty-six participants with AD were assigned to one of three conditions: an experimental group (EG) that received 20 sessions of rehabilitation of emotion recognition and 20 sessions of cognitive stimulation therapy (CST), a control group (CG) that received 40 sessions of CST, and a treatment as usual group (TAU). RESULTS: A positive treatment effect favoring the EG was found; participants were better able to correctly identify emotions (p = 0.021), made fewer errors of commission (p = 0.002), had greater precision of processing (p = 0.021), and faster processing speed (p = 0.001). Specifically, the EG were better able to identify sadness (p = 0.016), disgust (p = 0.005), and the neutral expression (p = 0.014), with quicker processing speed for disgust (p = 0.002). These gains were maintained at one month follow-up with the exception of processing speed for surprise, which improved. CONCLUSION: Capacity to recognize facial expressions of emotions can be improved through specific rehabilitation in people with AD, and gains are still present at a one month follow up. These findings have implications for the design of rehabilitation techniques for people with AD that may lead to improved quality of life and social interactions for this population.

Computer-based cognitive interventions for people living with dementia: a systematic literature review and meta-analysis.

OBJECTIVES: To estimate the efficacy of computer-based cognitive interventions for improving cognition in people with dementia (PWD). METHOD: Online literature databases were searched for relevant studies. Interventions were categorised as follows: cognitive recreation, cognitive rehabilitation, cognitive stimulation or cognitive training. A systematic review, quality assessment and meta-analyses were conducted. RESULTS: Twelve studies were identified. Their methodological quality was acceptable according to Downs & Black criteria, the weakest methodological area being the external validity. The meta-analyses indicated cognitive interventions lead to beneficial effects on cognition in PWD (SMD 0.69; 95% CI = 1.02-0.37; P < 0.0001; I(2) = 29%), [corrected] depression (SMD 0.47; 95% CI = 0.16-0.78; P = 0.003; I(2) = 0%) and anxiety (SMD 0.55; 95% CI = 0.07-1.04; P < 0.03; I(2) = 42%). [corrected]. They benefited significantly more from the computer-based cognitive interventions than from the non-computer-based interventions in cognition (SMD 0.48; 95% CI = 0.09-0.87; [corrected] P = 0.02; I(2) = 2%). CONCLUSION: Computer-based cognitive interventions have moderate effects in cognition and [corrected] anxiety and small effects in depression in PWD. No significant effects were found on activities of daily living. They led to superior results compared to non-computer-based interventions in cognition. Further research is needed on cognitive recreation and cognitive stimulation. There is also a need for longer term [corrected] follow-up to examine the potential retention of treatment effects, and for the design of specific outcome measures.

Structure of Enhanced Cued Recall Task in the 7 Minute Screen Test.

Episodic memory in the 7 Minute Screen is assessed by the Enhanced Cued Recall (ECR) test. The ECR test is composed of three phases, Identification, Immediate Recall, and Free and Cued Recall. However, just the last phase is considered for the total score. We believe that collecting the performance data of the Identification and Immediate Recall phases could provide information regarding possible difficulties or impairments in the different aspects involved in the temporal mnesic process of acquisition of new information, such as in working memory or visual identification. The objective was to assess the goodness of fit for the three phases of the ECR test using a Confirmatory Factor Analysis (CFA) to show if each phase is separated from each other as a different aspect that participates in the mnesic process. A total of 311 participants greater than 65 years were included in this study. Confirmatory factor analyses were conducted for each individual phase. The analyses show that the ECR test consists of three separate phases that identify different steps of the mnesic process. Individual scores for each phase could allow for investigation of patient performance in different aspects of the memory process and could help in further neuropsychological assessment.

Deterioro cognitivo y factores asociados. Estudio DERIVA / Cognitive impairment and associated factors. DERIVA study

Diversos factores sociodemográficos, funcionales y clínicos han sido asociados a la prevalencia de deterioro cognitivo (DC) en las personas mayores de 65 años. Objetivo: estudiar la relación entre la presencia de DC y factores sociodemográficos y clínicos en una población urbana de mayores de 65 años. Método: los 327 participantes del estudio DERIVA, mayores de 65 años, se clasificaron en participantes sin DC (n = 265) y con DC (n = 62). Se les aplicó el OARS MFAQ, el índice de Katz y el de comorbilidad de Charlson para obtener datos sociodemográficos, de funcionalidad y comorbilidad. Se realizó un análisis de regresión logística para conocer los factores de riesgo de DC. Resultados: la edad (odds ratio [OR] = 1,08; intervalo de confianza [IC] del 95 %, 1,03-1,12]; p < 0,01), la presencia de ansiedad-depresión (OR = 3,47; IC del 95 %, 1,61-7,51; p < 0,01) y la diabetes (OR = 2,07; IC del 95 %, 1,02-4,18; p = 0,04) se comportan como factores de riesgo, mientras que los años de estudio se muestran como un factor protector (OR = 0,79; IC del 95 %, 0,70-0,90; p < 0,01). Conclusión: sería conveniente realizar un seguimiento de los factores relacionados con la ansiedad-depresión y la diabetes, ya que aquellas personas mayores de 65 años que los presenten pueden tener mayor riesgo de desarrollar DC (AU)

Certain sociodemographic, functional and clinical factors have been associated to the prevalence of cognitive impairment (CI) among people older than 65 years old. Aim: To study the association between CI and sociodemographic and clinical factors in an urban sample older than 65 years old. Method: 327 participants from DERIVA Study older than 65 years old classified into the group without CI (n = 265) and with CI (n = 62). OARS-MFAQ, Katz Index and Charlson comorbidity Index to obtain sociodemographic, functional and comorbidity data. A logistic regression analysis to know risk factors of CI was performed. Results: Age (OR = 1.08; 95 % CI, 1.03-1.12; p < 0.01), anxiety-depression (OR = 3.47; 95 % CI, 1.61-7.51; p < 0.01) and diabetes (OR = 2.07; 95 % CI, 1.02-4.18; p = 0.04) were risk factors of CI, whereas years of education was a protector factor (OR = 0.79; 95 % IC, 0.70-0.90; p < 0.01). Conclusion: It’d be convenient to follow patients that present these factors related to anxietydepression and diabetes, since people older than 65 years old presenting them, can have more risk of developing CI (AU)

Deterioro cognitivo leve: detección temprana y nuevas perspectivas / Mild cognitive impairment: early detection and new perspectives

Introducción. En los últimos años ha habido un creciente interés en el estudio del deterioro cognitivo leve (DCL) y su detección temprana. A diferencia de las primeras teorías, tendencias actuales e internacionales de investigación nos sugieren que el DCL es un síndrome que se caracteriza por presentar alteración en una o más funciones cognitivas superiores, sin interferir en las habilidades funcionales de la vida diaria y acompañado de una preocupación por el cambio cognitivo producido. Aunque la detección temprana del DCL se suele realizar mediante tests de rastreo cognitivo, la mayoría de ellos no parecen detectar correctamente el DCL, a diferencia de la demencia. Objetivo. Exponer un análisis de las pruebas de rastreo cognitivo más recomendables para utilizar en la clínica habitual para la detección del DCL, basándose en las actuales tendencias de investigación. Desarrollo y conclusiones. Existen tres tipos de tests de rastreo cognitivo: los tests de rastreo generales, los de rastreo específico y los de rastreo de un subtipo de DCL. Observamos que la mayoría de los tests no se ajustan a los criterios de DCL actuales. En este sentido, proponemos la aplicación conjunta de tests, así como la necesidad de ser cautos en su elección, para poder detectar más eficazmente el DCL en la práctica clínica (AU)

Introduction. Along past years, interest in mild cognitive impairment (MCI) research and its early detection has been increased. Unlike first theories, international current proposals suggest that MCI is a syndrome characterized by an impairment in one or more cognitive functions without interfering in daily functional abilities and it is also accompanied by a concern because of the cognitive change. Although early MCI detection is usually made by cognitive screening tests, most of them do not seem to correctly detect MCI, but dementia. Aim. To expose an analysis of the cognitive screening tests more suitable for clinical MCI detection, according to current researches. Development and conclusions. There are three kind of cognitive screening tests: general cognitive screening tests, specific cognitive screening tests and MCI-subtype cognitive screening test. We observe that most of the tests don’t follow current MCI criteria. In this respect we propose to jointly apply tests, as well as the necessity of a carefully test choice to effectively detect MCI in clinical practice (AU)

Detection of mild cognitive impairment in people older than 65 years of age and its relationship to cardiovascular risk factors (DECRIVAM).

BACKGROUND: Studies centered on the detection of cognitive impairment and its relationship to cardiovascular risk factors in elderly people have gained special relevance in recent years. Knowledge of the cardiovascular risk factors that may be associated to cognitive impairment could be very useful for introducing treatments in early stages - thereby possibly contributing to improve patient quality of life.The present study explores cognitive performance in people over 65 years of age in Salamanca (Spain), with special emphasis on the identification of early symptoms of cognitive impairment, with the purpose of detecting mild cognitive impairment and of studying the relationships between this clinical situation and cardiovascular risk factors. METHODS/DESIGN: A longitudinal study is contemplated. The reference population will consist of 420 people over 65 years of age enrolled through randomized sampling stratified by healthcare area, and who previously participated in another study. MEASUREMENT: a) Sociodemographic variables; b) Cardiovascular risk factors; c) Comorbidity; d) Functional level for daily life activities; and e) Study of higher cognitive functions based on a neuropsychological battery especially adapted to the evaluation of elderly people. DISCUSSION: We hope that this study will afford objective information on the representative prevalence of cognitive impairment in the population over 65 years of age in Salamanca. We also hope to obtain data on the relationship between cognitive impairment and cardiovascular risk factors in this specific population group. Based on the results obtained, we also will be able to establish the usefulness of some of the screening tests applied during the study, such as the Mini-Mental State Examination and the 7 Minute Screen test. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01327196.

[Long-term cognitive deficits in patients operated on for cerebral aneurysm by craniotomy and clipping]. / Déficits cognitivos a largo plazo en pacientes intervenidos de un aneurisma cerebral mediante craneotomía y clipaje.

INTRODUCTION: An important number of patients continue to present cognitive disorders after cerebral aneurysm surgeries, not only within the acute phase but also years after the subarachnoid hemorrhage and in spite of their good functional recovery. GOALS: The percentage of patients who continues to present cognitive alterations after 4 years of cerebral aneurysm surgery is studied within a sample of people who had pterional craniotomy and ICA clipping (Intracranial Aneurysm Clips). The repercussions on their daily life activities and quality of life are also considered and we analyze how are these deficits related to the cerebral location of the aneurysm. SAMPLE AND METHOD: Twenty-nine adults of both sexes, without cognitive disorder or psychiatric precedents who had an aneurysm surgery in different cerebral locations. RESULTS AND CONCLUSIONS: All the patients were independent in their daily life activities. The majority of the patients had good neurological resolution four years after the surgery and their cognitive performances were within the normality. Nevertheless, there is a small group that continues to present cognitive performances below what was expected for their age and educational level. The performances in cognitive tasks of attention, temporalspatial orientation, visual naming, memory, auditory verbal learning, visual-constructive skills and executive function do not depend on the cerebral location of the aneurysm.

Rendimientos mnésicos en traumatismo craneoencefálico moderado al año / Mnesic performances one year after moderate traumatic brain injury

Las alteraciones raciones mnésicas han sido ampliamente estudiadas on traumatismo craneoencefálico (TCE) leve y severo, existiendo pocos datos en relación a los pacientes con TCE moderado. El objetivo es estudiar la existencia o no de alteraciones mnésicas en TCE moderado al año del traumatismo comparándolo con los rendimientos de sujetos adultos normales. Muestra: 28 sujetos adultos con TCE moderado y 28 sujetos normales con características demográficas similares. Material: Span de dígitos; Test de Aprendizaje Auditivo Verbal de Rey; Historia de Babcock; Test de Retención Visual de Benton y Figura Compleja de Rey de memoria. Análisis estadísticos, Anova de medidas repetidas. Los pacientes al año del traumatismo no alcanzan los patrones de normalidad en sus rendimientos en memoria verbal lógica demorada en un 60 por ciento, en un 57 por ciento en aprendizaje y en un 86 por ciento en la capacidad de retención auditiva verbal. En memoria visuoconstructiva y en memoria visuoespacial están dentro del rango de la normalidad el 64 por ciento y el 75 por ciento respectivamente. (AU)

Mnesic alterations have been largely studied in mild and severe traumatic brain injury (TBI), but there are few data about patients with moderate TBI. Our objective is to study the existence of mnesic alterations in moderate TBI after one year in comparison with performance of normal adult subjects. Sample: 28 adult subjects with moderate TBI and 28 normal subjects with similar demographical characteristics. Material: Digit span; Rey’s Audio-verbal Learning Test; Babcock story; Benton’s Visual retention Test; and Re’y Complex figure. Statistical analyses: repeated measures Anova. One year after traumatic injury, patients dot not attain normal patters in their performances in logical, verbal memory, at 60%; at 57% in learning; and 86% in audio-verbal retention capacity. Visuocontractive memory and visuospatial memory are within the limits of normality, at 64% and 75% respectively (AU)

Aprendizaje verbal en el traumatismo craneoencefálico / Verbal learning in traumatic brain injury

Las dificultades en el aprendizaje, los déficits en la evocación de nueva información y la reducción del span son frecuentes en sujetos que han sufrido un traumatismo craneoneoencefálico (TCE) e incluso pueden persistir durante años. En este trabajo estudiamos la evocación inmediata, aprendizaje y recuerdo verbal, a través del aprendizaje de una lista de palabras (Test de aprendizaje auditivo verbal de Rey -TAVR -; Rey 1964) en pacientes que han sufrido un TCE, contemplando en el análisis la influencia de la evolución sobre los rendimientos, comparando los resultados obtenidos en el TAVR en diferentes momentos evolutivos (desde el ingreso hasta el año). Muestra: 100 sujetos adultos con TCE estudiados en cuatro momentos evolutivos y 1000 sujetos adultos normales con características demográficas similares. Análisis estadísticos: Anovas de medidas repetidas y prueba aposteriori Scheffe F-test. Los resultados ponen de manifiesto que la capacidad para realizar tareas de evocación inmediata alcanza a partir de los seis meses los límites de la normalidad. Sin embargo, el aprendizaje verbal y la capacidad de retención del material, continúan alterados en los estudios realizados al año del TCE (AU)

Difficulties in learning, deficits in new information recall, and span reduction are recurrent in subjects who have incurred in Traumatic Brain Injury (TBI) and may endure for years. In the present study, we have studied immediate recall, verbal learning and recollection, through the learning of a list of words (Rey Auditory-Verbal Learning Test - RAVLT - ; Rey 1964) in TBI patients. We have analysed the effects of evolution on performances, comparing results in RAVLT in different evolutionary stages (from clinic intake to one year following TBI). Sample: 100 adult subjects with TBI studied in 4 evolutionary stages and 100 normal adult subjects with similar demographic characteristics. Statistical analysis: repeated measure Anovas and a posteriori Scheffe F-test. The results show that the ability to perform immediate recall tasks reaches a normal level after six months. Verbal learning and material retention ability, however, are still altered in studies one year after TBI (AU)