The effects of individual music therapy in nursing home residents with dementia to improve general well-being: study protocol of a randomized controlled trial.

BACKGROUND: Dementia is often associated with Neuropsychiatric Symptoms (NPS) such as agitation, depression, hallucinations, anxiety, that can cause distress for the resident with dementia in long-term care settings and can impose emotional burden on the environment. NPS are often treated with psychotropic drugs, which, however, frequently cause side effects. Alternatively, non-pharmacological interventions can improve well-being and maintain an optimal quality of life (QoL) of those living with dementia. Other QoL related outcomes, such as pain, discomfort and sleep disruption are relevant outcomes in music trials as well. Music therapy is a non-pharmacological intervention that can reduce NPS and improve well-being, and its associated symptoms in dementia. METHODS: The research will be conducted at eight nursing home facilities of a health care organization in the Netherlands. A sample size of 30 in each group (experimental and control group) is required, totalling 60 residents increased to 80 when considering expected drop out to follow up. The participants in the intervention group receive 30 min of individual music therapy (MT) in their own room by a music therapist twice a week for 12 weeks. The participants in the control group will receive 30 min of individual attention in their own room by a volunteer twice a week for 12 weeks. Assessments will be done at baseline, 6 weeks and 12 weeks. An independent observer, blinded for the intervention or control condition, will assess directly observed well-being (primary outcome) and pain (secondary outcome) before and after the sessions. Nurses will assess other secondary outcomes unblinded, i.e., perceived quality of life and NPS, both assessed with validated scales. The sleep duration will be indirectly assessed by a wrist device called MotionWatch. Information about psychotropic drug use will be derived from electronic medical chart review. DISCUSSION: The main purpose of this study is to assess the effects of individual music therapy on directly observed well-being controlled for individual attention in nursing home residents with dementia with NPS. The outcomes refer to both short-term and long-term effects consistent with therapeutic goals of care for a longer term. We hope to overcome limitations of previous study designs such as not blinded designs and music facilitators that were not only music therapists but also occupational therapists and nurses. This study should lead to more focused recommendations for practice and further research into non-pharmacological interventions in dementia such as music therapy. TRIAL REGISTRATION: The trial is registered at the International Clinical Trials Registry Platform (ICTRP) search portal in the Netherlands Trial Registration number NL7708, registration date 04-05-2019.

Active music making and leisure activities for people with intellectual disabilities: A cluster randomized pilot study.

AIM: A pilot cluster randomized controlled trial was performed to evaluate the effects of a music group intervention and a leisure activities group intervention on well-being, self-esteem, social acceptance, challenging behaviour and three components of executive functions (inhibitory control, cognitive flexibility and visual working memory) of adults with intellectual disabilities (ID). METHOD: Twenty-nine participants living in four residential facilities for people with ID were randomized into a music or a leisure activities group intervention. Sixteen weekly sessions of one hour were performed with six to eight participants per group. Measurements were carried out at baseline, post-intervention and 11 weeks follow- up. Results were analysed with linear mixed models. RESULTS: The leisure activities group intervention improved more than the music group intervention on internalizing behaviour overall and on inhibitory control at post-intervention. However, further analyses showed that this improvement was only significant in one of the two leisure activities facilities. CONCLUSION: A leisure activities group intervention seems a promising intervention to improve internalizing behaviour and inhibitory control of younger adults with mild ID. Implications for the delivery of leisure activities group interventions and especially music group interventions are discussed. WHAT THIS PAPER ADDS: Involvement in leisure activities of people with ID is associated with better well-being, an improvement in social skills and a reduction in emotional and behavioural problems. Active music making, as a specific form of leisure activities, seems to improve well-being, social acceptance and challenging behaviour (CB) as well. Moreover, in different (non-clinical) groups a significant effect of active music making has been found on self-esteem and executive functioning (EF). So far, little attention has been paid to the possible positive effects of active music making on adults with ID. In the current paper, a randomized controlled trial (RCT) was conducted to compare the post-intervention and follow-up measurements with baseline measurements between a music group intervention and a leisure activities group intervention on well-being, self-esteem, social acceptance, CB and EF in adults with ID. Multilevel models were used to detect possible intervention effects of 16 weekly sessions. Overall, inhibitory control and internalizing behaviour improved more amongst the participants of the leisure activities group than amongst the participants of the music group. This was mainly the case for younger participants who had mild ID. These effects are discussed and recommendations regarding the improvement of a music intervention for people with ID are presented.

Prison and the brain.

Imprisonment is a common punishment in most countries. Goals of imprisonment are often not only retribution, but also prevention. Specific prevention aims to reduce the risk of reoffending of the imprisoned offender. The question is whether the goals of retribution and specific prevention contradict each other. Retribution is not only expressed in taking away ones freedom, but also in the prison environment itself. Prisoners live in a sober regime, with a minimal amount of autonomy. There are few cognitive challenges, meaningful social interaction is reduced significantly, and many prisoners are highly sedentary. In other words, prison can be viewed as an impoverished environment. In the last few decades, much knowledge has been gained on the influence of enriched versus impoverished environment on the brain. In this chapter, we discuss the influence of the impoverished prison environment on brain functions of prisoners, with an emphasis on self-regulation and executive functions, since these functions are (1) often impaired in offenders, (2) highly sensitive to environmental influences, and (3) crucial for successful resocialization. We conclude this chapter by discussing possibilities for and potential effects of enriching prison environments.

Aggressive Incidents by Incarcerated People With Psychiatric Illness and Their Relationship With Psychiatric Symptoms.

AIM: A prospective design was used to investigate the relationship of current psychiatric symptoms of incarcerated people with serious mental illness (SMI) and aggressive behavior on a penitentiary ward for crisis intervention. METHODS: One hundred sixty detainees with SMI, detained in a high-security penitentiary psychiatric facility, were screened every 2 weeks with the Brief Psychiatric Rating Scale-Extended (BPRS-E) by trained clinicians, to ensure that the data on psychiatric symptoms were up-to-date. Aggressive behavior was registered with the Staff Observation Aggression Scale-Revised. A binary logistic regression analysis was performed to examine the relationships between factor scores of the BPRS-E and aggressive behavior. RESULTS: Significant relationships between the BPRS-E factor hostility, antisocial traits, and aggressive incidents were found, but not between the positive symptoms or manic factor scores and aggressive incidents. DISCUSSION: Symptoms of SMI measured with the BPRS-E did not help to explain the occurrence of aggressive behavior. This is not in line with what is commonly found. The implication is that it can be expected that this population will display aggressive behavior but that symptoms do not help in predicting when this will occur. In addition, hostility and antisocial traits were related to aggressive behavior. For this specific population, an interactional approach might be more effective in the management of aggression than treatment of symptoms of SMI.

The effects of a moderate physical activity intervention on physical fitness and cognition in healthy elderly with low levels of physical activity: a randomized controlled trial.

BACKGROUND: Increasing physical activity is one of the most promising and challenging interventions to delay or prevent cognitive decline and dementia. METHODS: We conducted a randomized controlled trial to assess the effects of a physical activity intervention, aimed at increasing step count, in elderly with low levels of physical activity on measures of strength, balance, aerobic capacity, and cognition. Participants were assigned to 9 months of exercise counseling or active control. RESULTS: The intention-to-treat analyses show that the intervention, compared to control, increases the level of physical activity, but has no significant effect on physical fitness and cognition. Those who increased their physical activity with 35% or more show significant improvements in aerobic capacity, gait speed, verbal memory, executive functioning, and global cognition, compared to those who did not achieve a 35% increase. LIMITATIONS: The number of participants that achieved the intended improvement was lower than expected. CONCLUSION: Responder analyses suggest an improvement of physical fitness and cognition in those who achieved an increase in physical activity of at least 35%. TRIAL REGISTRATION: The trial protocol is registered at the Dutch Trial Register NL5675, August 1, 2016.

The long-term relation between physical activity and executive function in the Rotterdam Study.

BACKGROUND: Research on the association between physical inactivity and cognitive decline and dementia is dominated by studies with short-term follow-up, that might be biased by reverse causality. OBJECTIVE: Investigate the long-term association between physical activity, cognition, and the rate of age-associated cognitive decline. METHODS: We investigated the association between late-life physical activity and executive functioning and rate of decline of executive abilities during follow-up of up to 16 years, in 3553 participants of the prospective Rotterdam Study cohort. Measurement took place in 1997-1999, 2002-2004, 2009-2011, and 2014-2015. RESULTS: At baseline (age ± 72 years), higher levels of physical activity were associated with higher levels of executive functioning (adjusted mean difference = 0.03, 95% CI: 0.00 ; 0.06, p = 0.03). This difference remained intact up to 16 years of follow-up. The level of physical activity at baseline was unrelated to the rate of decline of executive abilities over time, in the whole group (adjusted mean difference in changetime*physical activity = 0.00, 95% CI: -0.00 ; 0.01, p = 0.31). However, stratification by APOE genotype showed that the accelerated decline of executive abilities observed in those with the ApoE-ε4 allele might be attenuated by higher levels of physical activity in late adulthood (ApoE-ε4 carriers: Btime*physical activity = 0.01, 95% CI: 0.00 ; 0.01, p = 0.03). CONCLUSION: Higher levels of physical activity in late adulthood are related to higher levels of executive functioning, up to 16 years of follow-up. Accelerated decline of executive abilities observed in those with the ApoE-ε4 allele might be mitigated by higher levels of physical activity.

Brief report: Free-living physical activity levels and cognitive control in multi-problem young adults.

Previous studies indicate a positive association between physical activity and cognitive control in sedentary but healthy adults, yet not much is known about physical activity levels in multi-problem young adults. We examined the level of self-reported free-living physical activity (i.e., MET minutes per week) in an ecologically valid sample of young adults facing multiple problems, including unemployment, lack of education, frequent substance use, and history of delinquency. We compared cognitive control with an age- and sex-matched control sample. Additionally, the association between physical activity and cognitive control (i.e., response inhibition, error processing, interference effect) in the multi-problem group was examined. Physical activity and cognitive control were measured with the International Physical Activity Questionnaire-Long Form and three cognitive control experiments (i.e., Flanker, Go/NoGo, Stroop), respectively. With M = 4428 Metabolic Equivalents (METs), our multi-problem sample (n = 63) showed physical activity levels similar to the age- and sex-matched control sample from the general population (n = 62). The multi-problem young adults also showed impaired cognitive control indexed as decreased response inhibition and decreased Flanker correctness effect compared to their peers. We could not find an association between self-reported physical activity and cognitive control in the multi-problem sample. Due to the small sample size, results should be interpreted with caution. However, future dose-response studies could still use these results to further examine if within-individual increased physical activity may possibly lead to improved cognitive control in (already relatively active) multi-problem young adults.

Neural basis of affective touch and pain: A novel model suggests possible targets for pain amelioration.

Pain is one of the most common health problems and has a severe impact on quality of life. Yet, a suitable and efficient treatment is still not available for all patient populations suffering from pain. Interestingly, recent research shows that low threshold mechanosensory C-tactile (CT) fibres have a modulatory influence on pain. CT-fibres are activated by slow gentle stroking of the hairy skin, providing a pleasant sensation. Consequently, slow gentle stroking is known as affective touch. Currently, a clear overview of the way affective touch modulates pain, at a neural level, is missing. This review aims to present such an overview. To explain the interaction between affective touch and pain, first the neural basis of the affective touch system and the neural processing of pain will be described. To clarify these systems, a schematic illustration will be provided in every section. Hereafter, a novel model of interactions between affective touch and pain systems will be introduced. Finally, since affective touch might be suitable as a new treatment for chronic pain, possible clinical implications will be discussed.

A Randomized Controlled Trial on the Effects of a 12-Week High- vs. Low-Intensity Exercise Intervention on Hippocampal Structure and Function in Healthy, Young Adults.

Physical exercise affects hippocampal structure and function, but the underlying neural mechanisms and the effects of exercise intensity remain incompletely understood. Therefore, we undertook a comprehensive, multi-modal 3T and 7T MRI randomized controlled trial (Netherlands Trial Register - NL5847) in which we randomized 52 young, non-athletic volunteers to a 12-week low- or high-intensity exercise program. Using state-of-the-art methods, we investigated changes in hippocampal volume, as well as changes in vasculature, neuro-metabolites, and peripheral growth factors as potential underpinnings. Cardiorespiratory fitness improved over time (p < 0.001), but no interaction with exercise intensity was found (p = 0.48). Accordingly, we did not observe significant interactions between exercise condition and time on MRI measures (all p > 0.06). However, we found a significant decrease in right hippocampal volume (p < 0.01), an increase in left hippocampal glutathione (p < 0.01), and a decrease of left hippocampal cerebral blood volume (p = 0.01) over time, regardless of exercise condition. Additional exploratory analyses showed that changes in brain-derived neurotrophic factor (p = 0.01), insulin-like growth-factor (p = 0.03), and dorsal anterior cingulate cortex N-acetyl-aspartate levels (p = 0.01) were positively associated with cardiorespiratory fitness changes. Furthermore, a trend toward a positive association of fitness and gray-matter cerebral blood flow (p = 0.06) was found. Our results do not provide evidence for differential effects between high-intensity (aerobic) and low-intensity (toning) exercise on hippocampal structure and function in young adults. However, we show small but significant effects of exercise on hippocampal volume, neurometabolism and vasculature across exercise conditions. Moreover, our exploratory results suggest that exercise might not specifically only benefit hippocampal structure and function, but rather has a more widespread effect. These findings suggest that, in agreement with previous MRI studies demonstrating moderate to strong effects in elderly and diseased populations, but none to only mild effects in young healthy cohorts, the benefits of exercise on the studied brain measures may be age-dependent and restorative rather than stimulatory. Our study highlights the importance of a multi-modal, whole-brain approach to assess macroscopic and microscopic changes underlying exercise-induced brain changes, to better understand the role of exercise as a potential non-pharmacological intervention.

Cognitive reserve relates to executive functioning in the old-old.

Cognitive reserve (CR) is known to reduce or even protect against the negative effects of aging on cognitive functioning. Nonetheless, little is known about how CR influences the relationship between different cognitive abilities and age in the old-old. The goal of the present study was, therefore, to test the hypothesis whether, in the old-old, CR still modifies the relationship between age and cognitive functioning. Eighty-three adults (aged 71-94) without mild cognitive impairment or dementia residing in residential care facilities completed a detailed neuropsychological test battery. CR was estimated using a combination of educational attainment and an estimation of verbal intelligence. Moderation analyses revealed a significant effect for fluency and a trend for flexibility, showing that the negative relationship between age and cognitive performance is reduced as the level of CR increases. These results demonstrate that CR still influences the relationship between age and executive functions in adults of advanced age.

The impact of pain on the course of ADL functioning in patients with dementia.

BACKGROUND: Understanding if and how pain influences activities of daily living (ADL) in dementia is essential to improving pain management and ADL functioning. This study examined the relationship between the course of pain and change in ADL functioning, both generally and regarding specific ADL functions. METHODS: Participants were Dutch nursing home residents (n = 229) with advanced dementia. ADL functioning was assessed with the Katz ADL scale, and pain with the Dutch version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-D). Changes of PACSLAC-D and Katz ADL scores were computed based on the difference in scores between baseline, 3-month and 6-month follow-up. Multivariate linear regression models were used to assess the relationships between change in pain score, change in total ADL score and specific ADL item scores during follow-up. RESULTS: At baseline, residents had a median ADL score of 18 (interquartile range 13-22, range 6-24) and 48% of the residents were in pain (PACSLAC-D ≥ 4). Residents with pain were more ADL dependent than residents without pain. A change in pain score within the first 3 months was a significant predictor for a decline in ADL functioning over the 6-month follow-up (B = 0.10, SE = 0.05, P = 0.045), and specifically, a decline on the items 'transferring' over the 6-month follow-up and 'feeding' during the first 3 months of follow-up. CONCLUSIONS: Pain is associated with ADL functioning cross-sectionally, and a change in pain score predicts a decline in ADL functioning, independent of dementia severity. Awareness of (changes in) ADL activities is clearly important and might result in both improved recognition of pain and improved pain management.

Chewing Efficiency, Global Cognitive Functioning, and Dentition: A Cross-sectional Observational Study in Older People With Mild Cognitive Impairment or Mild to Moderate Dementia.

Introduction: Previous studies suggest an association between poor mastication and cognitive impairment. The role of chewing efficiency and dentition in this relation is unclear. The aim was to examine global cognitive functioning and dentition as predictors for chewing efficiency, in older people with mild cognitive impairment (MCI) or dementia. Methods: In this observational cross-sectional study, 136 people with MCI or dementia were included. The chewing efficiency was assessed with a two-colored chewing gum and analyzed with the Chewing Efficiency Analysis software. The level of global cognitive functioning was measured with the Mini Mental State Examination (MMSE) by trained clinical staff. An oral examination was performed by a dentist and included the number of present teeth, the number of occluding pairs, and the presence of prostheses. Age, gender, and educational years were derived from the medical records. Univariate and multivariate backward stepwise linear regression analyses were used to evaluate global cognitive functioning and dentition as predictors for chewing efficiency. Results: The mean age of the participants was 82.1 (SD 5.8) years, and 74 (54.4%) were female. The participants had a median MMSE score of 22.4 (IQR 18.0-26.0) and a median Chewing Efficiency Analysis score of 0.46 (IQR 0.14-0.59). The median number of teeth was 13.0 (IQR 0.0-23.0), and the median number of occluding pairs was 0.0 (IQR 0.0-7.0). Sixty-four (47.4%) of the participants wore full prosthesis in the upper jaw. In univariate linear regression analyses, predictive factors for the Chewing Efficiency Analysis score were age, MMSE score, full prosthesis in the upper jaw, number of present teeth, and number of occluding pairs. In the multivariate model, full prosthesis in the upper jaw and number of occluding pairs were significant predictors for the Chewing Efficiency Analysis score. Participants with full prosthesis in the upper jaw had a lower Chewing Efficiency Analysis score than participants with natural dentition in the upper jaw. Conclusion: Better mastication is associated with a higher number of occluding pairs. Full prosthesis in the upper jaw is related to a lower chewing efficiency. Global cognitive functioning is not associated with mastication in older people with MCI or mild-to-moderate dementia. This might be explained by sufficient capacity for compensation of reduced mastication in this group.

Psychotropic drug use in residents with dementia living in small-scaled special care facilities; a longitudinal study.

Objectives: Over the past decade, a trend has been noticed in the Netherlands to replace large-scaled special care units (SCUs) caring for 20-30 residents with dementia by small-scaled SCUs caring for up to 8 residents. Systematic evaluations, however, have yielded a differentiated picture of the effects. As the impact on psychotropic drug use has hardly been addressed thus far, we examined the (potential) impact of psychotropic drug use when moving residents with dementia from large-scaled to small-scaled SCUs.Methods: We conducted a non-randomized, controlled study with a six-month follow-up. Among 145 residents with dementia living a large-scaled SCUs for dementia caring for 20-30 residents per unit, a total of 77 residents were moved to small-scaled SCUs caring for up to 8 residents per unit. Psychotropic drug use, classified according to the Anatomical Therapeutic Chemical Classification (ATC) system was monitored at 2 months before replacement, as well as at 3 and 6 months thereafter. Repeated measures ANOVAs were conducted for the mean Defined Daily Doses (DDDs) of both groups.Results: No significant differences between both groups in psychotropic medication use were found over a period of 8 months.Conclusion: Prescription of psychotropic drugs does not change after a transfer from a large-scaled SCU to a small-scaled SCU of patients with moderate to severe dementia.Current Controlled Trials: ISRCTN11151241.

Mood and behavioral problems are important predictors of quality of life of nursing home residents with moderate to severe dementia: A cross-sectional study.

OBJECTIVES: To examine the predictors associated with quality of life of nursing home residents with dementia, in order to identify which predictors are most important and hold most promise for future intervention studies. METHODS/DESIGN: This cross-sectional analysis of data collected in two intervention trials included 143 participants with moderate to severe dementia who resided in 40 psychogeriatric wards in 13 nursing homes. The outcome measure quality of life was assessed with the Qualidem. Predictors examined were demographic factors, cognition, mood, behavioral problems, and comorbid conditions. RESULTS: Linear mixed regression analyses showed that all nine domains of quality of life showed independent (negative) associations with either depression, agitation, apathy, or a combination of these predictors. Agitation, apathy, depression, and the presence of neurological disease explained 50% of the variance in total quality of life. Male gender, psychiatric/mood disorders, and having one or more comorbid conditions was associated with worse social relations, while the presence of comorbid neurological diseases was associated with more social isolation and a worse care relationship. The presence of endocrine/metabolic disorders and pulmonary disorders was associated with less restless tense behavior. CONCLUSIONS: Different domains of quality of life showed different associations, confirming the multidimensionality of quality of life in nursing home residents with dementia. Quality of life is independently associated with mood and behavioral problems, comorbid conditions, and gender. This knowledge may help to identify older persons at risk of a lower quality of life, and to offer targeted interventions to improve quality of life. TRIAL REGISTRATION: Dutch Trial registration NTR5641.

Revisiting the Role of Insulin-Like Growth Factor-I Receptor Stimulating Activity and the Apolipoprotein E in Alzheimer's Disease.

Background: Alterations in insulin-like growth factor I (IGF-I) signaling have been associated with dementia and Alzheimer's disease (AD). Studies on the association between IGF-I levels and dementia risk have been inconclusive. We reported earlier that higher levels of IGF-I receptor stimulating activity are associated with a higher prevalence and incidence of dementia. Objective: In the present study, we test the robustness of the association between IGF-I receptor stimulating activity and dementia by extending the follow-up period to 16 years and investigate possible effect modification by apolipoprotein E (ApoE). Methods: At baseline, circulating IGF-I receptor stimulating activity was determined by the IGF-I kinase receptor activation (KIRA) assay in 1,014 elderly from the Rotterdam Study. Dementia was assessed from baseline (1997-1999) to follow-up in January 2015. Associations of IGF-I receptor stimulating activity and incident dementia were assessed with Cox proportional hazards models. Results: During 10,752 person-years of follow-up, 174 people developed dementia. In the extended follow-up we no longer observed a dose-response relationship between IGF-I receptor stimulating activity and risk of dementia [adjusted odds ratio 1.11; 95% confidence interval (CI) 0.97-1.28]. Interestingly, we found evidence of an interaction between ApoE-ε4 and tertiles of IGF-I receptor stimulating activity. IGF-I receptor stimulating activity in the median and top tertiles was related to increased dementia incidence in hetero- and homozygotes of the ApoE-ε4 allele, but did not show any association with dementia risk in people without the ApoE-ε4 allele (adjusted odds ratio medium vs. low IGF-I receptor stimulating activity in ApoE-ε4 carriers: 1.45; 95% CI 1.00-2.12). These findings suggest a threshold effect in ApoE-ε4 carriers. In line with the hypothesis that downregulation of IGF-I signaling is associated with increased dementia risk, ApoE-ε4 homozygotes without prevalent dementia displayed lower levels of IGF-I receptor stimulating activity than heterozygotes and non-carriers. Conclusion: The findings shed new light on the association between IGF-I signaling and the neuropathology of dementia and ask for replication in other cohorts, using measures of IGF-I receptor stimulating activity rather than total serum levels as putative markers of dementia risk.

Predictors of care dependency in nursing home residents with moderate to severe dementia: A cross-sectional study.

BACKGROUND: Nursing home residents with dementia show a rapid decline in their ability to perform activities of daily living. This decline is linked to a greater care dependency, which is associated with a reduced quality of life. Care dependency is influenced by multiple predictors, yet current research often focuses on the contribution of a single or a small number of predictors of care dependency. OBJECTIVES: To examine the contribution of multiple predictors in predicting care dependency. DESIGN: The present study analyzed baseline data from a 6-month double-parallel randomized controlled trial which examined the effect of three physical activity interventions on multiple outcomes. SETTING: This study was conducted in eleven nursing homes in Bergen op Zoom, the Netherlands. PARTICIPANTS: In total, 85 nursing home residents with moderate to severe dementia were included in the study, of which 75 were included for analysis. METHODS: Predictors considered were cognitive, physical, neuropsychiatric, demographic, and disease related factors. The outcome measure care dependency was assessed with the Care Dependency Scale and the Erlangen Test of Activities of Daily Living. Linear multilevel regression analyses were used to identify the most important predictors of care dependency. RESULTS: Apathy, physical endurance, number of comorbidities, and global cognition were significant predictors of care dependency. The model explained 66% of the variance in care dependency. Global cognition was a significant predictor of ability to perform activities of daily living and explained 60% percent of its variance. CONCLUSION: The present study shows that multiple predictors (i.e., apathy, cognitive and physical abilities, and disease-related factors) contribute to predicting care dependency. Future research could focus on the effectiveness of multifactorial interventions to maintain the highest possible level of independence in nursing home residents with dementia.

Orofacial pain and its potential oral causes in older people with mild cognitive impairment or dementia.

BACKGROUND: The number of people with dementia and natural dentition is growing. As dementia progresses, the degree of self-care decreases and the risk of oral health problems and orofacial pain increases. OBJECTIVES: To examine and compare the presence of orofacial pain and its potential causes in older people with Mild Cognitive Impairment (MCI) or dementia. METHODS: In this cross-sectional observational study, the presence of orofacial pain and its potential causes was studied in 348 participants with MCI or dementia with all levels of cognitive impairment in two outpatient memory clinics and ten nursing homes. RESULTS: Orofacial pain was reported by 25.7% of the 179 participants who were considered to present a reliable pain self-report (Mini-Mental State Examination score ≥14 points), while it could not be determined in people with more severe cognitive impairment. The oral health examination of the 348 participants indicated that potential painful conditions, such as coronal caries, root caries, tooth root remnants or ulcers were present in 50.3%. There was a significant correlation between the level of cognitive impairment and the number of teeth, r = 0.185, P = 0.003, teeth with coronal caries, r = -0.238, P < 0.001, and the number of tooth root remnants, r = -0.229, P = 0.004, after adjusting for age. CONCLUSIONS: This study indicated that orofacial pain and its potential causes were frequently present in participants with MCI or dementia. Therefore, a regular oral examination by (oral) healthcare providers in people with MCI or dementia remains imperative, even if no pain is reported.

Exposure to a musically-enriched environment; Its relationship with executive functions, short-term memory and verbal IQ in primary school children.

BACKGROUND: Previous literature has shown a putative relationship between playing a musical instrument and a benefit in various cognitive domains. However, to date it still remains unknown whether the exposure to a musically-enriched environment instead of playing an instrument yourself might also increase cognitive domains such as language, mathematics or executive sub-functions such as for example planning or working memory in primary school children. DESIGN: Cross-sectional. METHOD: Exposure to a musically-enriched environment like listening to music at home, during play or when attending concerts was assessed using a comprehensive intake questionnaire administered to a sample of 176 primary school children. Furthermore, participants completed the verbal intelligence section of the Wechsler Intelligence Scale (WISC III), performed executive sub-function tasks such as planning (Tower of London), working memory (Klingberg Matrix backward span) and inhibition (Go/no-Go task), and a short-term memory task (Klingberg Matrix forward span). RESULTS: Linear and multiple regression analyses showed no significant relationship between exposure to a musically-enriched environment, executive sub-functions (planning, inhibition and working memory), and short-term memory. The relationship between an enriched musical environment and verbal IQ has revealed trends. DISCUSSION: Experiencing a musically enriched environment does not serve as predictor for higher performance on executive sub-functions, however, can influence verbal IQ.

Oral function of older people with mild cognitive impairment or dementia.

OBJECTIVES: The aim of this study was to examine and compare the oral function of older people with mild cognitive impairment (MCI) or dementia. METHODS: This cross-sectional observational study included participants with MCI or dementia aged 60 years or older. Global cognitive functioning was evaluated with the Mini Mental State Examination (MMSE) and the oral function was evaluated with subjective and objective assessments, including the perceived quality of chewing and swallowing, the function of the prostheses, the number of occluding pairs (OP), the degree of tooth wear and the active and passive maximum mouth opening. RESULTS: The quality of chewing and swallowing was perceived as good in, respectively, 86.0% and 90.9% of the participants. Full or partial prostheses were worn by 63.8% of the participants, and the retention was good in 58.4% of the upper and 50.0% of the lower prostheses. Participants with MCI had a median of 3.0 (Inter Quartile Range [IQR] 0.0-7.5) occluding pairs, while participants with dementia had a median of 0.0 (IQR 0.0-1.0) occluding pairs, U = 3838.50, P < 0.001. There was a weak positive correlation between the number of occluding pairs and the MMSE score, r = 0.267, also when adjusted for age, r = 0.230. The median tooth wear score was 2.0 (IQR 2.0-2.0) in participants with MCI or dementia. The active maximum mouth opening was 45.8 (SD 9.3) mm in participants with dementia, while it was 49.8 (SD 8.1) mm in those with MCI, t(253) = 2.67, P = 0.008. CONCLUSION: For most participants with MCI or dementia, the swallowing ability and chewing ability were perceived as good. In addition, more than half of the prostheses had good retention and occlusion. Participants with more severe cognitive impairment had fewer occluding pairs and a smaller active mouth opening. The degree of tooth wear was less than one-third of the clinical crown in most participants with MCI or dementia.