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1.
Fortschr Neurol Psychiatr ; 87(9): 504-510, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31519026

RESUMO

BACKGROUND: Neuropsychological dementia diagnosis of migrants are limited regarding the testing of cognitive abilities as well as the recording of everyday activities (Activities of Daily Living, ADL) such as linguistic, educational, lifestyle and cultural-religious factors have not been taken into account in psychometric instruments. AIM OF THE STUDY: We aimed to develop a culturally sensitive ADL scale, which is suitable for both German people and Turkish migrants that takes into consideration gender, cultural-religious and lifestyle aspects. A further aim was to determine the quality criteria for the newly proposed ADL scale. METHODS: After the initial phase, including qualitative interviews (N = 15) with cognitively unimpaired German participants and Turkish migrants, a first version of the ADL instrument was developed. This version was then completed by cognitively unimpaired Germans (n = 197) and Turkish participants (n = 53) and the shortened ADL scale was generated based on an item analysis. It consisted of the three subscales 'cognition', 'Basic Activities of Daily Living (BADL)' and 'Instrumental Activities of Daily Living (IADL)'. For Turkish participants, questions about Islamic prayers were added. Montreal Cognitive Assessment (MoCA) and Geriatric Depression Scale (GDS) were applied to rule out cognitive impairment and depression. The 'Bayer-ADL' was used to measure the validity of the scale. RESULTS: The everyday life of Germans and Turkish migrants differs in aspects of religious practice and in terms of sociocultural activities, which are taken into account in the CC-ADL. The reliability of the new ADL scale in terms of internal consistency (Cronbach's alpha) were regarding 'cognition' α = .43 for Germans and α = .80 for Turkish migrants; 'BADL' α = .55 for Germans and α = -.04 for Turkish migrants; 'IADL' α = .91 for Germans and α = .83 for Turkish migrants and α = .73 for Turkish migrants under the 'prayer items'. The correlation of the ADL total score with the Bayer ADL for Germans was ρ = .347 (p < .00) and for the Turkish sample ρ = .520 (p < .01). CONCLUSION: The development of a final version of the CC-ADL scale requires further data from healthy participants and patients (Mild Cognitive Impairment and dementia).


Assuntos
Atividades Cotidianas , Competência Cultural , Demência/diagnóstico , Demência/psicologia , Emigrantes e Imigrantes/psicologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Feminino , Alemanha , Humanos , Estilo de Vida/etnologia , Masculino , Testes Neuropsicológicos , Religião e Psicologia , Reprodutibilidade dos Testes , Turquia/etnologia
3.
Lancet ; 394(10203): 1002-1003, 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31544739
4.
BMJ ; 366: l4912, 2019 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-31444168

RESUMO

The studyFeatherstone K, Northcott A, Harden J, et al. Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study. Health Serv Deliv Res 2019;7.This study was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 13/10/80).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000779/understanding-dementia-care-in-hospitals.


Assuntos
Demência/enfermagem , Demência/psicologia , Hospitalização , Cooperação do Paciente , Inglaterra , Humanos , Relações Profissional-Paciente , Medicina Estatal/normas , País de Gales
5.
Cyberpsychol Behav Soc Netw ; 22(8): 543-551, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31403855

RESUMO

The aim of this study was to evaluate the usage of a reminiscence app by people living with dementia and their family carers, by comparing event log data generated from app usage alongside the qualitative experience of the process. A cross-comparative analysis of electronic event logging data with qualitative interview data was conducted. Electronic event logging data were obtained for 28 participating dyads (n = 56) and the interview sample comprised 14 people living with dementia and 16 family carers (n = 30). A thematic analysis framework was used in the analysis of interview transcripts and the identification of recurrent themes. The cross-comparison of electronic event log data and qualitative data revealed 25 out of 28 dyads regularly engaged with a reminiscence app, with the analysis of usage patterns revealing four clusters classifying different levels of user engagement. The cross-comparison of data revealed that the nature of the relationship was a significant factor in ongoing user engagement. The comparative analysis of the electronic event logs as "ground truth" in combination with the qualitative lived experience can provide a deeper understanding on the usage of a reminiscence app for those living with dementia and their family carers. This work not only shows the benefits of using automated event log data mining but also shows its clear limitations without using complementary qualitative data analysis. As such, this work also provides key insights into using mixed methods for evaluating human-computer interaction technologies.


Assuntos
Cuidadores/psicologia , Demência/psicologia , Processamento Eletrônico de Dados/estatística & dados numéricos , Aplicativos Móveis/estatística & dados numéricos , Participação dos Interessados/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Memória , Pessoa de Meia-Idade , Pesquisa Qualitativa
6.
J Music Ther ; 56(3): 265-286, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31346625

RESUMO

Family caregivers often feel ill-equipped to handle bothersome behavioral and psychological symptoms of dementia, such as agitation, apathy, and sleep disturbances, leading to increased caregiver distress and nursing home placement for people with dementia. Therapies for such symptoms are currently limited and non-pharmacological options are preferred, given potential side effects of medications. Neurologic music therapy (NMT) could provide an additional treatment option for managing behavioral and psychological symptoms for community-dwelling people with dementia and their caregivers. This pilot study sought to evaluate the feasibility, acceptability, and effectiveness of home-based NMT for behavioral and psychological symptoms of dementia. Eighteen persons with dementia-caregiver dyads were enrolled to receive one-hour weekly sessions of home-based NMT for 6 weeks. Demographic, quality of life, neuropsychiatric symptom, and caregiver burden and self-efficacy information was collected at baseline, 6 weeks, and 12 weeks. Seven dyads (38.9%) withdrew from therapy before completing all sessions; these participants had higher Neuropsychiatric Inventory scores and were of older age at baseline. For those who completed therapy, neuropsychiatric symptom scores improved at 6 weeks, an effect that was sustained at 12 weeks. No other outcome measures changed significantly after therapy. Initiating NMT too late in the course of dementia, when behavioral symptoms are already present, may be impractical for people with dementia and increase caregiver stress, even when provided within the home. Introducing and incorporating the principles of NMT earlier in the course of dementia could allow for increased comfort and benefit for people with dementia and their caregivers.


Assuntos
Sintomas Comportamentais/terapia , Cuidadores/psicologia , Demência/terapia , Musicoterapia , Qualidade de Vida/psicologia , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Ansiedade , Sintomas Comportamentais/etiologia , Sintomas Comportamentais/psicologia , Demência/complicações , Demência/psicologia , Estudos de Viabilidade , Feminino , Humanos , Música , Projetos Piloto , Autoeficácia , Transtornos do Sono-Vigília/etiologia , Resultado do Tratamento
7.
Artigo em Alemão | MEDLINE | ID: mdl-31297549

RESUMO

BACKGROUND: Currently, there are 1.7 million people living with dementia (PwD) in Germany. This number is expected to double within the next decades. Estimates of the total societal economic burden of dementia are currently missing. OBJECTIVES: The aim was to estimate the current and future total cost and excess cost of dementia from a public payer and societal perspective. METHODS: Studies demonstrating the healthcare resource utilization of PwD in Germany were identified. Utilization data were aggregated using the sample size of different studies as a weight. Annual per capita costs of PwD and excess cost of dementia were calculated using standardized unit costs. Current and future costs were calculated based on published prevalence and population forecasts. RESULTS: PwD living at home had lower costs from a payer perspective compared to those who are institutionalized, but higher total societal cost due to the higher informal care time. The total cost for PwD from a payer perspective was 34 billion € in 2016. These costs could reach 90 billion € by 2060. The excess cost of dementia was 18 billion € in 2016 and is estimated to become 49 billion € by 2060 from a payer perspective, representing 54% of the total cost of PwD and up to 15% of the total costs associated with the elderly population. The total societal cost was 73 billion € in 2016 and is estimated to become 194 billion € by 2060. The excess cost of dementia was 54 billion € in 2016 and is estimated to become 145 billion € by 2060, representing 74% of the total societal cost of PwD and 36% of the total societal cost of the elderly. CONCLUSION: Dementia diseases represent a tremendous social and economic burden. Without a cure, supporting caregivers and implementing interventions that delay the functional and cognitive decline will be crucial to relieving the increasing costs.


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Demência/economia , Demência/psicologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Cuidadores/estatística & dados numéricos , Alemanha , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Alocação de Recursos
8.
Z Gerontol Geriatr ; 52(6): 607-622, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31346680

RESUMO

The causes of pain must always be clarified, as long as it can be justified. In dementia the placebo effect can be lacking. A treatment on demand is difficult to implement. Correctly applied nonmedicinal treatment has few unwanted effects but mostly needs constant support by personnel. Medications with anticholinergic effects should be used with caution due to the high risk of delirium and falling. With analgesics and coanalgesics the principles of geriatric treatment must also be adhered to: start low, go slow. Complaints that can be triggered by analgesics or coanalgesics should be recorded before starting treatment. Education and clarification by therapists are given priority. Multimorbidity and polypharmacy restrict the analgesic treatment. Strategies of self-efficacy and other psychological procedures have limited implementation. The course of treatment is difficult to monitor.


Assuntos
Analgésicos/uso terapêutico , Delírio , Demência/complicações , Manejo da Dor/métodos , Dor/tratamento farmacológico , Idoso , Delírio/induzido quimicamente , Delírio/prevenção & controle , Demência/psicologia , Humanos , Dor/complicações , Polimedicação
9.
Maturitas ; 127: 26-34, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351517

RESUMO

This review considers how research into the impact of music on people with dementia has been conducted, with a focus on the means used to measure outcomes. Although there is a rapidly growing amount of research in this relatively new area, it has evolved largely independently within different fields, such as psychology, music therapy and nursing. Using principles from the meta-narrative review method, this paper systematically surveys the qualitative and quantitative measures which have been used in studies relating to music and dementia from 1980 to the present day. Data extracted include the outcome measures used, the type of musical interventions, the setting of the studies, and methodology and study design. The quantitative studies greatly outnumber the qualitative studies, and most research has been done in long-term care settings. Instruments which measure neuropsychiatric symptoms of dementia, especially agitation, were the most frequently used. Other domains that were targeted in the studies included quality of life, physiological change, music-related outcomes and cognitive skills; the inter-relations between these domains are represented as a diagram. Researchers' rationales for choosing to target these outcomes are discussed. Although reduction of neuropsychiatric symptoms is a valuable outcome, it is important that researchers are open to the possibility of other outcomes. We suggest that measuring an increase in positive responses might be an alternative to measuring a reduction of negative symptoms, and we highlight the importance of listening to people with dementia and carers when designing studies.


Assuntos
Demência/psicologia , Música , Humanos , Qualidade de Vida
10.
Maturitas ; 127: 55-63, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351521

RESUMO

Co-designing with people with dementia (PwD) can uncover their needs and preferences, which have been often overlooked. It is difficult for PwD to understand designers and express themselves in a conventional co-design session. This study aims to evaluate the effects of involving PwD in design research on both PwD and the design process; to identify the trends of involving PwD in design research; to extract tools, recommendations, and limitations of involving PwD from reviewed studies to update the recommendations on how to co-design with PwD. A scoping review was carried out within the electronic databases PubMed and Scopus, and eight research questions were proposed, in order to gain specific knowledge on the involvement of PwD in design research. Twenty-six studies met the inclusion criteria, and 32 sessions were evaluated. Beneficial effects on both PwD and the design process were reported. The number of studies involving PwD in the moderate and severe stages of dementia has increased. Based on the review, an update of the existing tools and recommendations for co-designing with PwD is provided and a list of limitations of involving PwD is presented. The review shows that involving PwD in design research is beneficial for both the PwD and the design process, and there is a shift towards involving people who are in the moderate and severe stages of dementia. The authors propose that multidisciplinary meetings and case studies should be carried out to evaluate and refine the list of tools and recommendations as well as the list of limitations generated in this review.


Assuntos
Demência/psicologia , Projetos de Pesquisa , Humanos
11.
BMC Health Serv Res ; 19(1): 349, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151437

RESUMO

BACKGROUND: The Targeted Intervention Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a three-month cluster randomised controlled trial demonstrated reduction in agitation in nursing home residents with dementia. To ease replication and future implementation, and to clarify possible causal mechanisms, we performed a process evaluation of the intervention based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). METHODS: An exploratory and a quasi-experimental design with mixed methods were used. The RE-AIM dimensions were explored by questionnaires to 807 staff members and 46 leading ward nurses in both the intervention nursing homes (INH) and the control nursing homes (CNH), before the start of the trial (baseline), and six and 12 months later. These questionnaires assessed data regarding the reach, effectiveness (staff level) and adoption dimensions. To assess implementation, we used a checklist for performance of the main components in TIME and analysed the minutes from 84 case conferences in the INH. To explore adoption and maintenance, five focus group interviews with 32 participants from the staff in the INH were conducted three to 6 months after the end of the trial. RESULTS: Reach: On average 61% (SD 22) of the staff in each ward in the INH attended the training sessions. Effectiveness at staff level: There were no between-group differences throughout the study period for attitudes towards dementia, perceived competence or perception of mastery and social interaction. Adoption: 16 of the 17 INH completed the intervention. IMPLEMENTATION: 75% or more of the components of TIME were performed for 91% of the included residents. Maintenance: Most of the nursing homes used TIME three to 6 months after the end of the trial. An easy to grasp model and an engaged leadership facilitated the intervention and maintenance. CONCLUSIONS: A high degree of reach, adoption, implementation and maintenance contributed to the effectiveness of TIME at resident level. One other causal assumption of the effectiveness of TIME is the development in the staff of a new, shared and situated knowledge about each individual resident, not reflected by measurements in general knowledge and attitudes. TRIAL REGISTRATION: The trial was registered January 6, 2016 with ClinicalTrials.gov ( NCT02655003 ).


Assuntos
Demência/psicologia , Agitação Psicomotora/etiologia , Adulto , Idoso , Atitude do Pessoal de Saúde , Análise por Conglomerados , Demência/terapia , Feminino , Grupos Focais , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Avaliação de Processos (Cuidados de Saúde) , Projetos de Pesquisa
12.
BMC Public Health ; 19(Suppl 4): 462, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196017

RESUMO

BACKGROUND: Motoric cognitive risk (MCR) syndrome is characterized by slow gait and memory complaints that could be used to predict an increased risk of dementia. This study aims to determine the MCR syndrome and its risk factors among low-income (B40) older adults in Malaysia. METHODS: Data from TUA cohort study involving 1366 older adults (aged 60 years and above) categorized as low-income were analysed, for risk of MCR syndrome based on defined criteria. Chi-square analysis and independent t test were employed to examine differences in socioeconomic, demographic, chronic diseases and lifestyle factors between MCR and non-MCR groups. Risk factors of MCR syndrome were determined using hierarchical logistic regression. RESULTS: A total of 3.4% of participants fulfilled the criteria of MCR syndrome. Majority of them were female (74.5%, p = 0.001), single/widow/widower/divorced (55.3%, p = 0.002), living in rural area (72.3%, p = 0.011), older age (72.74 ± 7.08 year old, p <  0.001) and had lower years of education (3.26 ± 2.91 years, p = 0.001) than non-MCR group. After adjustment for age, gender and years of education, participants living in rural area (Adjusted OR = 2.19, 95% CI = 1.10-4.35, p = 0.026), with obesity (Adjusted OR = 3.82, 95% CI = 1.70-8.57, p = 0.001), diabetes (Adjusted OR = 2.04, 95% CI = 1.01-4.11, p = 0.046), heart disease (Adjusted OR = 2.50, 95% CI = 1.00-6.20, p = 0.049) and cancer (Adjusted OR = 6.57, 95% CI = 1.18-36.65, p = 0.032) were associated with increased risk of MCR syndrome. CONCLUSION: Only 3.4% of older adults from low-income group were identified as having MCR syndrome. Women, those living in rural areas, had obesity, diabetes, heart disease and cancer were more likely to have MCR syndrome. Further investigation on MCR as a predementia syndrome will help in development of preventive strategies and interventions to reduce the growing burden of dementia, especially among individuals with low socioeconomic status.


Assuntos
Transtornos Cognitivos/epidemiologia , Demência/epidemiologia , Pobreza/psicologia , Idoso , Transtornos Cognitivos/psicologia , Estudos de Coortes , Demência/psicologia , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Síndrome
13.
BMC Public Health ; 19(Suppl 4): 447, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196141

RESUMO

BACKGROUND: The main aim of this study was to determine the association between Behavioral and Psychological Symptoms of Dementia (BPSD) and caregiver burden, and the mediating role of coping strategy and personality style of caregivers to patients with dementia (PWD). METHODS: This cross-sectional study was conducted among 202 caregivers to PWD in home-based settings. Recruited caregivers were administered questionnaires regarding BPSD which was measured using Neuropsychiatric Inventory-Questionnaire (NPI-Q), caregiver burden using Zarit Burden Interview (ZBI), Brief COPE for coping strategies and Big-Five Inventory which measured personality traits. RESULTS: Majority of the caregivers were female (71.3%), aged 50 and above (55%), single (46%), married (43.6%), working full time (45%) while the rest work part time (22.3%), unemployed (7.4%) and retiree (25.2%), and majority were parents (58.9%) and spouse (18.3%). The duration of caregiving was less than a year (33.7%) while the rest are more than a year. Results demonstrated that the most frequent types of BPSD exhibited by PWD was irritability, followed by apathy and agitation. All of the types of BPSD showed to be significantly correlated to caregiver burden except for anxiety, elation and appetite. Of personality traits, only conscientiousness was found to mediate the relationship between BPSD and caregiver burden (p < .05). Self-distraction, active coping, planning and acceptance were the coping strategies that demonstrated to have mediation effect on the relationship between BPSD and caregiver burden. CONCLUSION: Presentation of BPSD is correlated to caregiver burden which is partially mediated by coping strategies and personality styles.


Assuntos
Adaptação Psicológica , Cuidadores/psicologia , Demência/psicologia , Personalidade , Pobreza/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
14.
Front Neurol Neurosci ; 44: 1-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220844

RESUMO

Of the main principles of human neuropsychology, the best known may be cerebral specialization: the left and right hemispheres play different roles in language and other higher-order functions. This chapter discusses when and how and by whom the differences were found. It begins with an account of Gall's cortical localization theory, which set the stage. It then describes the discoveries themselves, reviews how the differences were explained, and concludes with a summary of further developments.


Assuntos
Encéfalo/fisiopatologia , Demência/psicologia , Neuropsicologia/história , Fala/fisiologia , Encéfalo/fisiologia , Emoções/fisiologia , História do Século XVIII , História do Século XIX , Humanos
15.
BMJ ; 365: l4223, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221622

RESUMO

The studyClare L, Kudlicka A, Oyebode J R, et al. Goal-oriented cognitive rehabilitation for early-stage Alzheimer's and related dementias: the GREAT RCT. Health Technol Assess 2019;23:1-242.The trial was funded by the NIHR Health Technology Assessment Programme (project number11/15/04).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000767/goal-setting-in-early-stage-dementia-can-improve-function.


Assuntos
Disfunção Cognitiva/economia , Disfunção Cognitiva/reabilitação , Demência/psicologia , Atividades Cotidianas , Disfunção Cognitiva/psicologia , Análise Custo-Benefício , Demência/economia , Demência/epidemiologia , Demência/reabilitação , Metas , Humanos , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoeficácia , Avaliação da Tecnologia Biomédica , Resultado do Tratamento , Reino Unido
16.
BMC Public Health ; 19(1): 659, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142290

RESUMO

BACKGROUND: Several observational studies have shown that exercise reduces the risk of cognitive decline; however, evidences from long-term, well-conducted, randomized controlled trials are scanty. The principal aim of this study is to verify whether a long-term program of multimodal supervised exercise improves the cognitive function and/or reduces the rate of cognitive decline in older adults at different degrees of risk for dementia. METHODS/DESIGN: EPD is a parallel group, double-blind, randomized controlled trial. Community-dwelling volunteers aged 50 years or more are being recruited from different community centers and screened for eligibility. Enrolled subjects are being divided in 3 groups: a) without subjective or objective cognitive impairment, b) with subjective memory complaints, and c) with mild cognitive impairments. Participants in each group (at least 180) are being randomly assigned (1:1) to an experimental group, performing a supervised training including aerobic and resistance exercises of moderate/high intensity, or to a control group. Primary outcome will be 48-months changes in Mini Mental State Examinations. Secondary outcomes will be changes in several cognitive tests including a composite cognitive score. Time points will be at baseline, and at 6, 12, 24, 36 and 48 months. Statistical analysis will be done as intention to treat, complete case and mixed model analysis. DISCUSSION: EPD is the first trial to examine the effects of a long exercise program (48 months) on cognitive performances. If successful, this trial may provide evidence for using long-term and multimodal exercise interventions for dementia prevention programs in the aging population. TRIAL REGISTRATION: The study is registered at ClinicalTrials.gov with the code NCT02236416 .


Assuntos
Demência/prevenção & controle , Exercício/psicologia , Idoso , Cognição , Disfunção Cognitiva/prevenção & controle , Demência/psicologia , Método Duplo-Cego , Feminino , Humanos , Vida Independente , Masculino , Memória , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Medição de Risco
17.
Acta Neurol Scand ; 140(2): 140-146, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31070777

RESUMO

OBJECTIVE: Subjective memory complaints are common in both elderly individuals and patients with dementia. This study investigated the power of subjective memory, divided into declarative and working memory, to differentiate between patients with dementia and normal elderly individuals. METHOD: Two groups of participants, patients with dementia (n = 117) and normal elderly individuals (n = 117), individually matched with regard to age, gender, and education. All subjects had participated in the third wave of the HUNT population health survey in Nord-Trøndelag County in Norway and completed the Meta-Memory Questionnaire (MMQ) in the HUNT study. The MMQ was subdivided into two components, one associated with declarative memory (episodic and semantic) and the other with working memory. RESULTS: Patients with dementia reported significantly more subjective memory concerns than normal elderly individuals. The difference between working and declarative memory components was significantly greater in patients with dementia than in normal elderly individuals. This finding made it possible to differentiate patients with dementia from the normal elderly individuals. Mental and somatic health conditions did not significantly add power to differentiating the two groups. CONCLUSION: In clinical and research applications, subjective memory components could contribute to differentiation of patients with dementia and normal elderly individuals by using self-reported impairment in working memory, rather than declarative memory.


Assuntos
Demência/fisiopatologia , Autoavaliação Diagnóstica , Memória de Curto Prazo , Idoso , Demência/psicologia , Feminino , Humanos , Masculino , Autorrelato
18.
Health Psychol ; 38(5): 391-402, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045422

RESUMO

OBJECTIVE: To test the effects of Life Enhancing Activities for Family Caregivers (LEAF), a 6-week positive emotion regulation intervention, on outcomes of positive emotion, depression, anxiety, and physical health as measured by the Patient-Reported Outcomes Measurement Information System® (PROMIS®). METHOD: A randomized controlled trial (N = 170) comparing LEAF (N = 86) to an emotion reporting/waitlist condition (N = 84) in dementia caregivers. LEAF was individually delivered online by trained facilitators. Participants in the control condition completed daily online emotion reports and then crossed over into the intervention condition after 6 weeks. The study was registered with Clinicaltrials.gov (NCT01825681) and funded by R01NR014435. RESULTS: Analyses of difference in change from baseline to 6 weeks demonstrated significantly greater decreases in PROMIS® depression (d = -.25; p = .02) and Quality of Life in Neurological Disorders (NeuroQOL) anxiety (d = -.33; p < .01), as well as improvements in PROMIS® physical health (d = .24; p = .02) in the intervention condition compared to the emotion reporting/waitlist control. The intervention also showed greater improvements in positive emotion (d = .58; p < .01) and positive aspects of caregiving (d = .36; p < .01). Increases in positive emotion significantly mediated the effect of LEAF on depression over time. CONCLUSIONS: This randomized controlled trial of the online-facilitated positive emotion regulation intervention in dementia caregivers demonstrated small to medium effect sizes on caregiver well-being and shows promise for remotely delivered programs to improve psychological well-being in caregivers of people with dementia and other chronic illnesses. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Cuidadores/psicologia , Demência/enfermagem , Emoções/fisiologia , Qualidade de Vida/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Demência/psicologia , Educação a Distância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente
19.
Drugs Aging ; 36(7): 589-605, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30957198

RESUMO

Behavioral and psychological symptoms associated with dementia are highly prevalent and are associated with an increased risk of institutionalization and mortality. Current pharmacological treatments for these symptoms include cholinesterase inhibitors, antipsychotics, and selective serotonin reuptake inhibitors. When used for treating behavioral and psychological symptoms associated with dementia, they are associated with limited efficacy and/or serious adverse events. As such, there has been extensive research into novel agents with varying mechanisms of action targeting behavioral and psychological symptoms associated with dementia. In this article, we present the results of a comprehensive literature search and review that evaluates current agents that have completed or are currently in clinical trials for treating behavioral and psychological symptoms associated with dementia as a primary outcome. We highlight novel agents from miscellaneous drug classes, such as dextromethorphan/quinidine, bupropion/dextromethorphan, lumateperone, deudextromethorphan/quinidine, methylphenidate and scyllo-inositol, and drugs from various therapeutic classes (including atypical antipsychotics, selective serotonin reuptake inhibitors, and cannabinoids) that have demonstrated promising results and were generally well tolerated. Future research with large appropriately powered studies using validated outcome measures for behavioral and psychological symptoms associated with dementia should be conducted to further establish the clinical utility of these agents.


Assuntos
Antipsicóticos/uso terapêutico , Canabinoides/uso terapêutico , Inibidores da Colinesterase/uso terapêutico , Demência/tratamento farmacológico , Demência/psicologia , Inibidores de Captação de Serotonina/uso terapêutico , Animais , Comportamento/efeitos dos fármacos , Desenvolvimento de Medicamentos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Artigo em Inglês | MEDLINE | ID: mdl-31013959

RESUMO

Nature-based adult day services (ADSs) for people with dementia (PwD) are well-known in rural areas. In recent years, a number of providers have started offering these services in urban contexts, e.g., in city farms and community gardens, where people with dementia participate in outdoor activities, such as gardening and caring for animals. At the moment, little is known about these services within an urban context, and the aim of this study is to characterize different types of nature-based ADSs in urban areas for PwD living at home, as well as to identify general and specific challenges with regard to the development of different types of ADSs. An inventory was carried out and 17 ADS providers in urban areas were interviewed about their initiatives, settings, client groups, motivations for starting their nature-based ADS, and their experiences with, competences for, and funding of urban nature-based ADS. The interviews were recorded, transcribed verbatim and thematically analyzed. Five types of nature-based ADSs were identified: (1) services offered by social entrepreneurs, (2) nursing homes opening their garden to people with dementia, (3) social care organization setting up nature-based, (4) community garden set up by citizens, and (5) hybrid initiatives. Common activities were gardening, preparing meals, and taking care of farm animals. The main activities organized by nursing homes included sitting and walking in the garden and attending presentations and excursions. General challenges included the availability of green urban spaces and acquiring funding for the nature-based services. Initiatives of social entrepreneurs depended strongly on their commitment. Challenges for nursing homes included a lack of commitment among nursing staff, involvement of PwD living at home and a lack of interaction with the neighborhood. Volunteers played a key role in the initiatives organized by social care organizations and in community gardens. However, it was a major challenge to find volunteers who know enough about care and gardening. Specific challenges for the hybrid types were related to differences in work culture between social entrepreneurs and care organizations. Different types of care-oriented and community-oriented nature-based adult day services in urban areas for people with dementia have been developed, facing different types of challenges. Care oriented initiatives like nursing homes opening their garden focus on risk prevention and their nature-based services tended to be less diverse and stimulating for people with dementia living at home. Collaboration between such care-oriented initiatives with initiatives of other types of organizations or social entrepreneurs can lead to more appealing community-oriented nature-based services.


Assuntos
Terapia Comportamental/métodos , Cuidadores/psicologia , Demência/psicologia , Demência/terapia , Jardinagem/estatística & dados numéricos , Jardins/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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