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3.
Psychol Bull ; 147(5): 455-476, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34292011

RESUMO

Cognitive stimulation (CS) is a nonpharmacological intervention often involving group activities and social interaction used to treat cognitive declines in people with dementia. This preregistered systematic review and meta-analysis evaluated the effectiveness of CS in producing benefits on cognition (primary outcome) and quality of life, activities of daily living, and psychological symptoms (secondary outcomes) across 44 randomized-controlled trials comprising 45 comparisons including 2,444 participants. A medium-sized effect (g = .49) on global cognition was found immediately after the intervention and was supported by decisive Bayesian evidence. Clinical relevance is defined as a reduction of 3 to 4 points on the Alzheimer's Disease Assessment Scale Cognitive subscale; the average attenuation of cognitive decline observed was 2.41 points (after removing 1 outlier). Therefore, the observed decline was of borderline clinical relevance. CS was also found to significantly improve memory, activities of daily living, depressive symptoms, and dementia ratings; most of these effects were supported by substantial and strong Bayesian evidence. No significant effects were found for global cognition at 1 to 10 months follow-up assessment for language, quality of life, anxiety, and behavior symptoms. However, evidence for the absence of these effects was ambiguous. A review of study bias highlighted that most studies lacked active, double-blinded controls, potentially leading to an overestimation of the effect, and making it difficult to conclusively attribute the observed improvements to the CS intervention. Hence, although effects are promising, the methodological issues highlight there is still a need for better controlled studies that provide more compelling evidence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Atividades Cotidianas , Cognição , Demência/psicologia , Demência/terapia , Interação Social , Teorema de Bayes , Humanos , Idioma , Memória , Qualidade de Vida
4.
J Alzheimers Dis ; 82(1): 1-4, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34219670

RESUMO

Technology has transformed the science and practice of medicine. In this special mini-forum, data using digital neuropsychological technology are reported. All of these papers demonstrate how coupling digital technology with standard paper and pencil neuropsychological tests are able to extract behavior not otherwise obtainable. As digital assessment methods mature, early identification of persons with emergent neurodegenerative and other neurological illness may be possible.


Assuntos
Tecnologia Digital , Testes Neuropsicológicos , Demência/psicologia , Humanos
6.
N Engl J Med ; 385(4): 309-319, 2021 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-34289275

RESUMO

BACKGROUND: Patients with dementia due to neurodegenerative disease can have dementia-related psychosis. The effects of the oral 5-HT2A inverse agonist and antagonist pimavanserin on psychosis related to various causes of dementia are not clear. METHODS: We conducted a phase 3, double-blind, randomized, placebo-controlled discontinuation trial involving patients with psychosis related to Alzheimer's disease, Parkinson's disease dementia, dementia with Lewy bodies, frontotemporal dementia, or vascular dementia. Patients received open-label pimavanserin for 12 weeks. Those who had a reduction from baseline of at least 30% in the score on the Scale for the Assessment of Positive Symptoms-Hallucinations and Delusions (SAPS-H+D, with higher scores indicating greater psychosis) and a Clinical Global Impression-Improvement (CGI-I) score of 1 (very much improved) or 2 (much improved) at weeks 8 and 12 were randomly assigned in a 1:1 ratio to continue receiving pimavanserin or to receive placebo for up to 26 weeks. The primary end point, assessed in a time-to-event analysis, was a relapse of psychosis as defined by any of the following: an increase of at least 30% in the SAPS-H+D score and a CGI-I score of 6 (much worse) or 7 (very much worse), hospitalization for dementia-related psychosis, stopping of the trial regimen or withdrawal from the trial for lack of efficacy, or use of antipsychotic agents for dementia-related psychosis. RESULTS: Of the 392 patients in the open-label phase, 41 were withdrawn for administrative reasons because the trial was stopped for efficacy; of the remaining 351 patients, 217 (61.8%) had a sustained response, of whom 105 were assigned to receive pimavanserin and 112 to receive placebo. A relapse occurred in 12 of 95 patients (13%) in the pimavanserin group and in 28 of 99 (28%) in the placebo group (hazard ratio, 0.35; 95% confidence interval, 0.17 to 0.73; P = 0.005). During the double-blind phase, adverse events occurred in 43 of 105 patients (41.0%) in the pimavanserin group and in 41 of 112 (36.6%) in the placebo group. Headache, constipation, urinary tract infection, and asymptomatic QT prolongation occurred with pimavanserin. CONCLUSIONS: In a trial that was stopped early for efficacy, patients with dementia-related psychosis who had a response to pimavanserin had a lower risk of relapse with continuation of the drug than with discontinuation. Longer and larger trials are required to determine the effects of pimavanserin in dementia-related psychosis. (Funded by Acadia Pharmaceuticals; HARMONY ClinicalTrials.gov number, NCT03325556.).


Assuntos
Antipsicóticos/uso terapêutico , Demência/psicologia , Alucinações/tratamento farmacológico , Piperidinas/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Ureia/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Demência/tratamento farmacológico , Método Duplo-Cego , Feminino , Alucinações/etiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/psicologia , Modelos de Riscos Proporcionais , Transtornos Psicóticos/etiologia , Recidiva , Ureia/uso terapêutico
7.
J Alzheimers Dis ; 82(2): 737-748, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092630

RESUMO

BACKGROUND: Older adults with bipolar disorder (BD) have increased dementia risk, but signs of dementia are difficult to detect in the context of pre-existing deficits inherent to BD. OBJECTIVE: To identify the emergence of indicators of early dementia in BD. METHODS: One hundred and fifty-nine non-demented adults with BD from the National Alzheimer's Coordinating Center (NACC) data repository underwent annual neuropsychological assessment up to 14 years (54.0 months average follow-up). Cognitive performance was examined longitudinally with linear mixed-effects models, and yearly differences between incident dementia cases and controls were examined in the six years prior to diagnosis. RESULTS: Forty participants (25.2%) developed dementia over the follow-up period ('incident dementia cases'). Alzheimer's disease was the most common presumed etiology, though this was likely a result of sampling biases within NACC. Incident dementia cases showed declining trajectories in memory, language, and speeded attention two years prior to dementia onset. CONCLUSION: In a sample of BD patients enriched for Alzheimer's type dementia, prodromal dementia in BD can be detected up to two years before onset using the same cognitive tests used in psychiatrically-healthy older adults (i.e., measures of verbal recall and fluency). Cognition in the natural course of BD is generally stable, and impairment or marked decline on measures of verbal episodic memory or semantic retrieval may indicate an early neurodegenerative process.


Assuntos
Envelhecimento , Transtorno Bipolar , Cognição/fisiologia , Demência , Doenças Neurodegenerativas , Sintomas Prodrômicos , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Demência/diagnóstico , Demência/etiologia , Demência/fisiopatologia , Demência/psicologia , Feminino , Humanos , Masculino , Memória Episódica , Processos Mentais/fisiologia , Rememoração Mental/fisiologia , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/fisiopatologia , Doenças Neurodegenerativas/psicologia , Testes Neuropsicológicos , Estados Unidos/epidemiologia
8.
J Alzheimers Dis ; 82(2): 771-779, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092634

RESUMO

BACKGROUND: Latinx elders are underrepresented in dementia research. In a previous study we assessed research attitudes in urban minority elders and found a significant minority expressed neutral to negative attitudes relating to trust, safety, and personal responsibility to help research. OBJECTIVE: To assess the impact of a composite intervention on attitudes toward research and research participation among elderly Latinx. The intervention was a collaboratively produced research participation video shown during presentations with our elderly community advisory board (CAB) as co-presenters. METHODS: The video was created by the ADRC and CAB. All senior center attendees were eligible to participate. Afterwards, the Research Attitudes Questionnaire (RAQ) and a brief questionnaire on the impact of the video were administered. Using Wilcoxon Rank Sum Tests, Chi Square, and OLS regressions, RAQ responses were compared to those from a historical cohort from similar centers. RESULTS: 74 in the "Historical Cohort 1" and 104 in "Intervention Cohort 2" were included. RAQ total score was higher in Cohort 2 than Cohort 1 (28.5 versus 26.1, p < 0.05) after controlling for age, education, and country of origin. In response to the question "Has the video influenced your willingness and interest to participate in research", 88.7%of the participants in Cohort 2 reported being "more" or "much more" interested in research. CONCLUSION: Tailoring community research recruitment programs to include relatable peers using novel recruitment techniques may have positive implications for improving enrollment of diverse elderly individuals in research.


Assuntos
Pesquisa Biomédica , Demência , Hispano-Americanos/psicologia , Participação do Paciente , Seleção de Pacientes , Intervenção Psicossocial/métodos , Idoso , Atitude Frente a Saúde , Recursos Audiovisuais , Pesquisa Biomédica/ética , Pesquisa Biomédica/métodos , Diversidade Cultural , Demência/etnologia , Demência/psicologia , Feminino , Humanos , Masculino , Participação do Paciente/métodos , Participação do Paciente/psicologia , Centros Comunitários para Idosos , Estados Unidos , População Urbana/estatística & dados numéricos
9.
Medicine (Baltimore) ; 100(25): e26397, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160423

RESUMO

BACKGROUND: Dementia is causing a huge medical and socioeconomic burden. Along with strategies to delay cognitive decline in dementia, behavioral and psychological symptoms of dementia (BPSD) are major contributing factor to the burden of dementia, and have been an important clinical issue for successful management of dementia. However, pharmacological strategies such as antipsychotics raise concerns in terms of risk-to-benefit ratio in managing BPSD. Therefore, there is a need for an effective and safe alternative in BPSD management. From this point of view, various complementary and alternative medicines (CAMs) are attracting attention in BPSD management. Therefore, the overview will make it possible to evaluate the feasibility of using CAM as a potential treatment strategy for BPSD in terms of evidence-based medicine. METHODS AND ANALYSIS: Comprehensive searching will be performed in 13 bibliographic databases from their inception dates to November 2021. Systematic reviews and/or meta-analyses that examined the effectiveness and safety of CAM modalities including herbal medicine, acupuncture, acupressure, aromatherapy, meditation, and relaxation on BPSD, will be included. The methodological quality of included reviews will be assessed by using the A MeaSurement Tool to Assess systematic Reviews-2. Two independent researchers will conduct study search, study selection, data extraction, and quality assessment processes. RESULTS: The results of overview will be disseminated by the publication of a manuscript in a peer-reviewed journal or presentation at a relevant conference. CONCLUSION: The findings of this overview will help to solve the major public health problem related to dementia, and will provide patients with dementia, their caregivers, clinicians, and health policy makers credible evidence in mitigating the burden of dementia. ETHICS AND DISSEMINATION: As this protocol is for an overview of systematic reviews and meta-analyses, ethical approval is not required. PROTOCOL REGISTRATION NUMBER: Open Science Framework registry (https://osf.io/g5f3m).


Assuntos
Terapias Complementares/métodos , Demência/terapia , Terapias Complementares/efeitos adversos , Demência/diagnóstico , Demência/epidemiologia , Demência/psicologia , Estudos de Viabilidade , Carga Global da Doença , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
10.
J Alzheimers Dis ; 82(3): 1001-1013, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120897

RESUMO

BACKGROUND: Timely diagnosis of dementia is a global healthcare priority, particularly in low to middle income countries where rapid increases in older adult populations are expected. OBJECTIVE: To investigate global perspectives on the role of brief cognitive assessments (BCAs) in dementia diagnosis, strengths and limitations of existing measures, and future directions and needs. METHODS: This is a qualitative study of 18 dementia experts from different areas of the world. Participants were selected using purposeful sampling based on the following criteria: 1) practicing in countries with projected growth of older adult population of over 100%by 2050; 2) expertise in dementia diagnosis and treatment; 3) involvement in clinical practice and training; and 4) recognition as a national dementia expert based on leadership positions within healthcare system, research, and/or policy work. Participants were individually interviewed in their language of choice over secure videoconference sessions. Interviews were analyzed by a multidisciplinary team using theme identification approach. RESULTS: Four domains with subthemes emerged illustrating participants' perspectives: 1) strengths of BCAs; 2) limitations of BCAs; 3) needs related to the use of BCAs; and 4) characteristics of an ideal BCA. While most experts agreed that BCAs were important and useful for dementia diagnosis, the themes emphasized the need for development and validation of novel measures that are sensitive, psychometrically sound, and culturally appropriate. CONCLUSION: BCAs are important for guiding diagnosis and care for dementia patients. Findings provide a roadmap for novel BCA development to assist in diagnostic decision making for clinicians serving a rapidly growing and diverse dementia population.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Saúde Global/normas , Médicos/normas , Pesquisa Qualitativa , Escala de Memória de Wechsler/normas , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Demência/epidemiologia , Demência/psicologia , Saúde Global/tendências , Humanos , Médicos/tendências , Inquéritos e Questionários/normas
11.
J Alzheimers Dis ; 82(3): 939-950, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120903

RESUMO

BACKGROUND: The study of emotion recognition could be crucial for detecting alterations in certain cognitive areas or as an early sign of neurological disorders. OBJECTIVE: The main objective of the study is to characterize research development on emotion recognition, identifying the intellectual structure that supports this area of knowledge, and the main lines of research attracting investigators' interest. METHODS: We identified publications on emotion recognition and dementia included in the Web of Science Core Collection, analyzing the scientific output and main disciplines involved in generating knowledge in the area. A co-citation analysis and an analysis of the bibliographic coupling between the retrieved documents elucidated the thematic orientations of the research and the reference works that constitute the foundation for development in the field. RESULTS: A total of 345 documents, with 24,282 bibliographic references between them, were included. This is an emerging research area, attracting the interest of investigators in Neurosciences, Psychology, Clinical Neurology, and Psychiatry, among other disciplines. Four prominent topic areas were identified, linked to frontotemporal dementia, autism spectrum disorders, Alzheimer's disease, and Parkinson's and Huntington disease. Many recent papers focus on the detection of mild cognitive impairment. CONCLUSION: Impaired emotion recognition may be a key sign facilitating the diagnosis and early treatment of different neurodegenerative diseases as well as for triggering the necessary provision of social and family support, explaining the growing research interest in this area.


Assuntos
Demência/diagnóstico , Demência/psicologia , Regulação Emocional/fisiologia , Expressão Facial , Reconhecimento Facial/fisiologia , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Análise por Conglomerados , Emoções/fisiologia , Humanos
12.
J Alzheimers Dis ; 82(3): 899-904, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120906

RESUMO

Diurnal salivary cortisol was measured in 334 older adults without dementia, at four times on two separate days, under quiet and stressful conditions. In multivariate Cox proportional hazard models, higher global diurnal cortisol secretion was associated with incident dementia (HR = 1.09 [1.02-1.15] per one-unit increase in cortisol measure, p = 0.007) and Alzheimer's disease (HR = 1.12 [1.04-1.21], p = 0.003) over a mean (SD) of 8.1 (4.0) years, independent of potential confounders and stressful conditions. Individuals with incident dementia had a slower rate of cortisol elimination under non-stressful conditions, reflected by higher cortisol levels in the evening, and an abnormal response to stress (blunted evening stress response).


Assuntos
Ritmo Circadiano/fisiologia , Demência/metabolismo , Demência/psicologia , Hidrocortisona/metabolismo , Achados Incidentais , Vida Independente/psicologia , Idoso , Idoso de 80 Anos ou mais , Demência/diagnóstico , Feminino , Seguimentos , Humanos , Hidrocortisona/análise , Vida Independente/tendências , Masculino , Sintomas Prodrômicos , Estudos Prospectivos , Saliva/química , Saliva/metabolismo , Estresse Psicológico/diagnóstico , Estresse Psicológico/metabolismo , Estresse Psicológico/psicologia
13.
Brain Pathol ; 31(5): e12997, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34145669

RESUMO

The actual role of SARS-CoV-2 in brain damage remains controversial due to lack of matched controls. We aim to highlight to what extent is neuropathology determined by SARS-CoV-2 or by pre-existing conditions. Findings of 9 Coronavirus disease 2019 (COVID-19) cases and 6 matched non-COVID controls (mean age 79 y/o) were compared. Brains were analyzed through immunohistochemistry to detect SARS-CoV-2, lymphocytes, astrocytes, endothelium, and microglia. A semi-quantitative scoring was applied to grade microglial activation. Thal-Braak stages and the presence of small vessel disease were determined in all cases. COVID-19 cases had a relatively short clinical course (0-32 days; mean: 10 days), and did not undergo mechanical ventilation. Five patients with neurocognitive disorder had delirium. All COVID-19 cases showed non-SARS-CoV-2-specific changes including hypoxic-agonal alterations, and a variable degree of neurodegeneration and/or pre-existent SVD. The neuroinflammatory picture was dominated by ameboid CD68 positive microglia, while only scant lymphocytic presence and very few traces of SARS-CoV-2 were detected. Microglial activation in the brainstem was significantly greater in COVID-19 cases (p = 0.046). Instead, microglial hyperactivation in the frontal cortex and hippocampus was clearly associated to AD pathology (p = 0.001), regardless of the SARS-CoV-2 infection. In COVID-19 cases complicated by delirium (all with neurocognitive disorders), there was a significant enhancement of microglia in the hippocampus (p = 0.048). Although higher in cases with both Alzheimer's pathology and COVID-19, cortical neuroinflammation is not related to COVID-19 per se but mostly to pre-existing neurodegeneration. COVID-19 brains seem to manifest a boosting of innate immunity with microglial reinforcement, and adaptive immunity suppression with low number of brain lymphocytes probably related to systemic lymphopenia. Thus, no neuropathological evidence of SARS-CoV-2-specific encephalitis is detectable. The microglial hyperactivation in the brainstem, and in the hippocampus of COVID-19 patients with delirium, appears as a specific topographical phenomenon, and probably represents the neuropathological basis of the "COVID-19 encephalopathic syndrome" in the elderly.


Assuntos
COVID-19/patologia , Demência/virologia , Microglia/patologia , Doenças do Sistema Nervoso/virologia , Idoso , Idoso de 80 Anos ou mais , Astrócitos/patologia , Encéfalo/patologia , COVID-19/psicologia , Estudos de Casos e Controles , Demência/patologia , Demência/psicologia , Feminino , Humanos , Masculino , Doenças do Sistema Nervoso/patologia , Doenças do Sistema Nervoso/psicologia , SARS-CoV-2/isolamento & purificação
14.
J Alzheimers Dis ; 82(3): 1219-1228, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34151804

RESUMO

BACKGROUND: The number of people living with dementia is rising globally due to population aging. Mass media campaigns which aim to reduce the risk of people developing dementia have been conducted across many countries, but few have reported evaluation findings. OBJECTIVE: The present study investigated the impact of the Your Brain Matters dementia risk reduction campaign in Australia. METHODS: The campaign was evaluated by observational cross-sectional surveys of 1000 Australian adults aged 18-75 years before and 24 months after delivery. The national campaign utilized multiple media channels to promote messages about the importance of brain health and reducing the risk of dementia. Dementia risk reduction knowledge, confidence, intentions and actions were measured at baseline and follow-up, and analyzed 2019-2020. RESULTS: Earned television and radio were the most common exposure channels. The proportion of people who understood that it is beneficial to take action to reduce dementia risk before middle age increased (54.1% to 59.4%, OR 1.20 95% CI: 1.01-1.44). There was also an increase (28.5% to 32.8%, OR 1.30, 95% CI: 1.07-1.59) in the proportion who reported taking action to improve brain health. There was no improvement in knowledge about vascular risk factors, or confidence to reduce personal dementia risk. CONCLUSION: The findings showed some receptivity and positive responses to messages about the benefits of taking action to reduce the risk of dementia. The campaign demonstrated the potential for generating news coverage about this issue, which should highlight the preventive benefits of vascular health behaviors.


Assuntos
Encéfalo/fisiologia , Demência/epidemiologia , Demência/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/tendências , Comportamento de Redução do Risco , Adulto , Idoso , Austrália/epidemiologia , Estudos Transversais , Demência/psicologia , Feminino , Promoção da Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
15.
Health Qual Life Outcomes ; 19(1): 170, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167529

RESUMO

BACKGROUND: Day care service (DCS) provides various activities in a professional environment to meet the old people with functional limitations. However, relatively little is known about the effects of DCS on physical and mental functions. METHODS: This was a retrospective study that we used a comprehensive geriatric assessment to evaluate the changes before and after DCS among participants in a hospital-affiliated geriatric day care center in Taiwan. The burden of the participants' families was also assessed. RESULTS: The 18 participants with a median age of 80.9 (interquartile range (IQR) 75.2-86.6 y/o) were enrolled and followed up for 6 months. Based on the clinical dementia rating (CDR), disease stage was very mild in 3 participants, mild in 10, moderate in 3, and severe in 2. The activities of daily living (ADL) scores of the participants improved significantly from 75 (IQR 60.0-80.0) at baseline to 77.5 (IQR 65.0-90.0) at the 6 month (p < 0.001), and mini-mental state examination (MMSE) scores from 15 (IQR 11.5-20.0) to 18 (IQR 15.8-24.0) (p = 0.026). There was a positive correlation of baseline mini-nutritional assessment-short form score and the 3-level version of the European Quality of Life-5 dimensions utility index with both ADL and MMSE scores at the 6-month follow-up. In addition, the family burden scale was reduced from 22 to 15 (p = 0.002). CONCLUSIONS: The physical and cognitive functions in old people with dementia who received DCS were maintained or partially improved, and their families' stress burden was alleviated.


Assuntos
Atividades Cotidianas , Cognição , Hospital Dia/psicologia , Demência/psicologia , Estado Funcional , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Feminino , Avaliação Geriátrica , Humanos , Masculino , Testes de Estado Mental e Demência , Avaliação Nutricional , Qualidade de Vida , Estudos Retrospectivos , Taiwan
16.
J Alzheimers Dis ; 82(4): 1531-1541, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092637

RESUMO

BACKGROUND: People with dementia (PWD) and their caregivers are populations highly vulnerable to COVID-19 pandemic and its consequences. A better knowledge of the living conditions during the first lockdown is necessary to prevent the risk of poor mental health (PMH) in this population. OBJECTIVE: The present study aimed to compare the mental health of caregivers of PWD living at home or in nursing-homes and to identify specific factors influencing their mental health. METHODS: We conducted an anonymous cross-sectional online survey in France from March 17 to May 11, 2020. Three hundred and eighty-nine caregivers accompanying a PWD living at home (HC) and 159 accompanying a PWD living in a nursing home (NHC) participated in the study. Caregivers' mental health including anxiety, depression, stress, and burden was assessed with self-reported standardized scales. RESULTS: Half of the caregivers exhibited PMH, including depression, anxiety, or self-reported stress. Similar PMH rates were provided whatever the PWD place of residence. Regarding HC, our results also highlighted a number of risk factors for PMH, including the fact that caregiver live with PWD, to give increased support to PWD, and to feel more isolated for managing PWD since lockdown. CONCLUSION: PMH was observed for caregivers of PWD during lockdown, whatever PWD living place, suggesting that concern for PWD may explain more of caregiver distress than increased material tasks. In the future, it will be necessary to pay attention to caregivers after the crisis by estimating the longer-term impact on their mental health.


Assuntos
COVID-19/epidemiologia , COVID-19/psicologia , Controle de Doenças Transmissíveis/tendências , Demência/epidemiologia , Demência/psicologia , Saúde Mental/tendências , Idoso , Cuidadores/psicologia , Cuidadores/tendências , Estudos Transversais , Demência/terapia , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
17.
J Alzheimers Dis ; 81(4): 1763-1779, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33998546

RESUMO

BACKGROUND: Auditory naming tests are superior to visual confrontation naming tests in revealing word-finding difficulties in many neuropathological conditions. OBJECTIVE: To delineate characteristics of auditory naming most likely to reveal anomia in patients with dementia, and possibly improve diagnostic utility, we evaluated a large sample of patients referred with memory impairment complaints. METHODS: Patients with dementia (N = 733) or other cognitive impairments and normal individuals (N = 69) were evaluated for frequency of impairment on variables of the Auditory Naming Test (ANT) of Hamberger & Seidel versus the Boston Naming Test (BNT). RESULTS: Naming impairment occurred more frequently using the ANT total score (φ= 0.41) or ANT tip-of-the tongue score (TOT; φ= 0.19) but not ANT mean response time compared to the BNT in patients with dementia (p < 0.001). Significantly more patients were impaired on ANT variables than on the BNT in Alzheimer's disease (AD), vascular dementia (VaD), mixed AD/VaD, and multiple domain mild cognitive impairment (mMCI) but not in other dementias or amnestic MCI (aMCI). This differential performance of patients on auditory versus visual naming tasks was most pronounced in older, well-educated, male patients with the least cognitive impairment. Impaired verbal comprehension was not contributory. Inclusion of an ANT index score increased sensitivity in the dementia sample (92%). Poor specificity (41%) may be secondary to the inherent limitation of using the BNT as a control variable. CONCLUSION: The ANT index score adds diagnostic utility to the assessment of naming difficulties in patients with suspected dementia.


Assuntos
Anomia/diagnóstico , Disfunção Cognitiva/complicações , Demência/complicações , Idoso , Idoso de 80 Anos ou mais , Anomia/complicações , Anomia/psicologia , Disfunção Cognitiva/psicologia , Demência/psicologia , Feminino , Humanos , Testes de Linguagem , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos
18.
J Alzheimers Dis ; 81(4): 1567-1578, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34057080

RESUMO

BACKGROUND: Dementia is commonly accompanied by neurobehavioral symptoms; however, the relationship between such symptoms and health-related outcomes is unclear. OBJECTIVE: To investigate the impact of specific neurobehavioral symptoms in dementia on healthcare resource use (HCRU), patient quality of life (QoL), and caregiver burden. METHODS: Data were taken from the 2015/16 Adelphi Real World Dementia Disease Specific Programme™, a point-in-time survey of physicians and their consulting dementia patients. Multiple regression analyses were used to examine associations between patient symptom groups and health-related outcomes. RESULTS: Each patient symptom group of interest (patients with agitation/aggression and related symptoms [AARS] with psychosis, patients with AARS without psychosis, and patients with other behavioral symptoms) had a positive association with HCRU variables (i.e., HCRU was greater), a negative association with proxy measures of patient QoL (i.e., QoL was decreased), and a positive association with caregiver burden (i.e., burden was greater) compared with patients with no behavioral symptoms (control group). The magnitude of effect was generally greatest in patients with AARS with psychosis. Regression analysis covariates that were found to be most often significantly related to the outcomes were dementia severity and the patients' living situation (i.e., whether they were in nursing homes or living in the community). CONCLUSION: Combinations of behavioral symptoms, particularly involving AARS plus psychosis, may have a detrimental impact on health-related outcomes such as HCRU, patient QoL, and caregiver burden in dementia. Our results have implications for intervention development in patients who report clusters of symptoms and caregivers, and for identifying at-risk individuals.


Assuntos
Fardo do Cuidador/psicologia , Cuidadores/psicologia , Demência/terapia , Recursos em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Agressão/psicologia , Atenção à Saúde , Demência/psicologia , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
19.
J Community Health Nurs ; 38(2): 103-119, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33949259

RESUMO

Ethnically diverse Americans experience 1.8-2.5 times higher risk of developing Alzheimer's disease than Whites (Mayeda, et al., 2016), yet cognitive screening is not routinely conducted among Haitian American communities. Dementia risk awareness is beneficial for improving management of chronic illness and behaviors that impact risk of cognitive decline. A quasiexperimental paired samples t-test design was employed to test the effectiveness of an educational intervention among 50 older faith- based Haitian adults using the Basic Knowledge of Alzheimer's Disease (BKAD) scale, cognitive screening using the Cognitive State Test (COST), and referrals to a local memory/wellness center. A significant difference was seen in knowledge scores: pre-test (M = 18.5, SD = 3.12) and post-test (M = 23.1, SD = 2.42); conditions t(41.9) = -9.5, p = .000. All of those who volunteered for screening completed follow-up neuropsychological evaluations. Outreach to faith-based settings is suggested as an avenue for improving dementia knowledge and detection.


Assuntos
Demência/diagnóstico , Testes Neuropsicológicos , Educação de Pacientes como Assunto , Religião , Idoso , Idoso de 80 Anos ou mais , Enfermagem em Saúde Comunitária , Demência/etnologia , Demência/psicologia , Grupos Étnicos , Feminino , Haiti , Humanos , Masculino , Pessoa de Meia-Idade
20.
Nurs Clin North Am ; 56(2): 265-274, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34023120

RESUMO

Restless legs syndrome (RLS), one of the more prevalent sleep disturbances among older adults, impacts quality of life. Patients with dementia are at high risk for developing RLS and may be unable to describe their symptoms. Often underdiagnosed, RLS can contribute to discomfort, pain, nighttime agitation, disturbed sleep, and falls. Clinical assessment is crucial and should include a thorough evaluation with input from the patient and family, deprescribing medication if possible, and consideration of common sleep-disturbing factors. Evidence-based treatment in this population is limited; overall focus should center on relieving discomfort while identifying and treating bothersome sleep symptoms.


Assuntos
Tomada de Decisões , Demência/complicações , Síndrome das Pernas Inquietas/etiologia , Idoso , Idoso de 80 Anos ou mais , Demência/epidemiologia , Demência/psicologia , Feminino , Humanos , Masculino , Síndrome das Pernas Inquietas/epidemiologia , Síndrome das Pernas Inquietas/psicologia , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/psicologia , Inquéritos e Questionários
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