International Practice Recommendations for the Recognition and Management of Hearing and Vision Impairment in People with Dementia.

INTRODUCTION: Hearing, vision, and cognitive impairment commonly co-occur in older people. However, the rate of recognition and appropriate management of combined hearing and vision impairment in people with dementia impairment is low. The aim of this work was to codevelop internationally relevant, multidisciplinary practice recommendations for professionals involved in the diagnosis, care, and management of older people with these concurrent conditions. METHODS: We applied consensus methods with professional and lay expert stakeholders, using an adapted version of the World Health Organization Handbook for Guideline Development. The development involved 4 phases and included: (1) collating existing evidence, (2) filling the gaps in evidence, (3) prioritising evidence, and (4) refining the final list of recommendations. Each phase encompassed various methodologies including a review of existing guidelines within the 3 clinical domains, systematic reviews, qualitative studies, a clinical professional consortium, surveys, and consensus meetings with interdisciplinary domain experts. RESULTS: The task force evaluated an initial list of 26 recommendations, ranking them in the order of priority. A consensus was reached on 15 recommendations, which are classified into 6 domains of "awareness and knowledge," "recognition and detection," "evaluation," "management," "support," and "services and policies." Pragmatic options for implementation for each domain were then developed. CONCLUSION: This is the first set of international, interdisciplinary practice recommendations that will guide the development of multidisciplinary services and policy to improve the lives of people with dementia and hearing and vision impairment.

The cortical and subcortical substrates of quality of life through substrates of self-awareness and executive functions, in chronic moderate-to-severe TBI.

BACKGROUND: Moderate-to-severe traumatic brain injury (TBI) follows a chronic neuro-psychological sequelae, interfering with quality of life (QOL). OBJECTIVE: To investigate the chronic effects of moderate-to-severe TBI as expressed by greater atrophy in specific regions-of-interest relating to executive functions (EF) and self-awareness (SA); and whether this atrophy reflects on EF, SA deficits and QOL. METHODS: Thirty-one males with chronic moderate-to-severe TBI, aged 18-51, were compared to 24 non-injured males (age range = 21-49), matched on age and education. EF was assessed through a composite score. SA and QOL were assessed using generic and TBI-specific measures. Online masks were applied on magnetic resonance images to extract EF and SA - related regions-of-interest. RESULTS: Findings revealed that participants with TBI presented with less volume in fronto-temporal cortical and subcortical regions, than controls. An interrelation between EF and SA - related regions was revealed. Participants with TBI scored lower on neuropsychosocial measures, than controls. Differences in EF and SA were reflected on the related regions-of-interest. Satisfaction with QOL was predicted by these regions-of-interest. CONCLUSION: Chronic TBI effects on brain volume extend on EF, SA, and QOL; highlighting the role of SA between EF and QOL, and the need for personalized interventions in improving recovery outcome.

Alzheimer's disease research progress in the Mediterranean region: The Alzheimer's Association International Conference Satellite Symposium.

As research and services in the Mediterranean region continue to increase, so do opportunities for global collaboration. To support such collaborations, the Alzheimer's Association was due to hold its seventh Alzheimer's Association International Conference Satellite Symposium in Athens, Greece in 2021. Due to the COVID-19 pandemic, the meeting was held virtually, which enabled attendees from around the world to hear about research efforts in Greece and the surrounding Mediterranean countries. Research updates spanned understanding the biology of, treatments for, and care of people with Alzheimer's disease (AD_ and other dementias. Researchers in the Mediterranean region have outlined the local epidemiology of AD and dementia, and have identified regional populations that may expedite genetic studies. Development of biomarkers is expected to aid early and accurate diagnosis. Numerous efforts have been made to develop culturally specific interventions to both reduce risk of dementia, and to improve quality of life for people living with dementia.

Psychosocial Impacts of the COVID-19 Quarantine: A Study of Gender Differences in 59 Countries.

Background and Objectives: There is strong evidence in the literature that women experience psychological disorders at significantly higher rates than men. The higher rates of psychological disorders in women may partly be attributable to gender differences in response to stressors and coping styles. The objective of this study was to contribute to the growing body of literature investigating gender differences in mental health outcomes and coping styles during the coronavirus disease 2019 pandemic in a large sample of individuals from 59 countries with variable demographic and socio-cultural characteristics. Materials and Methods: Survey data were collected from the general population following a snowball sampling method, and the survey was promoted through social media platforms and mailing lists. Participants included 6882 individuals from the general population from 59 countries around the world. A combination of both standardized and adapted measures was used to create a survey, originally in English and then translated to Spanish, Italian, French, German, and Turkish. Results: Compared with men, women presented with higher levels of trauma-related distress; had a harder time decompressing; were more depressed, anxious and stressed; showed decreased frustration tolerance and reported lower quality of sleep and an increased likelihood of taking sleep medication or other natural sleep remedies. Overall, women tended to be more vulnerable during the pandemic in developing symptoms consistent with various forms of mental disorders such as depression, anxiety and post-traumatic distress. However, they also were more likely than men to use a variety of adaptive coping strategies, including concentrating on doing something about the situation and getting emotional support from others. Conclusions: A high prevalence of mood symptoms was noted among women. In addition to meeting the physical health needs of the population, emphasis needs to be given to mental health and the prevention of psychiatric disorders, particularly in women.

Impact of an intervention to support hearing and vision in dementia: The SENSE-Cog Field Trial.

OBJECTIVES: Hearing, vision, and cognitive impairment commonly co-occur in older adults. Improving sensory function may positively impact outcomes in people with dementia (PwD). We developed a "sensory intervention" (SI) to support hearing and vision in PwD. Here, we report the findings of an international open-label field trial, and nested case series, to explore the impact of the SI on dementia-related outcomes. METHODS: This was a home-based trial conducted in France, England, and Cyprus. Participants were people with mild-to-moderate dementia and hearing and/or vision impairment (n = 19) and their study partners (unpaid carers; n = 19). The "basic" SI included a hearing and vision assessment and provision of glasses and/or hearing aids. A subsample received the "extended" SI with additional weekly visits from a sensory support therapist (SST). Exploratory analyses of dementia-related, health utility and resource utilisation outcomes were performed. RESULTS: Quality of life (QoL) and sensory functional ability improved. Change in QoL exceeded the threshold for a minimum clinically important difference. There was a modest improvement (in absolute terms) post intervention in behavioural disturbance, self-efficacy, and relationship satisfaction. Study partner time assisting instrumental activities of daily living (iADL) and supervision decreased by about 22 and 38 hours per month, respectively, although time for personal ADL support increased. Qualitative data supported effectiveness of the intervention: PwD were more socially engaged, less isolated, less dependent on study partners, and had improved functional ability and communication. CONCLUSIONS: These findings support the need for a definitive randomised controlled trial (RCT) to evaluate the effectiveness of the intervention.

Measurement of everyday dysexecutive symptoms in normal aging with the Greek version of the dysexecutive questionnaire-revised.

The Dysexecutive Questionnaire is a sensitive and ecologically valid measure of everyday dysexecutive symptoms. Recently, a revised version of the tool has been proposed (DEX-R). The current study aimed to examine the factorial validity of the Greek DEX-R, the level of agreement between the self and informant rating versions and the effect of age on each dysexecutive symptoms component. The questionnaire was administered to a sample of older adults (n = 235) and to a sample of informants (n = 187) in the context of the Neurocognitive Study for the Aging in Cyprus. Confirmatory Factor Analysis results showed that dysexecutive symptoms can be grouped into three underlying components or factors: (a) Motivation and Attention, (b) Flexibility, Fluency and Working Memory, and (c) Social Self-Regulation. Overall, the elderly reported more symptoms than their relatives, however the difference was significant only for the Flexibility, Fluency and Working memory factor. In a structural equation model, a weak positive effect of age was observed on the Flexibility, Fluency and Working Memory factor, based on the informant ratings. This study provides empirical evidence about the use of the DEX-R questionnaire in the Greek-speaking elderly population as a valid and reliable measure of everyday dysexecutive symptoms.

Assessing and managing concurrent hearing, vision and cognitive impairments in older people: an international perspective from healthcare professionals.

BACKGROUND: there is a significant gap in the understanding, assessment and management of people with dementia and concurrent hearing and vision impairments. OBJECTIVE: from the perspective of professionals in dementia, hearing and vision care, we aimed to: (1) explore the perceptions of gaps in assessment and service provision in ageing-related hearing, vision and cognitive impairment; (2) consider potential solutions regarding this overlap and (3) ascertain the attitudes, awareness and practice, with a view to implementing change. METHODS: our two-part investigation with hearing, vision, and dementia care professionals involved: (1) an in-depth, interdisciplinary, international Expert Reference Group (ERG; n = 17) and (2) a wide-scale knowledge, attitudes and practice survey (n = 653). The ERG involved consensus discussions around prototypic clinical vignettes drawn from a memory centre, an audiology clinic, and an optometry clinic, analysed using an applied content approach. RESULTS: the ERG revealed several gaps in assessment and service provision, including a lack of validated assessment tools for concurrent impairments, poor interdisciplinary communication and care pathways, and a lack of evidence-based interventions. Consensus centred on the need for flexible, individualised, patient-centred solutions, using an interdisciplinary approach. The survey data validated these findings, highlighting the need for clear guidelines for assessing and managing concurrent impairments. CONCLUSIONS: this is the first international study exploring professionals' views of the assessment and care of individuals with age-related hearing, vision and hearing impairment. The findings will inform the adaptation of assessments, the development of supportive interventions, and the new provision of services.

Whole brain and corpus callosum diffusion tensor metrics: How do they correlate with visual and verbal memory performance in chronic traumatic brain injury.

This research investigates the chronic effect of moderate to severe traumatic brain injury on brain white matter integrity, as reflected by diffusion tensor imaging metrics, and the assessment of their correlation to neuropsychological response. Thirteen male participants with traumatic brain injury (8.4 years average post-injury time) were compared to a matched group of neurologically healthy controls. None of the traumatic brain injury subjects had received post-acute neurocognitive and/or neuropsychological rehabilitation. Between-group comparison of fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity was performed for the whole brain and corpus callosum. An extensive battery of visual and verbal memory tasks was employed for the comparative assessment of neurocognitive performance. Between-group and within-group performance differences were correlated with fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity of corpus callosum. Significant changes in global fractional anisotropy, mean diffusivity, and radial diffusivity were associated with traumatic brain injury. Visual memory capacity was reduced in traumatic brain injury, and this deficit was correlated to white matter integrity loss at the corpus callosum. Participants with traumatic brain injury underperformed controls in verbal memory as well, but no correlation with corpus callosum diffusion tensor imaging properties was established. Between-group performance difference was correlated with corpus callosum diffusion metrics in several tasks. Significant correlations were found between corpus callosum diffusion tensor imaging metrics and neuropsychological response within the traumatic brain injury group. Changes in whole brain and corpus callosum diffusion tensor metrics inflicted by moderate to severe traumatic brain injury are still evident several years post-injury and relate to neurocognitive impairment, while loss of white matter integrity seems to correlate with episodic and working memory impairment.

Multidisciplinary Management of Collegiate Sports-Related Concussions.

PURPOSE: Collegiate varsity athletes are at risk for sustaining a sports-related concussion, which can negatively impact performance during academic, social, work, and athletic endeavors. Because of the complex nature of concussions and high rates of underreporting by athletes, concussion education, identification, and postinjury care require a collaborative, multidisciplinary approach. Therefore, the purpose of this paper is to describe the specific responsibilities of the team members along with the established pre- and postconcussion procedures of one of the oldest university-based multidisciplinary concussion management programs that is coordinated by speech-language pathology. METHOD: The authors provide a theoretical review of current best practices for the multidisciplinary team along with a discussion of baseline and postconcussion neurocognitive assessment and management procedures directly involving speech-language pathology. Included is a case example illustrating the postinjury procedures utilized by the team. CONCLUSION: Management of the complex sequelae of sports-related concussion for the varsity collegiate athlete necessitates implementation of a multidisciplinary, collaborative approach. Speech-language pathologists' training in the assessment and treatment of brain injury provides the team with an objective perspective in the evaluation and postinjury management of the injured student athlete. While our understanding of concussions has improved greatly over the past two decades, researchers and clinicians on the front lines of care recognize that continued voids exist in our knowledge, with the need to continually explore new methods to identify and manage the complex immediate and potentially long-term ramifications of concussion.

Discrete capacity limits and neuroanatomical correlates of visual short-term memory for objects and spatial locations.

Working memory is responsible for keeping information in mind when it is no longer in view, linking perception with higher cognitive functions. Despite such crucial role, short-term maintenance of visual information is severely limited. Research suggests that capacity limits in visual short-term memory (VSTM) are correlated with sustained activity in distinct brain areas. Here, we investigated whether variability in the structure of the brain is reflected in individual differences of behavioral capacity estimates for spatial and object VSTM. Behavioral capacity estimates were calculated separately for spatial and object information using a novel adaptive staircase procedure and were found to be unrelated, supporting domain-specific VSTM capacity limits. Voxel-based morphometry (VBM) analyses revealed dissociable neuroanatomical correlates of spatial versus object VSTM. Interindividual variability in spatial VSTM was reflected in the gray matter density of the inferior parietal lobule. In contrast, object VSTM was reflected in the gray matter density of the left insula. These dissociable findings highlight the importance of considering domain-specific estimates of VSTM capacity and point to the crucial brain regions that limit VSTM capacity for different types of visual information. Hum Brain Mapp 38:767-778, 2017. © 2016 Wiley Periodicals, Inc.

Cognitive-Linguistic Performance and Quality of Life in Healthy Aging.

BACKGROUND/AIMS: This study investigated quality of life (QoL) in relation to cognitive-linguistic performance and demographic characteristics (age, education and gender) in a large cohort of cognitively healthy older adults. METHOD: A total of 578 Greek-Cypriots aged 60-91 years were recruited from the Neurocognitive Study on Aging. Of those, 395 healthy participants (171 males and 224 females) who met all study criteria were retained. They completed measures of executive functioning, working memory, receptive vocabulary and confrontational naming in addition to the WHOQOL-BREF (brief version of the WHO QoL questionnaire). RESULTS: There were modest but significant relationships between executive functioning, working memory, vocabulary measures and the WHOQOL-BREF (p < 0.01). MANOVA yielded significant gender and education effects on QoL. Sequential stepwise regression confirmed that gender, depression scores and years of education made significant contributions to predicting the total score on WHOQOL-BREF and accounted for 31% of the variance (R² = 0.310). CONCLUSION: Self-reports of QoL remain stable in older adulthood. Demographic variables such as gender and years of education affected several domains of QoL, and, along with depression symptomatology, accounted for a significant part of the WHOQOL-BREF variance. Cognitive-linguistic measures correlated on the physical and psychological health domains of the WHOQOL-BREF in healthy older adults.

An International Perspective on Quality of Life in Aphasia: A Survey of Clinician Views and Practices from Sixteen Countries.

OBJECTIVE: To gain an insight into speech and language therapists' perspectives on and practices in quality of life in aphasia. PARTICIPANTS AND METHODS: The International Association of Logopedics and Phoniatrics Aphasia Committee developed a survey questionnaire, which was delivered online, anonymously, through SurveyMonkey (November 2012 to April 2013) to clinicians working with people with aphasia in 16 countries across the world. RESULTS: A large number of speech and language therapists responded to the survey, with 19/21 questions answered by 385-579 participants. Clinicians were well informed on what constitutes quality of life and viewed it as a complex construct influenced by health, participation, in/dependence, communication, personal factors, and environmental factors. In their clinical practice, they considered quality of life as important, used informal approaches to explore it and aimed to address quality of life goals; yet, the majority did not evaluate quality of life in a systematic way. CONCLUSION: There is a need for training on quality of life to help speech and language therapists incorporate quality of life outcome measures in their interventions. There is also a need for further research on which interventions improve quality of life in aphasia.

Age-related decline in verbal learning is moderated by demographic factors, working memory capacity, and presence of amnestic mild cognitive impairment.

Age-related memory changes are highly varied and heterogeneous. The study examined the rate of decline in verbal episodic memory as a function of education level, auditory attention span and verbal working memory capacity, and diagnosis of amnestic mild cognitive impairment (a-MCI). Data were available on a community sample of 653 adults aged 17-86 years and 70 patients with a-MCI recruited from eight broad geographic areas in Greece and Cyprus. Measures of auditory attention span and working memory capacity (digits forward and backward) and verbal episodic memory (Auditory Verbal Learning Test [AVLT]) were used. Moderated mediation regressions on data from the community sample did not reveal significant effects of education level on the rate of age-related decline in AVLT indices. The presence of a-MCI was a significant moderator of the direct effect of Age on both immediate and delayed episodic memory indices. The rate of age-related decline in verbal episodic memory is normally mediated by working memory capacity. Moreover, in persons who display poor episodic memory capacity (a-MCI group), age-related memory decline is expected to advance more rapidly for those who also display relatively poor verbal working memory capacity.

Long-term psychological impact of the pandemic COVID-19: Identification of high-risk groups and assessment of precautionary measures five months after the first wave of restrictions was lifted.

Critical facets of our lives have been disrupted by the COVID-19 outbreak for almost three years. During this time, there has been a lot of clinical and research interest in issues related to mental health. However, few have examined the pandemic's long-term psychological effects. The aims of the present study were to assess the long-term psychological impact of the pandemic COVID -19, five months after the first wave restriction measures were lifted, to identify high-risk groups and to address the use of precautionary measures (PM). Information about sociodemographic characteristics, mental health, coping mechanisms, and compliance with precautionary measures (PM) were all gathered in Cyprus through an anonymous online survey. The poll was completed by 1128 people (73% of whom were female). For the purposes of the present study, descriptive statistics and structural equation modeling were used. 32.3% of participants experienced moderate-to-severe anxiety symptoms, where 16.4% and 23% reported moderate-to-severe depression and post-traumatic stress symptoms respectively. Lower levels of anxiety, depression, and post-traumatic stress symptoms as well as greater compliance to PM were linked to higher levels of resilience. Additionally, subgroups of participants, at a higher risk for negative psychological effects were identified, such as women and young adults. Our findings demonstrate the long-lasting effects of the COVID-19 pandemic on mental health and provide guidance on how to deal with similar situations. It also raises questions about the concurrent effects on people with the long COVID syndrome.

A new multidimensional group intervention for cognitive and psychosocial functioning for older adults: Background, content, and process evaluation.

Introduction: An essential element of quality aging is the maintenance of cognitive and psychosocial functioning. The principal objective of the present paper was to present the theoretical framework, content and process evaluation of a newly developed multi-dimensional group intervention designed to strengthen/improve areas of cognitive and psychosocial functioning in adults over 65. Methods: The intervention implements multiple methodologies aiming to facilitate contextual integration of learned concepts and strategies derived from clinical psychology and rehabilitation. It moves seamlessly on the cognition-emotion axes and consists of five active ingredients selected to address challenges associated with aging: Memory Compensatory Strategies, Problem-Solving, Emotion Regulation, Mindfulness, and Locus of Control. Thirty participants joined the intervention group aged 65-75 years (M = 69.03; SD = 3.04). All 30 participants who were included in the intervention group completed the program. Results: Results from the Participant Satisfaction Scale indicate that the program was perceived very positively by participants, who also reported implementing their newly learned strategies in activities of daily life. Furthermore, there was high correlation between internal locus of control and the learned strategies. Discussion: The outcomes of this analysis indicate that the intervention is feasible and well tolerated by our target group. This multidimensional intervention may offer a valuable contribution to public health care and dementia prevention for older adults. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/results?cond=NCT01481246], identifier [NCT01481246].

Evolution of rehabilitation services in response to a global pandemic: reflection on opportunities and challenges ahead.

The rapidly evolving COVID-19 public health emergency has disrupted and challenged traditional healthcare, rehabilitation services, and treatment delivery worldwide. This perspective paper aimed to unite experiences and perspectives from an international group of rehabilitation providers while reflecting on the lessons learned from the challenges and opportunities raised during the COVID-19 pandemic. We discuss the global appreciation for rehabilitation services and changes in access to healthcare, including virtual, home-based rehabilitation, and long-term care rehabilitation. We illustrate lessons learned by highlighting successful rehabilitation approaches from the US, Belgium, and Japan.

Psychosocial adjustment of epilepsy patients in Cyprus.

This study investigated aspects of psychosocial adjustment in epilepsy patients in Cyprus. Sixty-three patients under 55 years of age with idiopathic or symptomatic epilepsy and 89 neurologically matched healthy volunteers participated. Subjects completed the State and Trait Anxiety Inventory and the Beck Depression Inventory; patients with epilepsy also completed the Epilepsy Foundation Concerns Index. Results showed that patients with symptomatic epilepsy had significantly higher scores on state and trait anxiety and depressive symptoms. Sociodemographic characteristics including gender, marital status, and education levels contributed to differences in trait and state anxiety, depressive symptom scales, autonomy concerns, and fear for seizure recurrence. Variables such as poor seizure control and use of polytherapy were associated with lower adjustment scores and reduced psychosocial outcome. Finally, patients with epilepsy scored significantly higher on depression and anxiety symptoms. The results provide further evidence on challenges patients with epilepsy face and on the need for implementing psychosocial prevention programs.

Assessment of executive functioning in brain injury: collaboration between speech-language pathology and neuropsychology for an integrative neuropsychological perspective.

BACKGROUND: Executive functioning (EF) deficits are common sequelae of traumatic brain injury (TBI). These deficits extend beyond the acute stages of recovery and pose a significant challenge in rehabilitation efforts. Current theories of EF propose a multidimensional construct. This paper provides an integrative theoretical framework with interactive dimensions for the assessment and treatment of EF that can assist the interdisciplinary team to successfully manage EF deficits secondary to TBI. METHODS: This paper is a review of pertinent literature related to assessment of EF. It concludes with a case presentation that illustrates the utility of the proposed theoretical framework in the rehabilitation context. CONCLUSIONS: Formal neuropsychological, standardized psychometric measures and informal clinical observations, particularly as they relate to contextual assessment, should be incorporated in order to effectively assess EF difficulties in survivors of TBI. The paper concludes with recommendations for effective assessment and treatment of EF by the interdisciplinary team consisting of speech-language pathologists and neuropsychologists.