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Participants from an outpatient treatment program for cognitive disorders have been offered bridging measures because of limited access to the outpatient clinic during a Covid-19-caused lock-down. The aim of this study was to assess perceived stress, acceptance, and appreciation of the measures among patients and their caregivers compared to the previous bridging measure. Forty participants were offered treatment in person or online depending on their cognitive performance level. To evaluate acceptance, data collected from clinical routine was incorporated into a treatment observation. The evaluation of bridging measures by 25 participants was positive. Perceived stress was moderate to high among participants and has increased significantly compared to previous special treatment. Perceived stress in older patients had increased over the course of the pandemic. Bridging measures represented a treatment alternative and may offer previously untapped potential for location-independent psychosocial treatments in order to ameliorate both the patients' and their caregivers' convenience.
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AIM OF STUDY: The aim of the present study was to investigate the use and subjective benefit of specific temporary hearing-improvement measures (unidirectional hearing aids) in hearing-impaired, geriatric psychiatric patients. Simultaneously, employees evaluated the handling and acceptance of the hearing-improving measures. MATERIAL AND METHOD: Between October 2022 and July 2023, subjective hearing ability and use of conventional hearing aids were recorded in outpatients and in those in partial inpatient care (n=151) based on a self-assessment questionnaire. After using unidirectional hearing aids in diagnostics and treatment for four to six weeks, the hearing ability of 21 patients who had not used the hearing-improving measures was surveyed again and the experiences of active users (n=34) and employees (n=24) with the hearing-improving measures were analyzed via questionnaires. RESULTS: Of the 151 included patients (79.2 years, 62.1% female), 147 patients and 24 employees (79.2% female) took part in the study. Subjective hearing impairments were reported by 50 patients (34.0%). The hearing of 93 patients (63.2%) had already been assessed once. Treatment with conventional hearing aids was recommended for 34 of those surveyed (23.1%). Likewise, 34 patients (23.1%) took advantage of the offer of hearing-improving measures. All 34 users and all participating employees rated the hearing-improving measures used as mostly positive. CONCLUSION: Hearing impairment in geriatric psychiatric patients is common and often not adequately treated with conventional hearing aids, yet hearing-improving measures are only used to a limited extent. Mostly positive results among the users of hearing-improving measures favor their implementation in patients in routine outpatient and (partial) inpatient geriatric psychiatric care.
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THE AIM OF THE STUDY: was the assessment of the feasibility of a cognitive training program for employees of care 50+. METHOD: A cognitive training program (13 h, 5 sessions) was conducted with 15 nurses of the University Hospital Munich (KUM). Acceptance of and effects on cognitive and psychological performance were determined. RESULTS: The measure was well accepted and received positive ratings. In addition, there were significant improvements in cognitive performance and self-efficacy. CONCLUSION: The training program can be implemented on a regular basis; initial results providing evidence in support of positive training effects must be confirmed in future randomized controlled trials.
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Cognição , Recursos Humanos de Enfermagem , Estudos de Viabilidade , Alemanha , Humanos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/educação , Projetos PilotoRESUMO
Neuropsychological assessment should be an integral component of clinical psychiatric diagnostics. Yet, the commonly used tests have not been investigated adequately for this population so far. The current study evaluated a clinically approved neuropsychological test battery by analyzing data on 226 mentally ill patients using factor and regression analyses. The extraction of three factors (Speed, Memory, and Executive Functions) proved to be adequate as the tests could be allocated properly. Regression analysis revealed an economical basis assessment consisting of three tests (TAP Alertness, VLMT, and Matrices Test). Based on acceptance, economy, and factorial structure aspects, we recommend the investigated test battery for neuropsychological assessment of psychiatric and psychosomatic patients.
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Transtornos Mentais/psicologia , Testes Neuropsicológicos , Transtornos Psicofisiológicos/psicologia , Adolescente , Adulto , Idoso , Função Executiva , Análise Fatorial , Feminino , Humanos , Masculino , Memória , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Transtornos Psicofisiológicos/diagnóstico , Tempo de Reação , Análise de Regressão , Reprodutibilidade dos Testes , Adulto JovemRESUMO
The present study was designed to examine driving skills according to regulations of the German guidelines for road and traffic safety in unmedicated schizophrenic inpatients. A total of 13 first-episode (FES) and 13 recurrent-episode (RES) schizophrenic inpatients were included in the analysis and compared with a group of 20 healthy controls (HC). Data were collected with the computerised Wiener Testsystem measuring visual perception, reactivity and stress tolerance, concentration and vigilance. Analysis of data indicates that a great proportion (58 %) of schizophrenic patients were impaired in psychomotor functions related to driving skills. FES and RES significantly differed with respect to driving ability with a greater proportion in the FES (38 %) showing severe impairments when compared with RES (25 %). Differences with respect to HC performance were most pronounced in concentration and for the FES additionally in visual perception. Analysis of our data indicates that a great proportion of schizophrenic patients are impaired in psychomotor functions related to driving skills that cannot be attributed to adverse side effects of psychopharmacological treatment. Besides, we cannot confirm a chronical decline of psychomotor functions related to driving skills at least in the early course of schizophrenic illness.
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Condução de Veículo , Transtornos Psicomotores/etiologia , Esquizofrenia/complicações , Adulto , Atenção , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Transtornos Psicomotores/diagnóstico , Desempenho Psicomotor , Tempo de Reação , Estatística como Assunto , Estatísticas não Paramétricas , Percepção Visual , Adulto JovemRESUMO
BACKGROUND: Driving is an important activity of daily life and an integral part of mobility. However, impact of mental illness on road mobility is widely unexplored. METHOD: Driving status in 1497 psychiatric inpatients (PPs) and a clinical control group of 313 neurological inpatients (NPs) was investigated using a brief questionnaire. RESULTS: 67% of PPs (89% NPs) reported to have a valid driver's licence and 77% of them (92% NPs) reported to regularly use their cars. Within driver's license holders, patients with organic mental disorder (32%), substance dependence (37%) and psychotic disorder (40%) had the lowest proportion of current drivers. Higher educational qualification (odds ratio [OR] from 2.978 to 17.036) and being married/partnered (OR 3.049) or divorced (OR 4.840) significantly advanced the probability of possession of a driving license. Predictive factors for driving cessation were being female, an older age, drawing a pension and having an organic mental disease or schizophrenic disorder. CONCLUSION: Mental disease has a negative impact on driving status and this is especially true for illnesses frequently being accompanied by distinct cognitive impairments. Factors predicting road mobility elucidate the strong relationship with psychosocial status indicating that recovery of driving competence should be an integral goal of treatment strategies.
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Condução de Veículo/psicologia , Transtornos Mentais/psicologia , Limitação da Mobilidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Condução de Veículo/estatística & dados numéricos , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/psicologia , Análise de Regressão , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Recent studies demonstrated benefits of cognitive intervention in mild cognitive impairment (MCI), but few studies have determined long-term effects on cognition, conversion rate to Alzheimer's disease, and the role of early intervention. METHOD: A 6-month multicomponent cognitive group intervention was applied in participants with single- or multiple-domain amnestic MCI (defined according to Petersen's criteria). One group (n = 12) received the intervention at the beginning of the study period and was compared with an active control group (n = 12) who received it after an 8-month time lag. Follow-up assessments were conducted at 15 and 28 months (study period was August 2007-December 2009). The primary outcome was change in cognitive function as determined by changes in scores on the Mini-Mental State Examination and the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), and the secondary outcomes were change in specific cognitive and noncognitive functions and conversion to Alzheimer's disease (according to DSM-IV/NINCDS-ADRDA criteria and NAI-AA criteria for probable Alzheimer's dementia with increased level of certainty). RESULTS: Eighteen participants completed the study after 28 months. Long-term data revealed a stable intervention effect on the primary outcome ADAS-cog in the early-intervention group (P = .024). The participants in the later-intervention (control) group appeared to benefit to a lesser extent from the cognitive intervention compared to those who received it earlier. Only participants in the later-intervention group (6 of 12) converted to Alzheimer's disease during the 28-month study period. CONCLUSIONS: Benefits of our 6-month cognitive intervention on global cognitive status appear to be preserved over extended follow-up periods. Early cognitive intervention may delay conversion to Alzheimer's disease. Findings in a small sample encourage the use of the intervention in larger-scale studies. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00544856.
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Terapia Cognitivo-Comportamental , Disfunção Cognitiva/terapia , Instrução por Computador , Intervenção Médica Precoce , Lactente , Entrevista Psiquiátrica Padronizada , Testes Neuropsicológicos , Idoso , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/prevenção & controle , Doença de Alzheimer/psicologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Terapia Combinada , Estudos Cross-Over , Progressão da Doença , Diagnóstico Precoce , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Sintomas ProdrômicosRESUMO
Recent studies have shown that patients with Alzheimer's disease (AD) and its possible prodromal stage mild cognitive impairment benefit from cognitive interventions. Few studies so far have used an active control condition and determined effects in different stages of disease. We evaluated a newly developed 6-month group-based multicomponent cognitive intervention in a randomized controlled pilot study on subjects with amnestic mild cognitive impairment (aMCI) and mild AD patients. Forty-three subjects with aMCI and mild AD were recruited. Primary outcome measures were change in global cognitive function as determined by the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) and the Mini Mental Status Examination (MMSE). Secondary outcomes were specific cognitive and psychopathological ratings. Thirty-nine patients were randomized to intervention groups (IGs: 12 aMCI, 8 AD) and active control groups (CGs: 12 aMCI, 7 AD). At the end of the study, we found significant improvements in the IG(MCI) compared to the CG(MCI) in the ADAS-cog (p = 0.02) and for the secondary endpoint Montgomery Asberg Depression Rating Scale (MADRS) (p < 0.01) Effects on the MMSE score showed a non-significant trend (p = 0.07). In AD patients, we found no significant effect of intervention on the primary outcome measures. In conclusion, these results suggest that participation in a 6-month cognitive intervention can improve cognitive and non-cognitive functions in aMCI subjects. In contrast, AD patients showed no significant benefit from intervention. The findings in this small sample support the use of the intervention in larger scales studies with an extended follow-up period to determine long-term effects.
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Doença de Alzheimer/terapia , Amnésia/terapia , Terapia Cognitivo-Comportamental , Disfunção Cognitiva/terapia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/psicologia , Amnésia/psicologia , Disfunção Cognitiva/psicologia , Interpretação Estatística de Dados , Estudos de Viabilidade , Feminino , Objetivos , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Aceitação pelo Paciente de Cuidados de Saúde , Projetos Piloto , Índice de Gravidade de Doença , Fatores Socioeconômicos , Resultado do TratamentoRESUMO
The effect of cognitive intervention on brain metabolism in AD is largely unexplored. Therefore, we aimed to investigate cognitive parameters and 18FDG PET to test for effects of a cognitive intervention in patients with aMCI or mild AD. Patients with aMCI (N = 24) or mild AD (N = 15) were randomly assigned either to cognitive intervention groups (IGs), receiving weekly sessions of group-based multicomponent cognitive intervention, or active control groups (CGs), receiving pencil-paper exercises for self-study. We obtained resting-state FDG-PET scans and neuropsychological testing at baseline and after six-months. Normalized FDG-PET images were analyzed using voxel-based SPM5 approaches to determine longitudinal changes, group-by-time interactions and correlations with neuropsychological outcome parameters. Primary global cognitive outcome was determined by analyses of covariance with MMSE and ADAS-cog scores as dependent measures. Both, aMCI and AD subgroups of CGs showed widespread bilateral cortical declines in FDG uptake, while the AD subgroup of IGs showed discrete decline or rather no decline in case of the aMCI subgroup. Group by time analyses revealed strongest attenuation of metabolic decline in the aMCI subgroup of the IGs, involving left anterior temporal pole and anterior cingulate gyrus. However, correlation analyses revealed only weak non-significant associations between increased FDG uptake and improvement in primary or secondary outcome parameters. Concurrently, there was significant improvement in global cognitive status in the aMCI subgroup of the IGs. A six-month cognitive intervention imparted cognitive benefits in patients with aMCI, which were concurrent with an attenuated decline of glucose metabolism in cortical regions affected by neurodegenerative AD.
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Doença de Alzheimer/patologia , Doença de Alzheimer/reabilitação , Córtex Cerebral/metabolismo , Terapia Cognitivo-Comportamental/métodos , Disfunção Cognitiva/patologia , Disfunção Cognitiva/reabilitação , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico por imagem , Amnésia/complicações , Mapeamento Encefálico , Córtex Cerebral/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/etiologia , Feminino , Fluordesoxiglucose F18 , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Tomografia por Emissão de Pósitrons/métodos , Resultado do TratamentoRESUMO
The effect of cognitive intervention on brain metabolism in Alzheimer's disease (AD) is largely unexplored. Therefore, we aimed to investigate clinical cognitive parameters and 18FDG PET to test for effects of a cognitive intervention in patients with amnestic mild cognitive impairment (aMCI) or mild AD. Patients with aMCI (n = 24) or mild AD (n = 15) were randomly assigned either to cognitive intervention groups (IGs), receiving weekly sessions of group-based multicomponent cognitive intervention, or active control groups (CGs), receiving pencil-paper exercises for self-study. We obtained resting-state FDG-PET scans and neuropsychological testing at baseline and after six-months. Normalized FDG-PET images were analyzed using voxel-based SPM5 approaches to determine longitudinal changes, group-by-time interactions, and correlations with neuropsychological outcome parameters. Primary global cognitive outcome was determined by analyses of covariance with MMSE and ADAS-cog scores as dependent measures. Both, aMCI and AD subgroups of CGs showed widespread bilateral cortical declines in FDG uptake, while the AD subgroup of IGs showed discrete decline or rather no decline in case of the aMCI subgroup. Group by time analyses revealed strongest attenuation of metabolic decline in the aMCI subgroup of the IGs, involving left superior temporal- and anterior cingulate gyrus. However, correlation analyses revealed only weak non-significant associations between increased FDG uptake and improvement in primary or secondary outcome parameters. Concurrently, there was significant improvement in global cognitive status in the aMCI subgroup of the IGs. A six-month cognitive intervention imparted cognitive benefits in patients with aMCI, which were concurrent with an attenuated decline of glucose metabolism in cortical regions affected by neurodegenerative AD.
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Doença de Alzheimer/metabolismo , Doença de Alzheimer/terapia , Amnésia/metabolismo , Amnésia/terapia , Encéfalo/metabolismo , Transtornos Cognitivos/metabolismo , Transtornos Cognitivos/terapia , Terapia Cognitivo-Comportamental , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico por imagem , Amnésia/diagnóstico por imagem , Transtornos Cognitivos/diagnóstico por imagem , Interpretação Estatística de Dados , Feminino , Fluordesoxiglucose F18 , Glucose/metabolismo , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Tomografia por Emissão de Pósitrons , Compostos RadiofarmacêuticosRESUMO
Alzheimer disease (AD) is one of the most prevalent chronic medical conditions affecting the elderly population. The effectiveness of approved antidementia drugs, however, is limited-licensed AD medications provide only moderate relief of clinical symptoms. Cognitive intervention is a noninvasive therapy that could aid prevention and treatment of AD. Data suggest that specifically designed cognitive interventions could impart therapeutic benefits to patients with AD that are associated with substantial biological changes within the brain. Moreover, evidence indicates that a combination of pharmacological and non-pharmacological interventions could provide greater relief of clinical symptoms than either intervention given alone. Functional and structural MRI studies have increased our understanding of the underlying neurobiological mechanisms of aging and neurodegeneration, but the use of neuroimaging to investigate the effect of cognitive intervention on the brain remains largely unexplored. This Review provides an overview of the use of cognitive intervention in the healthy elderly population and patients with AD, and summarizes emerging findings that provide evidence for the effectiveness of this approach. Finally, we present recommendations for future research on the use of cognitive interventions in AD and discuss potential effects of this therapy on disease modification.