Smartphone use as an efficient tool to improve anomia in primary progressive aphasia.

Cognitive interventions are helpful in the non-pharmacological management of Primary progressive aphasia (PPA) and other neurodegenerative disorders of cognition, by helping patients to compensate for their cognitive deficits and improve their functional independence. In this study, we examined the effectiveness of cognitive rehabilitation based on the use of mobile device technology in PPA. The aim of this research study was to determine if BL, a patient with semantic variant PPA (svPPA) and severe anomia, was able to learn using specific smartphone functions and an application to reduce her word finding difficulties. She was trained during the intervention sessions on a list of target pictures to measure changes in picture naming performance. Errorless learning was applied during learning. BL quickly learned to use smartphone functions and the application over the course of the intervention. She significantly improved her anomia for trained pictures, and to a lesser extent for untrained semantically related pictures. Picture naming performance was maintained six months after the intervention, and she continued to use her smartphone regularly to communicate with family members and friends. This study confirms that smartphone use can be learned in PPA, which can help reduce the symptoms of anomia and improve communication skills.

Effectiveness of a Visual Imagery Training Program to Improve Prospective Memory in Older Adults with and without Mild Cognitive Impairment: A Randomized Controlled Study.

Prospective memory (PM) problems in aging and, to a greater extent, in mild cognitive impairment (MCI), compromise functional independence. This study examined the effectiveness of a cognitive training program based on visual imagery to improve PM among older adults with and without MCI. Participants were older adults, 24 with MCI and 24 cognitively healthy (HOA). Half of them (12 MCI and 12 HOA) were randomly assigned to the PM training program, the other half to the no-training control group. All participants also completed a pre- and post-test evaluation, including neuropsychological tests, questionnaires, and the Ecological Test of Prospective Memory (TEMP). There was no significant effect of the intervention on the TEMP total, event-based or time-based scores for either the MCI or HOA groups. However, the trained MCI group committed fewer false alarms (i.e., more efficient identification of prospective cues) in the event-based condition of the TEMP at post-test. On the other hand, all trained participants performed better than control participants on retrospective memory tests, which suggests that visual imagery-based training is more effective to improve retrospective memory than PM. Possible explanations for these results are explored.

Dance your stress away: comparing the effect of dance/movement training to aerobic exercise training on the cortisol awakening response in healthy older adults.

This study aimed to examine in healthy older adults the effects of dance/movement training (DMT) on the cortisol awakening response (CAR), a marker of chronic stress. Forty participants (mean age = 67.45, 75% women) were randomized into three groups: DMT (n = 12) - a set of exercises to promote gross motor skills, body awareness, and socialization; aerobic exercise training (AT; n = 14) - high intensity activity on a recumbent bicycle, and wait list (WL; n = 14). Both DMT and AT groups were supervised by licensed instructors and met three times a week for three months. Before and after their respective program, participants of all groups provided saliva samples on 3 d at 0-, 30- and 60-min after awakening, and had their fitness level evaluated. A significant group × time interaction (F(2,34) = 5.79, p = .01, η2partial = 0.25) was found, with the DMT group showing lower salivary cortisol values post-training, while the other two groups showed no change from baseline in their CAR. Cardiorespiratory fitness improved only in the AT group, while DMT showed no group-specific physical functioning improvements. The results are discussed in terms of the importance of physical and psychological effects of training on change in cortisol levels.

Assessment of the Relationship Between Executive Function and Cardiorespiratory Fitness in Healthy Older Adults.

Associations between cardiorespiratory fitness and brain health in healthy older adults have been reported using a variety of cardiorespiratory fitness estimates (CRFe). Using commonly used methods to determine CRF, we assessed the relationship between CRFe and executive function performance. Healthy older adults (n = 60, mean age 68 years, 77% women), underwent three CRF tests: a Maximal Graded Exercise Test performed on a cycle ergometer, the Rockport Fitness Walking Test, and a Non-Exercise Prediction Equation. Executive function was assessed by a computerized cognitive assessment using an N-Back task (updating cost) and a Stroop task (interference cost, global and local switch cost). Multiple hierarchical regression analyses were conducted to assess the relationship between different CRFe and executive function performance. Regardless of age and education, cardiorespiratory fitness estimated from the Maximal Graded Exercise Test and the Rockport Fitness Walking Test was significantly associated with the global switch cost. All CRFe were associated with the interference cost. No association was observed between CRFe and local switching costs or the updating costs. In the present study, not all subcomponents of executive function were related to CRFe. Interestingly, the executive functions that were associated with CRFe are those that are known to be the most affected by aging.

Effects of Dance/Movement Training vs. Aerobic Exercise Training on cognition, physical fitness and quality of life in older adults: A randomized controlled trial.

INTRODUCTION: It is generally accepted that physical activity promotes healthy aging. Recent studies suggest dance could also benefit cognition and physical health in seniors, but many styles and approaches of dance exist and rigorous designs for intervention studies are still scarce. The aim of this study was to compare the effects of Dance/Movement Training (DMT) to Aerobic Exercise Training (AET) on cognition, physical fitness and health-related quality of life in healthy inactive elderly. METHODS: A single-center, randomized, parallel assignment, open label trial was conducted with 62 older adults (mean age = 67.48 ±â€¯5.37 years) recruited from the community. Participants were randomly assigned to a 12-week (3x/week, 1hr/session) DMT program, AET program or control group. Cognitive functioning, physical fitness and health-related quality of life were assessed at baseline (T-0), and post-training (T-12 weeks). RESULTS: 41 participants completed the study. Executive and non-executive composite scores showed a significant increase post-training (F(1,37) = 4.35, p = .04; F(1,37) = 7.01, p = .01). Cardiovascular fitness improvements were specific to the AET group (F(2,38) = 16.40, p < .001) while mobility improvements were not group-dependent (10 m walk: F(1,38) = 11.67, p = .002; Timed up and go: F(1,38) = 22.07, p < .001). CONCLUSIONS: Results suggest that DMT may have a positive impact on cognition and physical functioning in older adults however further research is needed. This study could serve as a model for designing future RCTs with dance-related interventions. REGISTRATION: clinicaltrials. gov Identifier NCT02455258.

The Lost Years: Delay Between the Onset of Cognitive Symptoms and Clinical Assessment at a Memory Clinic.

BACKGROUND: Early assessment of cognitive symptoms is an issue in geriatrics. This study investigated the delay from the onset of cognitive symptoms to initial clinical assessment and its associations with patients' sociodemographic and clinical characteristics. METHODS: This is a cross-sectional retrospective study using medical chart review of 316 patients referred for assessment to a university-affiliated memory clinic. Symptom duration was self-reported by patients/carers. Severity of symptoms assessed by the MoCA and FAST instruments was compared according to delay duration (≥3 years vs. <3 years) using chi-squared tests. Logistic regression was used to determine the association between patients' characteristics and long symptom duration (≥3 years). RESULTS: At the initial assessment, 29.4% of patients reported experiencing cognitive symptoms for ≥3 years. They were more likely to have MoCA scores ≤17 (47.8 vs. 34.1%; p=.023) and FAST scores ≥5 (21.5 vs. 10.8%; p=.012). They were also significantly older than 75 years (75-84 yr: OR=2.22 [95%CI: 1.11-4.41]; ≥85 yr: 4.36 [2.08-9.11]), presented more depressive symptoms (2.37 [1.40-4.02]), and were less likely to live alone (0.55 [0.31-0.96]). CONCLUSIONS: A significant proportion of patients had cognitive symptoms for years when initially assessed, which delayed diagnosis and management. Stigma, depression, and compensatory help from carers may contribute to this delay.

Functional changes in the cortical semantic network in amnestic mild cognitive impairment.

OBJECTIVE: Semantic memory impairment has been documented in individuals with amnestic Mild cognitive impairment (aMCI), who are at risk of developing Alzheimer's disease (AD), yet little is known about the neural basis of this breakdown. The aim of this study was to investigate the brain mechanisms associated with semantic performance in aMCI patients. METHOD: A group of aMCI patients and a group of healthy controls carried out a semantic categorization task while their brain activity was recorded using magnetoencephalography (MEG). During the task, participants were shown famous faces and had to determine whether each famous person matched a given occupation. The main hypotheses were that (a) semantic processing should be compromised for aMCI patients, and (b) these deficits should be associated with cortical dysfunctions within specific areas of the semantic network. RESULTS: Behavioral results showed that aMCI participants were significantly slower and less accurate than controls at the semantic task. Additionally, relative to controls, a significant pattern of hyperactivation was found in the aMCI group within specific regions of the extended semantic network, including the right anterior temporal lobe (ATL) and fusiform gyrus. CONCLUSIONS: Abnormal functional activation within key areas of the semantic network suggests that it is compromised early in the disease process. Moreover, this pattern of right ATL and fusiform gyrus hyperactivation was positively associated with gray matter integrity in specific areas, but was not associated with any pattern of atrophy, suggesting that this pattern of hyperactivation may precede structural alteration of the semantic network in aMCI. (PsycINFO Database Record

Frontal assessment battery and differential diagnosis of frontotemporal dementia and Alzheimer disease.

BACKGROUND: The different distribution of pathologic features in frontotemporal dementia (FTD) and Alzheimer disease (AD) predicts a predominant dysexecutive syndrome in FTD. The Frontal Assessment Battery (FAB) has previously been validated in diseases associated with a frontal lobe dysfunction. OBJECTIVE: To evaluate the sensitivity of the FAB to differentiate FTD and AD. DESIGN: Comparison study. SETTING: Memory Clinic of the Salpêtrière Hospital, Paris, France. PATIENTS: Twenty-six patients with FTD and 64 patients with AD. MAIN OUTCOME MEASURES: Comparison of FAB and Mini-Mental State Examination (MMSE) scores between patients with FTD and those with AD. RESULTS: The mean +/- SD FAB scores significantly differed between patients with FTD (7.6 +/- 4.2) and those with AD (12.6 +/- 3.7) (P<.001), but not MMSE scores. The FAB correctly identified 78.9% of the patients. These results were maintained in a subgroup of mildly demented patients (MMSE score, > or =24). In these patients, a cutoff score of 12 on the FAB was optimal to differentiate both disorders (sensitivity, 77%; specificity, 87%). CONCLUSIONS: The FAB takes less than 10 minutes to administer and provides an objective measure to distinguish FTD from AD in mildly demented patients.

Physical functioning is associated with processing speed and executive functions in community-dwelling older adults.

OBJECTIVES: The aim of this study was to examine the association between physical functioning and cardiovascular burden on the cognitive performance of community-dwelling older adults. METHOD: Ninety-three adults aged 60 and older completed a medical evaluation by a geriatrician, performance-based physical tests, and neuropsychological assessments. Cognitive composite scores (memory, speed, and executive) as well as a physical functioning score were created by averaging standardized z-scores of selected tests. A cardiovascular burden index was also computed by totalling the number of cardiovascular risk factors and diseases. RESULTS: Multiple hierarchical regression analyses reveal that higher level of physical functioning was significantly associated with greater processing speed and better executive functions but was not associated with memory performance. These relations were independent of age, sex, and level of education. Cardiovascular burden was not significantly associated with any cognitive domain. DISCUSSION: These results suggest that cognition is related to simple performance-based physical tests and highlight the importance of intervention studies aimed at enhancing cognitive and physical functioning in older adults.

Management of end-stage dementia.

Dementia is a progressive and noncurable illness, and its management in late stages should follow a palliative care approach. However, many patients with advanced dementia sustain aggressive interventions that do not improve their survival and might hinder their comfort and quality of life. This is likely explained by a lack of research on this population; a lack of knowledge from health care providers, patients, and family members; and lack of communication between those caring for these patients. There is therefore an urgent need for research and education on this topic, as well as palliative care services devoted to this population.