Development of the Dementia Caregiver Positive Feeling Scale 21-item version (DCPFS-21) in Japan to recognise positive feelings about caregiving for people with dementia.

BACKGROUND: This study aimed to develop and validate the Dementia Caregiver Positive Feeling Scale 21-item version (DCPFS-21) in Japan. METHODS: We selected and generated 27 items based on the preliminary 25-item version of the DCPFS. Next, the DCPFS-21 was developed and validated through two phases. In Phase 1, we obtained data from 147 caregivers of people with dementia by using the 27-item version, examined the construct validity and internal consistency of the scale and then selected 21 items (DCPFS-21). In Phase 2, we compared the scores of 30 caregivers of people with dementia on the DCPFS-21 with the standard scales. Four weeks after the first examination, we re-examined the intra-rater reliability. RESULTS: In Phase 1, via factor analysis, we reduced the 27 items to 21 items (DCPFS-21). Moreover, the DCPFS-21 was grouped into four subscales, namely, meaning in caregiving, caregiving mastery, positive emotion on caregiving and support from others. This classification agreed with the following factors extracted from the pilot study. The DCPFS-21 showed good internal consistency (Cronbach's α = 0.92). In Phase 2, the DCPFS-21 correlated with the Caregiving Gratification Scale by 0.54 (P < 0.01). The DCPFS-21 also showed good intra-rater reliability (1.1: ρ = 0.62). CONCLUSION: We developed and validated the DCPFS-21, which measures the positive feelings of family caregivers of people with dementia, in Japan.

Effects of a group-based physical and cognitive intervention on social activity and quality of life for elderly people with dementia in a geriatric health service facility: a quasi-randomised controlled trial.

BACKGROUND: The aim of this study was to assess the effects of group-based motor and cognitive-combined intervention on social activity and quality of life. METHODS: This quasi-randomised controlled trial included 31 elderly participants with dementia in a geriatric health service facility. Participants were randomly allocated to the intervention group (n = 16) or the control group (n = 15) by stratification of cognitive function. The 8-week intervention program consisted of group exercise and cognitive stimulation twice per week for 45 min per session. Outcome measures were social activity in daily behaviour, cognitive function, apathy, muscle and grip strength, independence of activity of daily living, life-space, and objective quality of life (QOL). RESULTS: Twenty-five participants were analysed (10 in the control group, 15 in the intervention group). Analysis of covariance with covariates of age, gender, and baseline data showed a significant difference in social activity (F = 8.67, P = 0.008; significant decline in control group vs. maintenance in intervention group) and QOL (F = 9.74, P = 0.006; maintenance in control group vs. tendency of improvement in intervention group). A Wilcoxon signed-rank test revealed that helping behaviour (P = 0.035) increased in the intervention group, whereas interest to the surrounding (P = 0.026) decreased in the control group. CONCLUSIONS: Group-based combined intervention for dementia is effective for maintaining social activity and QOL in a geriatric health service facility.

The impact of subjective memory complaints on quality of life in community-dwelling older adults.

PURPOSE: The aim of this study was to evaluate the impact of memory complaints on quality of life (QOL) in elderly community dwellers with or without mild cognitive impairment (MCI). METHODS: Participants included 120 normal controls (NC) and 37 with MCI aged 65 and over. QOL was measured using the Japanese version of Satisfaction in Daily Life, and memory complaints were measured using a questionnaire consisting of four items. The relevance of QOL was evaluated with psychological factors of personality traits, sense of self-efficacy, depressive mood, self-evaluation of daily functioning, range of social activities (Life-Space Assessment), social network size, and cognitive functions including memory. The predictors of QOL were analyzed by multiple linear regression analysis. RESULTS: QOL was not significantly different between the NC and MCI groups. In both groups, QOL was positively correlated with self-efficacy, daily functioning, social network size, Life-Space Assessment, and the personality traits of extraversion and agreeableness; QOL was negatively correlated with memory complaints, depressive mood, and the personality trait of neuroticism. In regression analysis, memory complaints were a negative predictor of QOL in the MCI group, but not in the NC group. The partial correlation coefficient between QOL and memory complaints was -0.623 (P < 0.05), after scores of depressive mood and self-efficacy were controlled. Depressive mood was a common negative predictor in both groups. Positive predictors were Life-Space Assessment in the NC group and sense of self-efficacy in the MCI group. CONCLUSIONS: Memory complaints exerted a negative impact on self-rated QOL in the MCI group, whereas a negative correlation was weak in the NC group. Memory training has been widely practised in individuals with MCI to prevent the development of dementia. However, such approaches inevitably identify their memory deficits and could aggravate their awareness of memory decline. Thus, it is critical to give sufficient consideration not to reduce QOL in the intervention for those with MCI.

Relationship between Cognitive Decline and Daily Life Gait among Elderly People Living in the Community: A Preliminary Report.

Introduction: Early detection and intervention are important to prevent dementia. Gait parameters have been recognized as a potentially easy screening tool for mild cognitive impairment (MCI); however, differences in gait parameters between cognitive healthy individuals (CHI) and MCI are small. Daily life gait change may be used to detect cognitive decline earlier. In the present study, we aimed to clarify the relationship between cognitive decline and daily life gait. Methods: We performed 5-Cog function tests and daily life and laboratory-based gait assessments on 155 community-dwelling elderly people (75.5 ± 5.4 years old). Daily life gait was measured for 6 days using an iPod-touch with an accelerometer. Laboratory-based 10-m gait (fast pace) was measured using an electronic portable walkway. Results: The subjects consisted of 98 CHI (63.2%) and 57 cognitive decline individuals (CDI; 36.8%). Daily life maximum gait velocity in the CDI group (113.7 [97.0-128.5] cm/s) was significantly slower than that in the CHI group (121.2 [105.8-134.3] cm/s) (p = 0.032). In the laboratory-based gait, the stride length variability in the CDI group (2.6 [1.8-4.1]) was significantly higher than that in the CHI group (1.8 [1.2-2.7]) (p < 0.001). The maximum gait velocity in daily life gait was weakly but significantly correlated with stride length variability in laboratory-based gait (ρ = -0.260, p = 0.001). Conclusion: We found an association between cognitive decline and slower daily life gait velocity among community-dwelling elderly people.

[Behavioral and psychological symptoms in elderly people with cognitive impairment. Differences between assessment at home and at an adult day-care facility].

OBJECTIVES: In order for activities preventing cognitive decline in the elderly and burdens of the caregiver to be effective and efficient, it is important to assess cognitive impairment and the behavioral and psychological symptoms of dementia (BPSD) in community-dwelling elderly people with cognitive impairment. The purpose of this study was to investigate differences in BPSD between assessment at home and assessment at an adult day-care facility, and to assess the relationship, between BPSD and caregiver burden in disabled elderly people with and without mild cognitive impairment (MCI) or dementia. METHODS: We studied 594 participants with activity limitations out of a target population of 917 community-dwelling elderly persons utilizing adult day-care service. Dementia and MCI were determined using a clinical history of dementia, the Clinical Dementia Rating scale, and/or the Mini-Mental State Examination (MMSE); 116 were diagnosed with dementia, 103 as having MCI, and 243 as cognitively normal controls (CN). BPSD were assessed at home and at the adult day-care facility with the Neuropsychiatric Inventory (NPI) and the Dementia Behavior Disturbance Scale (DBD). Activities of daily living (ADL) were evaluated using the Barthel index, and caregiver burden was assessed using the short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI_8). RESULTS: People diagnosed with dementia were found to be significantly more impaired on the DBD, MMSE, BI, and J-ZBI_8, than CN or those with MCI. Those with MCI also showed significantly more impairments relative to CN. The scores on the NPI and DBD assessed at home were higher than that assessed at the adult day-care facility in each group. The differences of NPI and DBD scores between home assessment and assessment at the adult day-care facility were greater for people with dementia than for people with MCI or CN. Multiple regression analysis revealed that the best explanatory variables for J-ZBI_8 are home assessments of NPI and DBD, the MMSE for people with dementia, home assessment of DBD and MCI, and home assessment of NPI and BI for CN. Both NPI and DBD were not associated with the J-ZBI_8 when assessed at the adult day-care facility regardless of level of cognitive impairment. CONCLUSION: The scores of the BPSD and caregiver burden worsened with increasing severity of cognitive impairment, and the BPSD was more apparent when assessed at home compared to at the adult day-care facility. These findings suggest that the assessment of BPSD at home is important in determining MCI or dementia and to estimate caregiver burden in community-dwelling elderly people with basic ADL limitations.

A randomized controlled trial of the "positive diary" intervention for family caregivers of people with dementia.

PURPOSE: We examined the effectiveness of the "positive diary," in which family caregivers of people with dementia write down three good things that happened with reasons at the end of each day. DESIGN AND METHODS: In this randomized controlled trial, the intervention group used the "positive diary," while the control group kept a record of each meal for 4 weeks. FINDINGS: The intervention group showed improvement on several measures of wellbeing including Neuropsychiatric Inventory Questionnaire and Center for Epidemiologic Studies Depression Scale. PRACTICE IMPLICATIONS: The "positive diary" is a useful self-care tool for caregivers of people with dementia.

Effects of assessment-oriented group action supported by a health professional on the physical function in community-dwelling older adults: a feasibility study.

BACKGROUND: Assessment-oriented group action (AGA) could be used to empower community-dwelling older adults to maintain their health by groups. AGA can be implemented with the support of a health professional to provide feedback to older adults on physical and cognitive function. OBJECTIVE: To evaluate the effects of AGA. METHODS: For this feasibility study, we enrolled 23 and 20 participants in the intervention and control groups, respectively. Thοse in the intervention group received feedback of their assessments and devised exercise plans with professional support. The participants performed their exercises over 12 weeks; the follow-up examination was conducted at 40 weeks. The control group only received feedback. The change in health-related consciousness and behavior was evaluated. Muscle strength and mass were measured and the timed up and go test, and the Brief-balance evaluation system test (BESTest) were performed. RESULTS: There were no significant differences in consciousness or behavior between the groups. The score was higher in the intervention than in the control group at 40 weeks in Section-I of the Brief-BESTest, indicating that the muscle strength contributed to balance function. CONCLUSION: AGA did not show positive changes in consciousness or behaviors but demonstrated significant improvements and lasting effects in balance function.

Development and Evaluation of the Behavioral and Psychological Symptoms of Dementia Questionnaire 13-Item Version (BPSD13Q).

INTRODUCTION: Most behavioral and psychological symptoms of dementia (BPSD) scales have copyright issues and are difficult for care staff to use in daily care settings because they were primarily designed for physicians. Therefore, an easier tool for care staff is required. This study aimed to develop and validate the BPSD questionnaire 13-item version (BPSD13Q). METHODS: We obtained data from 444 people with dementia living in group homes in Japan using the BPSD plus questionnaire (BPSD + Q; 27-item version) and Neuropsychiatric Inventory Nursing Home version (NPI-NH). We selected appropriate items to make a short-form version of the BPSD + Q and examined the construct validity, internal consistency, and criterion-related validity of the questionnaire. RESULTS: By the pilot review, research on correlations with similar items from comparable scales, and factor analysis, we reduced 27 items to 13 items (BPSD13Q). The BPSD13Q and BPSD13Q-distress (BPSD13Q-D) showed good internal consistency (Cronbach's α = 0.76 and 0.80, respectively). Moreover, the BPSD13Q was positively correlated with the NPI-NH (r = 0.72, p < 0.001) and BPSD + Q (r = 0.95, p < 0.001). The BPSD13Q-D was positively correlated with the NPI-NH-caregiver distress (r = 0.74, p < 0.001) and BPSD + Q-distress (r = 0.96, p < 0.001). CONCLUSION: We developed and validated the BPSD13Q, which is a short-form version of the BPSD + Q and is downloadable. The BPSD13Q may make BPSD evaluations easier for the care staff.

Yamaguchi fox-pigeon imitation test: a rapid test for dementia.

BACKGROUND/AIMS: We herein propose a hand-gesture imitation test, consisting of a simple one-handed sign of a 'fox' and a complex two-handed sign of a 'pigeon', as a rapid, game-like test for detecting dementia/Alzheimer disease (AD) with low psychological burden. The test measures the visuomotor function, which deteriorates in the early stages of AD. METHODS: We examined 88 demented subjects, 19 with mild cognitive impairment (MCI), and 53 normal controls aged 65 years or over. The subjects were classified according to the Clinical Dementia Rating (CDR). RESULTS: The specificity of the test was 94%, and the sensitivity was 58% in CDR 0.5 (MCI), 77% in CDR 1 (mild dementia), 75% in CDR 2 (moderate dementia), and 90% in CDR 3 (severe dementia). The test could be conducted within 1 min and no subjects refused to be tested. CONCLUSION: This brief hand-gesture imitation test can sensitively evaluate visuomotor deficits in dementia/AD, while some subjects are unaware of their failure or even that their cognitive function is being tested. We herein describe the precise protocol for worldwide use.

Overview of non-pharmacological intervention for dementia and principles of brain-activating rehabilitation.

Non-pharmacological interventions for dementia are likely to have an important role in delaying disease progression and functional decline. Research into non-pharmacological interventions has focused on the differentiation of each approach and a comparison of their effects. However, Cochrane Reviews on non-pharmacological interventions have noted the paucity of evidence regarding the effects of these interventions. The essence of non-pharmacological intervention is dependent of the patients, families, and therapists involved, with each situation inevitably being different. To obtain good results with non-pharmacological therapy, the core is not 'what' approach is taken but 'how' the therapists communicate with their patients. Here, we propose a new type of rehabilitation for dementia, namely brain-activating rehabilitation, that consists of five principles: (i) enjoyable and comfortable activities in an accepting atmosphere; (ii) activities associated with empathetic two-way communication between the therapist and patient, as well as between patients; (iii) therapists should praise patients to enhance motivation; (iv) therapists should try to offer each patient some social role that takes advantage of his/her remaining abilities; and (v) the activities should be based on errorless learning to ensure a pleasant atmosphere and to maintain a patient's dignity. The behavioral and cognitive status is not necessarily a reflection of pathological lesions in the brain; there is cognitive reserve for improvement. The aim of brain-activating rehabilitation is to enhance patients' motivation and maximize the use of their remaining function, recruiting a compensatory network, and preventing the disuse of brain function. The primary expected effect is that patients recover a desire for life, as well as their self-respect. Enhanced motivation can lead to improvements in cognitive function. Amelioration of the behavioral and psychological symptoms of dementia and improvements in activities of daily living can also be expected due to the renewed positive attitude towards life. In addition, improvements in the quality of life for both patients and caregivers is an expected outcome. To establish evidence for non-pharmacological interventions, research protocols and outcome measures should be standardized to facilitate comparison among studies, as well as meta-analysis.

Life-space and Related Factors for the Elderly in a Geriatric Health Service Facility.

OBJECTIVE: To investigate (1) the concurrent validity of the Nursing Home Life-Space Diameter (NHLSD) and the Home-based Life-Space Assessment (Hb-LSA), (2) the correlated factors of life-space, and (3) the factors that affected the NHLSD score for the elderly in a geriatric health service facility, or Roken. METHODS: This cross-sectional study included 32 participants in a Roken. Staff members, who had received essential guidance for assessment, examined the cognitive function, physical function, mood, communication ability, objective quality of life, vitality, and daily behavior of the participants. Correlation analysis between NHLSD and other measurements and multiple regression analysis with NHLSD as a dependent variable were conducted. RESULTS: NHLSD and Hb-LSA were significantly correlated (r=0.710, P<0.01). NHLSD was significantly correlated with more measurements than Hb-LSA was; i.e., NHLSD was significantly correlated with communication ability, independence of daily living (Barthel Index; BI), maximum knee extension strength, grip strength, function in daily living, and three QOL measurements: positive affects, ability to communicate, and spontaneity and activity. A stepwise multiple regression analysis indicated that the BI total score, the maximum knee extension strength, and spontaneity and activity (one of the QOL items) were significantly correlated with the NHLSD score. CONCLUSIONS: NHLSD can measure the mobility levels of elderly persons in Roken. In addition to physical conditions and dependence of ADLs, spontaneity (or low levels of apathy) may be an important factor for promoting physical activity in Roken.

Obtaining Information from Family Caregivers Is Important to Detect Behavioral and Psychological Symptoms and Caregiver Burden in Subjects with Mild Cognitive Impairment.

BACKGROUND: The objectives of this study are to clarify the differences between the difficulties in daily life experienced by patients with both mild cognitive impairment (MCI) and chronic disease and those experienced by healthy elderly individuals. METHODS: We assessed (a) cognitive function; (b) gait ability; (c) behavioral and psychological symptoms (observed at home); (d) activities of daily living (observed at home); (e) family caregiver burden, and (f) intention to continue family caregiving of 255 cognitively normal and 103 MCI subjects attending adult day care services covered by long-term care insurance, and compared the two groups. RESULTS: Subjects with MCI display more behavioral and psychological symptoms than cognitively normal subjects, posing a heavy caregiver burden (p < 0.01). Behavioral and psychological symptoms most commonly observed in subjects with MCI are apathy, hallucinations, delusions, agitation, and aberrant motor behavior. CONCLUSION: Information regarding the behavioral and psychological symptoms displayed at home by patients with MCI can only be obtained from family caregivers living with the patients. To provide early-stage support for elderly patients with MCI, adult day care workers should collect information from family caregivers regarding behavioral and psychological symptoms observed at home.

Prevention of cognitive and physical decline by enjoyable walking-habituation program based on brain-activating rehabilitation.

AIM: Evaluating effects of an enjoyable walking-habituation program. METHODS: We carried out a 12-week intervention, consisting of an enjoyable walking-habituation program based on five principles of brain-activating rehabilitation: pleasant atmosphere, interactive communication, social roles, praising each other and errorless support. The program, once a week for 90 min, was carried out in small groups. Participants were 71 community-dwelling people (72.2 ± 4.3) without dementia. Cognitive function was evaluated in five cognitive domains: memory, executive function, word fluency, visuospatial abilities and sustained attention. Additionally, quality of life, depressive state, functional capacity, range of activities, social network and subjective memory complaints were assessed using questionnaires. Motor function was also evaluated. Measurement was carried out before the observation period, after observation and after intervention. RESULTS: A total of 63 participants were included in the analysis. Daily steps, executive function, subjective memory complaints, functional capacity and 5-m maximum walking time significantly improved during the intervention period (after observation to after intervention) compared with the observation period (before the observation period to after observation). No significant differences were seen in other evaluations. At 6 months after the intervention, 52 of 63 participants (82.5%) continued to walk once a week or more, and all of them were confident about continuing to walk in the future. Furthermore, all participants were satisfied with our walking-habituation program and all replied that they felt delighted. CONCLUSION: The intervention program, based on the five principles of brain-activating rehabilitation, resulted in improvement of some cognitive and physical functions, as well as a high walking-habituation rate at 6 months' follow up. Geriatr Gerontol Int 2015; ●●: ●●-●●.

A randomized controlled trial of brain-activating rehabilitation for elderly participants with dementia in residential care homes.

BACKGROUND/AIMS: We aimed to prove the effectiveness of brain-activating rehabilitation for dementia, which consisted of 5 principles: pleasant atmosphere, communication, praising, social role, and supportive care. METHODS: The design was a randomized controlled trial that was not blinded. Fifty-four elderly participants with dementia (mean age: 85.2 years) were selected. Intervention based on the 5 principles of brain-activating rehabilitation was conducted for 1 h, twice a week, for 12 weeks (24 sessions). The control group had no treatment. Outcome measures consisted of two observation scales, namely sum of boxes in clinical dementia rating (CDR-SB) and the multidimensional observation scale for elderly subjects (MOSES), and two cognitive tests: the Hasegawa dementia scale revised (HDS-R) and trail making test A. RESULTS: Repeated measure ANCOVA showed a significant interaction for total score of CDR-SB (F = 7.190, p = 0.015) and MOSES (F = 4.525, p = 0.038). There were no significant changes in the two cognitive test scores. CONCLUSION: Intervention based on the principles of brain-activating rehabilitation was effective in maintaining and improving daily life functions in elderly participants with dementia in residential care homes.

Pleasant physical exercise program for prevention of cognitive decline in community-dwelling elderly with subjective memory complaints.

AIM: Japan is one of the most rapidly aging societies in the world. Measures to prevent dementia are urgently required in Japan, although such strategies have not yet been established. This study investigated the effectiveness of a pleasant physical exercise intervention on the prevention of cognitive decline in community-dwelling elderly participants with subjective memory complaints. In this intervention, a pleasant atmosphere was emphasized to enhance the participants' motivation. METHOD: We administered a 12-week intervention program consisting of pleasant physical exercise. This program for the prevention of cognitive decline was carried out as a service of Maebashi city. The service targeted elderly residents aged 65 years and older who had subjective memory complaints. After a control period of 12 weeks, 42 participants, aged between 65-86 years, received intervention once a week at community centers. Participants carried out group exercise, and were encouraged to perform home exercise and walking during the intervention period. The program was carried out by co-medical professional staff, with the help of senior citizen volunteers. RESULTS: A total of 30 participants were included in the analysis. There was significant improvement on the Wechsler digit symbol substitution test (P = 0.01). CONCLUSION: Participants with subjective memory complaints who continued the pleasant physical exercise programs for 12 weeks showed improvement in some aspects of cognitive function. Participation of senior citizen volunteers enabled smooth implementation of the program, and alleviated the burden on the professional staff. The pleasant physical exercise intervention described in the present study could be regarded as a community-led intervention to prevent cognitive decline.

Effects of intervention using a community-based walking program for prevention of mental decline: a randomized controlled trial.

OBJECTIVES: To evaluate the efficacy of a municipality-led walking program under the Japanese public Long-Term Care Insurance Act to prevent mental decline. DESIGN: Randomized controlled trial. SETTING: The city of Takasaki. PARTICIPANTS: One hundred fifty community members aged 72.0 ± 4.0 were randomly divided into intervention (n = 75) and control (n = 75) groups. INTERVENTION: A walking program was conducted once a week for 90 minutes for 3 months. The program encouraged participants to walk on a regular basis and to increase their steps per day gradually. The intervention was conducted in small groups of approximately six, so combined benefits of exercise and social interaction were expected. MEASUREMENTS: Cognitive function was evaluated focusing on nine tests in five domains: memory, executive function, word fluency, visuospatial abilities, and sustained attention. Quality of life (QOL), depressive state, functional capacity, range of activities, and social network were assessed using questionnaires, and motor function was evaluated. RESULTS: Significant differences between the intervention and control groups were shown in word fluency related to frontal lobe function (F(1, 128) = 6.833, P = .01), QOL (F(1,128) = 9.751, P = .002), functional capacity including social interaction (F(1,128) = 13.055, P < .001), and motor function (Timed Up and Go Test: F(1,127) = 10.117, P = .002). No significant differences were observed in other cognitive tests. CONCLUSION: Walking programs may provide benefits in some aspects of cognition, QOL, and functional capacity including social interaction in elderly community members. This study could serve as the basis for implementation of a community-based intervention to prevent mental decline.