Reciprocal influences in individuals with traumatic brain injury (TBI) and their caregivers: neurocognitive status in TBI subjects, attachement style and burden in caregivers.

Traumatic Brain injury (TBI) in war veterans and civilians is a formidable health and socio- economic issue. Beyond the large number of deaths following a TBI, the survivors often live with physical, psychological, cognitive and social limitations related to the injury. The challenge faced by them is also shared by family members, friends, and even more specifically by the primary caregiver. In this context, it is necessary to include caregivers in the equation of the rehabilitation of TBI individuals. In a 40-year follow-up study of Vietnam War veterans, we were interested in the reciprocal relationship between these two partners: the TBI individual and his/her caregiver. The TBI patients we studied had suffered penetrating traumatic brain injuries (pTBI) and while they are rarer than blunt or blast head injuries, their lesions are much more focal and it is easier to interpret the effects of pTBI on particular functions. In the first study, we investigated the effects of TBI-related brain lesions on long-term caregiver burden in relation to dysexecutive syndrome. Burden was greater overall in caregivers of TBI individuals compared to healthy controls veterans. Also, caregivers of individuals with brain lesions located in areas affecting cognitive and behavioral indicators of a dysexecutive syndrome (i.e., left dorsolateral prefrontal and dorsal anterior cingulate cortices) showed greater long-term burden than caregivers of participants with lesion(s) elsewhere in the brain. In a second study, we investigated the role of the caregiver attachment style on the TBI individual's cognitive trajectory. After controlling for other factors, cognitive decline was more pronounced in TBI individuals with a highly fearful caregiver, compared to those with a caregiver who demonstrated low levels of fearfullness. Consequently, there is a long-lasting reciprocal influence between these two partners. First, some TBI-related brain lesions have a lasting effect on long-term caregiver burden due to cognitive and behavioral factors. Second, it seems that caregivers exercise a significant impact on TBI individuals' environments, sometimes negatively. These results, combined with compelling evidence in the literature about neural plasticity and cognitive reserve, lend support to the impact of the caregiver on the TBI individual; the caregiver can be a surrogate for the environment and provides key stimulation that can both modify and facilitate plasticity. Finally, we discuss potential intervention strategies based on these new findings. -- Le traumatisme crânio-cérébral (TCC) est un problème socio-économique et sanitaire important, voire dramatique, chez les militaires comme chez les civils. En plus de la haute prévalence de décès parmi les personnes présentant un TCC, les survivants sont souvent confrontés à des séquelles physiques, psychologiques et cognitives, associées à un possible isolement social. L'inévitable défi de vie imposé par ce TCC implique non seulement la personne elle-même, mais également l'entourage et, plus particulièrement, le proche-aidant. Dans ce contexte, il est nécessaire d'intégrer le proche-aidant dans l'équation de la prise en charge globale de la personne avec un TCC. Lors d'une étude de suivi prospectif sur 40 ans chez des vétérans de la guerre du Vietnam victimes d'un TCC, nous nous sommes intéressés à la relation réciproque entre les deux partenaires, à savoir la personne avec un TCC et son proche-aidant. Les TCC étudiés dans ce travail sont de type pénétrant. Alors qu'ils sont moins fréquents que les TCC fermés, les lésions sont plus focales, ce qui facilite l'interprétation de leur association avec des fonctions cognitives. Dans notre première étude, nous avons investigué les effets des lésions cérébrales du sujet avec un TCC sur le fardeau de son proche-aidant, 40 ans après le TCC. Comme nous l'avions prédit, le fardeau des proche-aidants des sujets avec un TCC est plus sévère que celui des proche-aidants des sujets du groupe contrôle (vétérans de la guerre du Vietnam sans TCC). Par ailleurs, les proche-aidants des sujets avec un TCC qui présentent une lésion dans les aires cérébrales principalement impliquées dans les fonctions exécutives (à savoir les cortex préfrontal dorsolatéral et cingulaire antérieur gauches) ont une valeur de fardeau significativement supérieure à celle des proche-aidants dont les sujets n'ont pas de lésion dans les régions cérébrales précitées. Dans notre seconde étude, nous avons exploré le rôle du style d'attachement du proche-aidant sur l'évolution cognitive du sujet avec un TCC. Après avoir contrôlé pour les autres facteurs, nous avons mis en évidence un déclin cognitif significativement supérieur chez les sujets avec un TCC dont le proche-aidant présente un style d'attachement anxieux. Par conséquent, il existe une influence réciproque entre ces deux partenaires avec, premièrement, un effet à long-terme de la localisation cérébrale des lésions du sujet avec un TCC sur le fardeau du proche-aidant, probablement dû à des facteurs cognitifs et comportementaux liés aux fonctions exécutives ; Deuxièmement, il semble que le proche- aidant exerce un effet important sur l'environnement du sujet avec un TCC, parfois négativement. Ces résultats sont interprétés à la lumière de la littérature existante sur la plasticité neuronale et la réserve cognitive et sont accompagnés d'une réflexion sur les interventions thérapeutiques potentielles

Association Between Long-Term Cognitive Decline in Vietnam Veterans With TBI and Caregiver Attachment Style.

OBJECTIVE: To examine whether a caregiver's attachment style is associated with patient cognitive trajectory after traumatic brain injury (TBI). SETTING: National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland. PARTICIPANTS: Forty Vietnam War veterans with TBI and their caregivers. MAIN OUTCOME MEASURE: Cognitive performance, measured by the Armed Forces Qualification Test percentile score, completed at 2 time points: preinjury and 40 years postinjury. DESIGN: On the basis of caregivers' attachment style (secure, fearful, preoccupied, dismissing), participants with TBI were grouped into a high or low group. To examine the association between cognitive trajectory of participants with TBI and caregivers' attachment style, we ran four 2 × 2 analysis of covariance on cognitive performances. RESULTS: After controlling for other factors, cognitive decline was more pronounced in participants with TBI with a high fearful caregiver than among those with a low fearful caregiver. Other attachment styles were not associated with decline. CONCLUSION AND IMPLICATION: Caregiver fearful attachment style is associated with a significant decline in cognitive status after TBI. We interpret this result in the context of the neural plasticity and cognitive reserve literatures. Finally, we discuss its impact on patient demand for healthcare services and potential interventions

Theory of mind impairment in patients with behavioural variant fronto-temporal dementia (bv-FTD) increases caregiver burden.

BACKGROUND: Theory of mind (ToM), the capacity to infer the intention, beliefs and emotional states of others, is frequently impaired in behavioural variant fronto-temporal dementia patients (bv-FTDp); however, its impact on caregiver burden is unexplored. SETTING: National Institute of Neurological Disorders and Stroke, National Institutes of Health. SUBJECTS: bv-FTDp (n = 28), a subgroup of their caregivers (n = 20) and healthy controls (n = 32). METHODS: we applied a faux-pas (FP) task as a ToM measure in bv-FTDp and healthy controls and the Zarit Burden Interview as a measure of burden in patients' caregivers. Patients underwent structural MRI; we used voxel-based morphometry to examine relationships between regional atrophy and ToM impairment and caregiver burden. RESULTS: FP task performance was impaired in bv-FTDp and negatively associated with caregiver burden. Atrophy was found in areas involved in ToM. Caregiver burden increased with greater atrophy in left lateral premotor cortex, a region associated in animal models with the presence of mirror neurons, possibly involved in empathy. CONCLUSION: ToM impairment in bv-FTDp is associated with increased caregiver burden

Use it or lose it! Cognitive activity as a protec-tive factor for cognitive decline associated with Alzheimer's disease.

Because of the worldwide aging of populations, Alzheimer's disease and other dementias constitute a devastating experience for patients and families as well as a major social and economic burden for both healthcare systems and society. Multiple potentially modifiable cardiovascular and lifestyle risk factors have been associated with this disease. Thus, modifying these risk factors and identifying protective factors represent important strategies to prevent and delay disease onset and to decrease the social burden. Based on the cognitive reserve hypothesis, evidence from epidemiological studies shows that low education and cognitive inactivity constitute major risk factors for dementia. This indicates that a cognitively active lifestyle may protect against cognitive decline or delay the onset of dementia. We describe a newly developed preventive programme, based on this evidence, to stimulate and increase cognitive activity in older adults at risk for cognitive decline. This programme, called "BrainCoach", includes the technique of "motivational interviewing" to foster behaviour change. If the planned feasibility study is successful, we propose to add BrainCoach as a module to the already existing "Health Coaching" programme, a Swiss preventive programme to address multiple risk factors in primary care

Dementia Caregiver Burden: A Research Update and Critical Analysis

Purpose of Review: This article provides an updated review of the determinants of caregiver burden and depression, with a focus on care demands and especially the differential effects of various neuropsychiatric symptoms or symptom clusters. Moreover, studies on caregivers for frontotemporal and Lewy body dementias were referred to in order to identify differences and similarities with the mainstream literature based largely on Alzheimer caregivers. Recent Findings: As a group, neuropsychiatric symptoms are most predictive of caregiver burden and depression regardless of dementia diagnosis, but the effects appear to be driven primarily by disruptive behaviors (e.g., agitation, aggression, disinhibition), followed by delusions and mood disturbance. Disruptive behaviors are more disturbing partly because of the adverse impact on the emotional connection between the caregiver and the care-recipient and partly because they exacerbate difficulties in other domains (e.g., caring for activities of daily living). In behavioral variant frontotemporal dementia, not only are these disruptive behaviors more prominent but they are also more disturbing due to the care-recipient’s insensitivity to others’ feelings. In Lewy body dementia, visual hallucinations also appear to be distressing. Summary: The disturbing nature of disruptive behaviors cuts across dementia conditions, but the roles played by symptoms that are unique or particularly serious in a certain condition need to be explored further

Musical and psychomotor interventions for cognitive, sensorimotor, and cerebral decline in patients with Mild Cognitive Impairment (COPE): a study protocol for a multicentric randomized controlled study

Background: Regular cognitive training can boost or maintain cognitive and brain functions known to decline with age. Most studies administered such cognitive training on a computer and in a lab setting. However, everyday life activities, like musical practice or physical exercise that are complex and variable, might be more successful at inducing transfer effects to different cognitive domains and maintaining motivation. "Body-mind exercises", like Tai Chi or psychomotor exercise, may also positively affect cognitive functioning in the elderly. We will compare the influence of active music practice and psychomotor training over 6 months in Mild Cognitive Impairment patients from university hospital memory clinics on cognitive and sensorimotor performance and brain plasticity. The acronym of the study is COPE (Countervail cOgnitive imPairmEnt), illustrating the aim of the study: learning to better "cope" with cognitive decline. Methods: We aim to conduct a randomized controlled multicenter intervention study on 32 Mild Cognitive Impairment (MCI) patients (60–80 years), divided over 2 experimental groups: 1) Music practice; 2) Psychomotor treatment. Controls will consist of a passive test–retest group of 16 age, gender and education level matched healthy volunteers. The training regimens take place twice a week for 45 min over 6 months in small groups, provided by professionals, and patients should exercise daily at home. Data collection takes place at baseline (before the interventions), 3, and 6 months after training onset, on cognitive and sensorimotor capacities, subjective well-being, daily living activities, and via functional and structural neuroimaging. Considering the current constraints of the COVID-19 pandemic, recruitment and data collection takes place in 3 waves. Discussion: We will investigate whether musical practice contrasted to psychomotor exercise in small groups can improve cognitive, sensorimotor and brain functioning in MCI patients, and therefore provoke specific benefits for their daily life functioning and well-being. Trial registration: The full protocol was approved by the Commission cantonale d’éthique de la recherche sur l'être humain de Genève (CCER, no. 2020–00510) on 04.05.2020, and an amendment by the CCER and the Commission cantonale d'éthique de la recherche sur l'être humain de Vaud (CER-VD) on 03.08.2021. The protocol was registered at clinicaltrials.gov (20.09.2020, no. NCT04546451).</p

Troubles cognitifs et interventions non médicamenteuses : qualité de vie des patients et de leurs proches [Cognitive impairment and non-medical interventions: quality of life of patients and their caregivers]

In the absence of curative pharmaceutical treatment for evolving cognitive impairment, non-drug interventions are key components in patients' and caregivers' care. These interventions, when combined and adapted to the needs of the patient and the caregiver, allow for maintaining functional autonomy, decreasing caregiver burden and, possibly, slowing down cognitive decline. An on-going study in Suisse Romande (INDID-MCI-QOL) assesses the effect of the number and type of interventions conducted over a year on the evolution of physical, psychological and cognitive health in this population

Musical and psychomotor interventions for cognitive, sensorimotor, and cerebral decline in patients with Mild Cognitive Impairment (COPE) ::a study protocol for a multicentric randomized controlled study

Background : Regular cognitive training can boost or maintain cognitive and brain functions known to decline with age. Most studies administered such cognitive training on a computer and in a lab setting. However, everyday life activities, like musical practice or physical exercise that are complex and variable, might be more successful at inducing transfer effects to different cognitive domains and maintaining motivation. "Body-mind exercises", like Tai Chi or psychomotor exercise, may also positively affect cognitive functioning in the elderly. We will compare the influence of active music practice and psychomotor training over 6 months in Mild Cognitive Impairment patients from university hospital memory clinics on cognitive and sensorimotor performance and brain plasticity. The acronym of the study is COPE (Countervail cOgnitive imPairmEnt), illustrating the aim of the study: learning to better "cope" with cognitive decline. Methods : We aim to conduct a randomized controlled multicenter intervention study on 32 Mild Cognitive Impairment (MCI) patients (60–80 years), divided over 2 experimental groups: 1) Music practice; 2) Psychomotor treatment. Controls will consist of a passive test–retest group of 16 age, gender and education level matched healthy volunteers. The training regimens take place twice a week for 45 min over 6 months in small groups, provided by professionals, and patients should exercise daily at home. Data collection takes place at baseline (before the interventions), 3, and 6 months after training onset, on cognitive and sensorimotor capacities, subjective well-being, daily living activities, and via functional and structural neuroimaging. Considering the current constraints of the COVID-19 pandemic, recruitment and data collection takes place in 3 waves. Discussion : We will investigate whether musical practice contrasted to psychomotor exercise in small groups can improve cognitive, sensorimotor and brain functioning in MCI patients, and therefore provoke specific benefits for their daily life functioning and well-being

Protocols for cognitive enhancement. A user manual for Brain Health Services-part 5 of 6.

Cognitive complaints in the absence of objective cognitive impairment, observed in patients with subjective cognitive decline (SCD), are common in old age. The first step to postpone cognitive decline is to use techniques known to improve cognition, i.e., cognitive enhancement techniques.We aimed to provide clinical recommendations to improve cognitive performance in cognitively unimpaired individuals, by using cognitive, mental, or physical training (CMPT), non-invasive brain stimulations (NIBS), drugs, or nutrients. We made a systematic review of CMPT studies based on the GRADE method rating the strength of evidence.CMPT have clinically relevant effects on cognitive and non-cognitive outcomes. The quality of evidence supporting the improvement of outcomes following a CMPT was high for metamemory; moderate for executive functions, attention, global cognition, and generalization in daily life; and low for objective memory, subjective memory, motivation, mood, and quality of life, as well as a transfer to other cognitive functions. Regarding specific interventions, CMPT based on repeated practice (e.g., video games or mindfulness, but not physical training) improved attention and executive functions significantly, while CMPT based on strategic learning significantly improved objective memory.We found encouraging evidence supporting the potential effect of NIBS in improving memory performance, and reducing the perception of self-perceived memory decline in SCD. Yet, the high heterogeneity of stimulation protocols in the different studies prevent the issuing of clear-cut recommendations for implementation in a clinical setting. No conclusive argument was found to recommend any of the main pharmacological cognitive enhancement drugs ("smart drugs", acetylcholinesterase inhibitors, memantine, antidepressant) or herbal extracts (Panax ginseng, Gingko biloba, and Bacopa monnieri) in people without cognitive impairment.Altogether, this systematic review provides evidence for CMPT to improve cognition, encouraging results for NIBS although more studies are needed, while it does not support the use of drugs or nutrients

Die Empfehlungen der Swiss Memory Clinics für die Diagnostik der Demenzerkrankungen [Recommendations of Swiss Memory Clinics for the Diagnosis of Dementia]

The early diagnosis of subjectively perceived or externally anamnestically observed cognitive impairments is essential for proving neurodegenerative diseases or excluding treatable causes such as internal, neurological or psychiatric disorders. Only in this way is early treatment made possible. As part of the project 3.1 of the National Dementia Strategy 2014–2019 («Development and expansion of regional and networked centres of competence for diagnostics»), the association Swiss Memory Clinics (SMC) set itself the goal of developing quality standards for dementia clarification and improving the community-based care in this field. In these recommendations, general guidelines of diagnostics and individual examination possibilities are presented, and standards for the related processes are suggested. Individual areas such as anamnesis, clinical examination, laboratory examination, neuropsychological testing and neuroradiological procedures are discussed in detail as part of standard diagnostics, and supplementary examination methods for differential diagnosis considerations are portrayed. The most important goals of the SMC recommendations for the diagnosis of dementia are to give all those affected access to high-quality diagnostics, if possible, to improve early diagnosis of dementia and to offer the basic service providers and the employees of Memory Clinics a useful instrument for the clarification