Ticket to Talk: Supporting Conversation between Young People and People with Dementia through Digital Media

We explore the role of digital media in supporting intergenerational interactions between people with dementia and young people. Though meaningful social interaction is integral to quality of life in dementia, initiating conversation with a person with dementia can be challenging, especially for younger people who may lack knowledge of someone’s life history. This can be further compounded without a nuanced understanding of the nature of dementia, along with an unfamiliarity in leading and maintaining conversation. We designed a mobile application - Ticket to Talk - to support intergenerational interactions by encouraging young people to collect media relevant to individuals with dementia to use in conversations with people with dementia. We evaluated Ticket to Talk through trials with two families, a care home, and groups of older people. We highlight difficulties in using technologies such as this as a conversational tool, the value of digital media in supporting intergenerational interactions, and the potential to positively shape people with dementia’s agency in social settings

Measures of resting state EEG rhythms for clinical trials in alzheimer's disease patients : recommendations of an expert panel

Background and Aim: Eyes-closed resting state electroencephalographic (rsEEG) rhythms reflect neurophysiological oscillatory mechanisms of synchronization/desynchronization of activity within neural populations of ascending reticular activating brain systems and thalamus-cortical circuits involved in quite vigilance regulation. Currently, they are not considered as biomarkers of Alzheimer’s disease (AD) in the amyloid, tau and neurodegeneration (ATN) Framework of Alzheimer’s Association and National Institute of Aging (AA-NIA). The Electrophysiology Professional Interest Area (EPIA) of AA and Global Brain Consortium endorsed this article written by a multidisciplinary Expert Panel to provide recommendations on candidate rsEEG measures for AD clinical trials. Method: The Panel revised the field literature and reached consensus about the rsEEG measures consistently associated with clinical phenotypes and neuroimaging markers of AD in previous international multicentric clinical trials. Most consistent findings: AD patients with mild cognitive impairment and dementia displayed reduced peak frequency, power, and paired-electrode “interrelatedness” in posterior alpha (8-12 Hz) rhythms and topographically widespread increases in delta (< 4 Hz) and theta (4-8 Hz) rhythms. Recommendations: (i) Careful multi-center standardization of instructions to patients, rsEEG recordings, and selection of artifact-free rsEEG periods; (ii) extraction of rsEEG power density and paired-electrode “interrelatedness” (e.g., directed transfer function, phase lag index, linear lagged connectivity, etc.) rsEEG measures computed at delta, theta, and alpha frequency bands by validated open-access software platforms for replicability; (iii) valid use of those measures in stratification of AD patients and monitoring of disease progression and intervention; and iv) international initiatives to cross-validate rsEEG measures (including nonlinear) for disease monitoring and intervention

Health promotion intervention for people with early-stage dementia: A quasi-experimental study

Introduction: With the limited advancements in medical treatment, there is a growing need for supporting people with early‐stage dementia adjust to their diagnosis and improve their quality of life. This study aimed to investigate the effects of a 12‐week health promotion course for people with early‐stage dementia. Methods: Quasi‐experimental, single group, pretest‐posttest design. A total of 108 persons with dementia participated in this study, and for each participant, a carer was interviewed. The 12‐week health promotion intervention consisted of 2‐hr sessions at weekly intervals. Outcome measures were cognition, measured by Mini‐Mental State Examination, personal, and instrumental activities of daily living (P‐ADL and I‐ADL), measured by Lawton and Brody's Physical Self‐Maintenance Scale and Instrumental Activities of Daily Living Scale, self‐rated health, measured by the European Quality of life Visual Analogue Scale, depressive symptoms, measured by the Cornell Scale for Depression in Dementia, and neuropsychiatric symptoms, measured by The Neuropsychiatric Inventory. Assessments were conducted at baseline and at follow‐up 1–2 months postintervention. Results: The results demonstrate a small but statistically significant improvement in depressive symptoms (p = .015) and in self‐rated health (p = .031). The results also demonstrated a small statistically significant decline in the participants’ I‐ADL (p = .007). The participants’ cognitive function, P‐ADL, and neuropsychiatric symptoms were stable during the 4‐month follow‐up. Conclusion: This study demonstrates promising results with regard to the benefit of attending a 12‐week health promotion intervention in promoting health and well‐being in people with early‐stage dementia. With the majority of participants with early‐stage dementia living at home without any healthcare services in a vulnerable stage of the condition, this study makes an important contribution to highlighting the need for, and benefit of, educational approaches for this population.publishedVersio

Limited validity of the Hospital Anxiety and Depression Scale (HADS) in dementia: evidence from a confirmatory factor analysis

OBJECTIVES: The Hospital Anxiety and Depression Scale (HADS) is a well-validated, self-report measure of both anxiety and depression. It is frequently used with people with dementia. However, its structural validity has never been examined in this population. The current study used confirmatory factor analysis (CFA) to assess this. METHODS: Baseline data from two intervention studies for people with mild to moderate dementia were combined (N = 268). CFA was used to test whether a one, two or three factor structure best fit the data. Indices of model misspecification were examined to test for poor quality items, and models re-specified accordingly. Finally, measurement invariance across gender and different levels of cognitive impairment was assessed. RESULTS: A one-factor structure did not fit the data. Two and three factor structures fitted the data equally well. Model fit was improved by removal of two items. Measurement invariance was adequate across gender, but poor across groups with differing levels of cognitive impairment. CONCLUSION: The HADS is acceptable and feasible but difficult to interpret in a dementia population. We suggest that it should be interpreted as measuring two separate factors of anxiety and depression and not one 'distress' factor. However, two items may need to be removed, affecting cut-off scores. Poor measurement invariance means the HADS may not be a good tool for measuring differences in anxiety and depression between those with mild and those with moderate cognitive impairment

Prevalence of oral health-related conditions that could trigger accidents for patients with moderate-to-severe dementia

OBJECTIVE: This study was performed to determine the prevalence of oral health conditions unnoticed by doctors and ward staff that may increase risk of incidents and/or accidents in hospitalised patients with moderate-severe dementia. BACKGROUND DATA DISCUSSING THE PRESENT STATUS OF THE FIELD: Dementia patients may not recognise risks in the mouth, such as tooth mobility or ill-fitting dental prostheses and/or dentures. In addition to the risk of choking, injury by sharp edges of collapsed teeth or prosthodontics could pose risks. However, many previous publications were limited to case reports or series. MATERIALS AND METHODS: Ninety-two consecutive hospitalised dementia patients (M: 52, F: 40, median age: 82.5 years, range: 62-99 years, from 2011 to 2014), referred for dentistry for dysphagia rehabilitation, were enrolled in this study. Participants referred for dental treatment with dental problems detected by ward staff were excluded. All participants had a Global Clinical Dementia Rating Score >2. Their dental records were evaluated retrospectively for issues that may cause incidents and/or accidents. RESULTS: Problems in the mouth, for example tooth stumps, dental caries, and ill-fitting dentures, were detected in 51.1% of participants (47/92). Furthermore, 23.9% (22/92) showed risk factors that could lead to incidents and/or accidents, for example falling out of teeth and/or prosthodontics or injury by sharp edges of teeth and/or prosthodontics. CONCLUSIONS: Hospitalised moderate-severe dementia patients had a high prevalence of oral health conditions unnoticed by doctors and ward staff that may increase risk of incidents and/or accidents

Educational inequalities in aging-related declines in fluid cognition and the onset of cognitive pathology

AbstractBackgroundEducation has been robustly associated with cognitive reserve and dementia, but not with the rate of cognitive aging, resulting in some confusion about the mechanisms of cognitive aging. This study uses longitudinal data to differentiate between trajectories indicative of healthy versus pathologic cognitive aging.MethodsParticipants included 9401 Health and Retirement Study respondents aged ≥55 years who completed cognitive testing regularly over 17.3 years until most recently in 2012. Individual-specific random change-point modeling was used to identify age of incident pathologic decline; acceleration is interpreted as indicating likely onset of pathologic decline when it is significant and negative.ResultsThese methods detect incident dementia diagnoses with specificity/sensitivity of 89.3%/44.3%, 5.6 years before diagnosis. Each year of education was associated with 0.09 (95% confidence interval [CI], 0.087–0.096; P < .001) standard deviation higher baseline cognition and delayed onset of cognitive pathology (hazard ratio, 0.98; 95% CI, 0.96–0.99; P = .006).ConclusionsLongitudinal random change-point modeling was able to reliably identify incident dementia. Accounting for incident cognitive pathology, we find that education predicts cognitive capability and delayed onset pathologic declines

Stigma and GPs’ perceptions of dementia

YesObjectives: General practitioners (GPs) are crucial to improving timely diagnosis, but little is reported about how they perceive dementia, and whether their perceptions display any elements of stigma. The aim of this study was to explore how GPs’ perceptions of dementia map onto current conceptualizations of stigma and whether GPs feel that stigma affects timely diagnosis. Methods: Twenty-three GPs from England were interviewed by telephone. Data were analyzed by means of content analysis. This involved open coding followed by the application of a coding framework derived from the literature to explore how and to what extent their perceptions relate to stigma as well as the unique nature of their perceptions. Results: Three themes emerged from the analysis: (1) ‘making sense of dementia’, (2) ‘relating perceptions of dementia to oneself’ and (3) ‘considering the consequences of dementia’. GPs’ perceptions of dementia mapped onto current conceptualizations of stigma. Perceptions about dementia that were linked to their own existential anxiety and to a perceived similarity between people with dementia and themselves were particularly salient. GPs perceived dementia as a stigma which was gradually being overcome but that stigma still hindered timely diagnosis. They provided examples of structural discrimination within the health service, including lack of time for patients and shortcomings in training that were to the detriment of people with dementia. Conclusion: Measures to involve GPs in tackling stigma should include training and opportunities to explore how they perceive dementia, as well as support to address structural discrimination.The study was funded by Alzheimer Europe (Luxembourg) in the form of tuition fees for Dianne Gove for her PhD study

Behavioral Interventions In Six Dimensions Of Wellness That Protect The Cognitive Health Of Community-Dwelling Older Adults: A Systematic Review

OBJECTIVES: To systematically identify, appraise, and summarize research on the effects of behavioral interventions to prevent cognitive decline in community-dwelling older adults using a holistic wellness framework. DESIGN: Systematic review of randomized controlled trials that tested the effectiveness of behavioral interventions within each of the six dimensions of wellness: occupational, social, intellectual, physical, emotional and spiritual. Databases searched included PubMed MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, ALOIS, and The Grey Literature Report through July 1, 2014. SETTING: Community. PARTICIPANTS: Individuals aged 60 and older (N = 6,254). MEASUREMENTS: Consolidated Standards of Reporting Trials Checklist. RESULTS: Eighteen studies met the inclusion criteria. Interventions in the physical dimension of wellness were most common (11 studies); interventions in the spiritual dimension were least common (0 studies). Fifty-nine different measures were used to measure multiple cognitive domains, with memory being the most commonly measured (17 studies) and language being the least commonly measured (5 studies). Fifty percent of the interventions examined in the 18 studies demonstrated statistically significant outcomes on at least one cognitive measure. Interventions in the intellectual dimension that examined cognitively stimulating activities using pen and paper or a computer represented the greatest percentage of statistically significant outcomes. CONCLUSION: Intellectual and physical interventions were most studied, with varied results. Future research is needed using more-consistent methods to measure cognition. Researchers should include the National Institutes of Health Toolbox Cognition Battery among measurement tools to facilitate effective data harmonization, pooling, and comparison