Assessing people with dementia participating in cognitive stimulation activities – A qualitative pilot video analysis exploring the importance of facilitating the participation

BACKGROUND: This pilot video analysis was part of a feasibility control study, which aimed to gain information about the size and variability of the changes in outcome measures to plan a substantive effect study. It compared a cognitive stimulation programme named Lifelong Learning with other existing dementia services. OBJECTIVE: The pilot video analysis explored how facilitation is performed, when assessing people with dementia with standardized measures, to ensure their participation in research. DESIGN: A test battery of five measures (Mini-Mental State Examination (MMSE), Quality of Life in Alzheimer's Disease Scale (QoL-AD), General Self-Efficacy Scale, Rosenberg Self-Esteem Scale and Hawthorn Friendship Scale) was used. Each assessment was video-recorded. The findings from a microanalysis of 10 videos are presented in this article. SETTING: The study involved 55 active participants with mild-to-moderate dementia in six municipalities in Northern Denmark. RESULTS: The identified themes related to supportive facilitation: Positive facilitator strategies; Creating a safe and comfortable environment; and to dilemmas in facilitation: Balancing multiple dilemmas and Balancing the MMSE test. DISCUSSION: Results are discussed in relation to using standardized measures. CONCLUSION: The quality of facilitation when using standardized measures is of great importance as it may influence the participant, the assessment and the answers given. The facilitation role needs to be thoroughly planned and executed with ethical consideration to improve the participation of vulnerable groups in research and ensure a person-centred approach. PATIENT OR PUBLIC CONTRIBUTION: The identified measures were chosen based upon previous qualitative results and user-involvement workshops with people with dementia

Spatial disorientation and executive dysfunction in elderly nondemented patients with Parkinson’s disease

Davide M Cammisuli,1 Simon Crowe2 1Department of Surgical, Medical, Molecular and Critical Area Pathology, Pisa University Medical School, Pisa, Italy; 2School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia Objectives: Patients with Parkinson’s disease (PD) present with a wide range of cognitive deficits. Cognitive impairment is recognized as an independent nonmotor aspect of the disorder and has a critical role in functional outcome and conversion into PD dementia. To date, everyday memory impairment in elderly patients with PD is underinvestigated and its relationship with executive dysfunction was not clearly explained. Our study aims at clarifying the neuropsychological pattern of everyday memory and executive deterioration in elderly patients with PD.Methods: Forty nondemented PD patients (mean age 71.2 years; M:F = 29:11) and 30 well-matched controls (mean age 70.7 years; M:F = 15:15) were assessed on everyday memory (Rivermead Behavioral Memory Test [RBMT]) and executive functioning (Frontal Assessment Battery [FAB]) measures. Mann–Whitney U-tests (Bonferroni corrected) were used to compare groups on these measures and Spearman’s rank correlations were performed to highlight their associations.Results: PD patients performed worse than controls on recall for novel tasks and geographic recall (RMBT) as well as lexical fluency and mental flexibility (FAB). Particularly, spatial orientation depending on egocentric navigation seems to be altered in PD patients. The clinical group showed poorer performances than controls in mental flexibility, sensitivity to interference, and inhibitory control. Such measures were associated with immediate and delayed recall, picture recognition, prospective memory, and orientation tasks of everyday memory.Conclusion: Executive-type difficulties and memory-type difficulties have an impact on cognitive performances of elderly patients with PD. We recommend using the RBMT and the FAB as part of routinely neuropsychological battery for assessing PD patients. Keywords: spatial disorientation, recall impairment, executive dysfunction, elderly people, Parkinson’s diseas

Detecting Mild Cognitive Deficits in Parkinson's Disease: Comparison of Neuropsychological Tests

Background: Numerous neuropsychological tests and test versions are used in Parkinson's disease research, but their relative capacity to detect mild cognitive deficits and their comparability across studies are unknown. The objective of this study was to identify neuropsychological tests that consistently detect cognitive decline in PD across studies. Methods: Data from 30 normed neuropsychological tests across 20 international studies in up to 2908 nondemented PD patients were analyzed. A subset of 17 tests was administered to up to 1247 healthy controls. A 2‐step meta‐analytic approach using standardized scores compared performance in PD with normative data. Results : Pooled estimates of the differences between PD and site‐specific healthy controls identified significant cognitive deficits in PD patients on 14 test scores across 5 commonly assessed cognitive domains (attention or working memory, executive, language, memory, and visuospatial abilities), but healthy control performance was statistically above average on 7 of these tests. Analyses based on published norms only, as opposed to direct assessment of healthy controls, showed high between‐study variability that could not be accounted for and led to inconclusive results. Conclusions: Normed neuropsychological tests across multiple cognitive domains consistently detect cognitive deficits in PD when compared with site‐specific healthy control performance, but relative PD performance was significantly affected by the inclusion and type of healthy controls versus the use of published norms only. Additional research is needed to identify a cognitive battery that can be administered in multisite international studies and that is sensitive to cognitive decline, responsive to therapeutic interventions, and superior to individual cognitive tests. © 2018 International Parkinson and Movement Disorder Societ

Malignant Mesothelioma: Mechanism of Carcinogenesis

International audienceAlmost 60 years ago, malignant mesothelioma (MM) was acknowledged as a specific cancer related to the inhalation of asbestos fibers (1). Its strong association with asbestos exposure triggered the development of researches. They consisted in epidemiological studies to know the risk factors that explain MM occurrence in the population, and of experimental studies to understand MM biological development as a neoplastic disease. Since that time, MM remains a rare and highly aggressive cancer that prompts researches to better manage patients with MM and to offer efficient therapies. To achieve this goal, a solid knowledge of the mechanisms of mesothelial carcinogenesis is needed and deserves basic researches to progress. So far, our knowledge is based on pathophysiological and toxicological researches, and from biological and molecular studies using MM tissue tumor samples and cell lines from humans and experimental animals. Most experimental studies have been based on the cellular and/or animal responses to asbestos fibers, and in genetically modified mice, demonstrating the genotoxic effect of asbestos and relationship with MM induction. The development of large-scale analyses allowing global integration of the molecular networks involved in mesothelial cell transformation should increase our understanding of mesothelial carcinogenesis. In human, MM tumors appeared as heterogeneous entities, based on morphological patterns and molecular specificities including gene mutations. The recent development of high throughput methods allowed classification of MM according to their histological type, genomic and epigenomic characteristics and deregulated pathways. The aim of the present review is to propose a potential mechanism of mesothelial carcinogenesis by integrating data, underlying the mechanisms that may be shared with other types of fibres that may pose current health issue