Feasibility and usability of remote monitoring in Alzheimer’s disease

Introduction: Remote monitoring technologies (RMTs) can measure cognitive and functional decline objectively at-home, and offer opportunities to measure passively and continuously, possibly improving sensitivity and reducing participant burden in clinical trials. However, there is skepticism that age and cognitive or functional impairment may render participants unable or unwilling to comply with complex RMT protocols. We therefore assessed the feasibility and usability of a complex RMT protocol in all syndromic stages of Alzheimer’s disease and in healthy control participants.Methods: For 8 weeks, participants (N=229) used two activity trackers, two interactive apps with either daily or weekly cognitive tasks, and optionally a wearable camera. A subset of participants participated in a 4-week sub-study (N=45) using fixed at-home sensors, a wearable EEG sleep headband and a driving performance device. Feasibility was assessed by evaluating compliance and drop-out rates. Usability was assessed by problem rates (e.g., understanding instructions, discomfort, forgetting to use the RMT or technical problems) as discussed during bi-weekly semi-structured interviews.Results: Most problems were found for the active apps and EEG sleep headband. Problem rates increased and compliance rates decreased with disease severity, but the study remained feasible.Conclusions: This study shows that a highly complex RMT protocol is feasible, even in a mild-to-moderate AD population, encouraging other researchers to use RMTs in their study designs. We recommend evaluating the design of individual devices carefully before finalizing study protocols, considering RMTs which allow for real-time compliance monitoring, and engaging the partners of study participants in the research.<br/

Αξιολόγηση εκπαιδευτικής παρέμβασης στη νοσηλευτική φροντίδα κατά την περίθαλψη ηλικιωμένων με άνοια σε δημόσια νοσοκομεία

The aim of this PhD thesis was to explore the needs of nurse staff and support a dementia training program in Greek general hospitals. The current thesis focuses on the development, implementation and evaluation of a dementia training program in staff of general hospitals. The main goals were: a) To explore the educational needs of the target group b) Design of the training program and development of the content based on the above needs c) Validation of tools, used in the training and an overall evaluation of the program.To develop the training curriculum, (i) a systematic literature review and (ii) a staff educational analysis were conducted. The systematic review aimed to explore the existing dementia training programs and evaluate them according to their effectiveness in hospital context. The results of this study revealed several characteristics of effective trainings which can be adapted and used in an upcoming training. The staff educational needs analysis aimed to explore staff preferences, needs and expectations of an upcoming dementia training. After the development of the training content, a validation study for the tools used as measurements of training outcomes in three time points (before after and 3 months later) was necessary. Three tools used to measure attitudes toward dementia (DAS), knowledge (DKAT2) and confidence in care (CODE), were explored for their psychometric properties in Greek population. All three scales were concerned as valid and robust measurements in Greek research. At the same time, due to major percentages of underdiagnosed cases of dementia including the admissions in hospital settings, two sub-studies were conducted to explore the staff attitudes of computerized dementia screening. The first study was a validation of a new questionnaire about the attitudes towards computerized dementia screening and the second one was a confirmatory factor analysis study in a bigger sample of staff. In specific, the acceptability and feasibility of questionnaire was tested while the barriers to future implementation of computerized dementia screening in the Greek healthcare system were also addressed. A final study was conducted for the implementation and the overall evaluation of the training. The main results were that positive attitudes towards dementia, improvement of confidence in care and decrease of feeling of anxiety as a trait, were sustained over time. Knowledge about dementia also increased after the training and sustained, with, however, a slight decrease over time. However, changes in the organizational level and a transformation of care culture are necessary for training sustainability over time. In future studies, dementia education should be transferred not only across the hospital sector but also at academic level, such as the nursing schools of universities. The systematic cooperation between PwD and their families, researchers, academia, policy makers and individual practitioners is required to reach the best care for PwD. No-one alone can make the change towards quality care for PwD.Στόχος αυτής της διδακτορικής διατριβής είναι να διερευνήσει τις ανάγκες του νοσηλευτικού προσωπικού και να υποστηρίξει ένα πρόγραμμα κατάρτισης για άνοια σε Eλληνικά γενικά νοσοκομεία. Η παρούσα διατριβή επικεντρώνεται στην ανάπτυξη, εφαρμογή και αξιολόγηση ενός προγράμματος κατάρτισης για την άνοια σε προσωπικό γενικών νοσοκομείων. Οι κύριοι στόχοι ήταν: α) Να διερευνήσει τις εκπαιδευτικές ανάγκες της ομάδας στόχου, β) Σχεδιασμός του προγράμματος κατάρτισης και ανάπτυξη του περιεχομένου με βάση τις παραπάνω ανάγκες, γ) Επικύρωση εργαλείων, που χρησιμοποιούνται στην κατάρτιση και συνολική αξιολόγηση του προγράμματος. Για την ανάπτυξη του προγράμματος κατάρτισης, διεξήχθησαν μια (i) συστηματική ανασκόπηση και (ii) μια ανάλυση για τις εκπαιδευτικές ανάγκες προσωπικού. Η συστηματική ανασκόπηση είχε ως στόχο να διερευνήσει τα υπάρχοντα προγράμματα για την άνοια και να τα αξιολογήσει ανάλογα με την αποτελεσματικότητά τους σε νοσοκομειακό πλαίσιο. Τα αποτελέσματα αυτής της μελέτης ανέδειξαν αρκετά χαρακτηριστικά αποτελεσματικών καταρτίσεων που μπορούν να προσαρμοστούν και να χρησιμοποιηθούν σε μια προσεχή κατάρτιση. Η ανάλυση των εκπαιδευτικών αναγκών του προσωπικού αποσκοπούσε στη διερεύνηση των προτιμήσεων του προσωπικού, των αναγκών και των προσδοκιών μιας επερχόμενης εκπαίδευσης για άνοια. Μετά την ανάπτυξη του εκπαιδευτικού περιεχομένου, ήταν απαραίτητη μια μελέτη επικύρωσης για τα εργαλεία που χρησιμοποιήθηκαν ως μετρήσεις των αποτελεσμάτων της κατάρτισης σε τρία χρονικά σημεία (πριν και μετά και 3 μήνες αργότερα). Τρία εργαλεία που χρησιμοποιήθηκαν για τη μέτρηση της στάσης απέναντι στην άνοια (DAS), τη γνώση (DKAT2) και την αυτοπεποίθηση στη φροντίδα (CODE), διερευνήθηκαν για τις ψυχομετρικές τους ιδιότητες στον ελληνικό πληθυσμό. Και οι τρεις κλίμακες αναδείχτηκαν έγκυρα και ισχυρά εργαλεία σε ελληνικό ερευνητικό πλαίσιο. Ταυτόχρονα, λόγω των μεγάλων ποσοστών υποδιάγνωσης της άνοιας, συμπεριλαμβανομένων των εισαγωγών σε νοσοκομεία, πραγματοποιήθηκαν δύο δευτερεύουσες μελέτες για τη στάση του προσωπικού στην ηλεκτρονική ανίχνευση άνοιας. Η πρώτη μελέτη αφορούσε μια επικύρωση ενός νέου ερωτηματολογίου σχετικά με τη στάση απέναντι στην ανίχνευση άνοιας ηλεκτρονικά και η δεύτερη ήταν μια επιβεβαιωτική μελέτη σε ένα μεγαλύτερο δείγμα προσωπικού. Συγκεκριμένα, εξετάστηκε η αποδοχή και η σκοπιμότητα του ερωτηματολογίου, ενώ αναδείχτηκαν επίσης πιθανά εμπόδια για τη μελλοντική εφαρμογή της ηλεκτρονικής ανίχνευσης της άνοιας στην υγειονομική περίθαλψη. Πραγματοποιήθηκε μια τελική μελέτη για την εφαρμογή και τη συνολική αξιολόγηση της εκπαίδευσης. Τα κύρια αποτελέσματα ήταν ότι οι θετικές στάσεις απέναντι στην άνοια, η βελτίωση της αυτοπεποίθησης στη φροντίδα και η μείωση του άγχους ως γνώρισμα, διατηρήθηκαν στον χρόνο. Η γνώση για την άνοια αυξήθηκε επίσης μετά την επιμόρφωση και διατηρήθηκε, με μια, ωστόσο, μικρή μείωση στην πάροδο του χρόνου. Παρόλα αυτά, οι αλλαγές σε επίπεδο οργανισμού και η αλλαγή στην κουλτούρα φροντίδας είναι απαραίτητες για την βιωσιμότητα αποτελεσμάτων εκπάιδευσης. Σε μελλοντικές μελέτες, η επιμόρφωση για την άνοια θα πρέπει να μεταφερθεί όχι μόνο στον νοσοκομειακό τομέα αλλά και σε ακαδημαϊκό επίπεδο, όπως οι νοσηλευτικές σχολές. Απαιτείται η συστηματική συνεργασία μεταξύ των ατόμων με άνοια και των οικογενειών τους, των ερευνητών, της ακαδημίας, των υπευθύνων χάραξης πολιτικής και των μεμονωμένων επαγγελματιών για την επίτευξη της καλύτερης φροντίδας των ασθενών με άνοια. Κανείς δεν μπορεί μόνος του να κάνει την αλλαγή ως προς την ποιοτική φροντίδα των ατόμων με άνοια

Daily Functionality of People with Low Vision: The Impact of Visual Acuity, Depression, and Life Orientation—A Cross-Sectional Study

Background. Low vision (LV) has a significant negative impact on the activities of daily life as well as on the psychological health of patients. Objectives. The objective of this study is to investigate psychological, clinical, and demographic factors that may impact the daily functionality of patients with LV. Methods. A convenience sample of 53 patients, meeting the WHO criteria for LV, was recruited. Questionnaires on daily functionality, depression, and life orientation (in terms of optimism/pessimism) were administered along with a semistructured personal interview. Key Findings. The main results revealed a significant negative correlation between daily functionality and depression (r=−0.423, p<0.001). Conversely, there is a positive correlation between daily functionality and visual acuity (r=0.415, p<0.001), while years since diagnosis were negatively correlated with depression (r=−0.345, p<0.001). Depression seems to be a moderate predictor of a person’s daily functionality (β=−0.389, p<0.002), followed by visual acuity (β=−0.344, p=0.006), explaining the 31.1% of the total variance. Conclusions. The study supports a correlation between daily functionality and both depression and visual acuity. Optimism as a personality characteristic did not factor into the prediction model for daily functionality, but it showed a strong correlation with lower levels of depressive symptoms. This highlights the potential for developing coping strategies for chronic disease management. Recommendations. The study could serve as a useful guide and may urge clinicians to pay attention to the psychological evaluation of these patients, supporting their unique emotional needs. Mental health professionals can use patients’ positive resources to provide appropriate counseling and embrace the coping skills that encourage their engagement in activities of daily life

Effects of maternal separation on behavior and brain damage in adult rats exposed to neonatal hypoxia–ischemia

Animal studies suggest that maternal separation, a widely used paradigm to study the effects of early life adversity, exerts a profound and life-long impact on both brain and behavior. The aim of the current study was to investigate whether adverse early life experiences interact with neonatal hypoxia–ischemia, affecting the outcome of this neurological insult at both functional and structural levels during adulthood. Rat pups were separated from their mothers during postnatal days 1–6, for either a short (15 min) or prolonged (180 min) period, while another group was left undisturbed. On postnatal day 7, a subgroup from each of the three postnatal manipulations was exposed to a hypoxic–ischemic episode. Behavioral examination took place approximately at three months of age and included tests of learning and memory (Morris water maze, novel object and novel place recognition), as well as motor coordination (rota-rod). We found that both prolonged maternal separation and neonatal hypoxia–ischemia impaired the animals’ spatial learning and reference memory. Deficits in spatial but not visual recognition memory were detected only in hypoxic–ischemic rats. Interestingly, prolonged maternal separation prior to neonatal hypoxia–ischemia augmented the reference memory impairments. Histological analysis of infarct size, hippocampal area and thickness of corpus callosum did not reveal any exacerbation of damage in hypoxic–ischemic rats that were maternally separated for a prolonged period. These are the first data suggesting that an adverse postnatal environmental manipulation of just 6 days causes long-term effects on spatial learning and memory and may render the organism more vulnerable to a subsequent insult

Validation of a European Cross-Cultural Neuropsychological Test Battery (CNTB) for evaluation of dementia

Background: The aims of this study were to establish the diagnostic accuracy of the European Cross-Cultural Neuropsychological Test Battery (CNTB) for dementia in different ethnic populations in Western Europe, to examine its ability to differentiate cognitive impairment profiles for dementia subtypes, and to assess the impact of demographic variables on diagnostic properties. Methods: The study was a Western European cross-sectional multi-center study. A total of 66 patients with dementia and 118 cognitively intact participants were included across six memory clinics; 93 had ethnic minority background and 91 had ethnic majority background. Tests in the CNTB cover global cognitive function, memory, language, executive functions, and visuospatial functions. Results: Significant differences with moderate to large effect sizes were present between patients with dementia and control participants on all CNTB measures. Area under the curves (AUC) ranged from.62 to.99 with a mean AUC across all measures of.83. Comparison of ethnic minority and majority groups generally revealed higher sensitivity in the minority group but no significant difference in the mean AUC's across all measures (.84 vs78, P =.42). Comparison of impairment profiles for patients with Alzheimer's disease (AD) and non-AD dementia revealed that AD patients were significantly more impaired on the memory domain, whereas patients with non-AD dementia were more impaired on the executive functions domain. Conclusions: The CNTB was found to have promising cross-cultural diagnostic properties for evaluation of dementia in the targeted minority and majority populations and could represent a valid cross-cultural alternative to other well-established neuropsychological test batteries when assessing patients from these populations

Validation of the Rowland Universal Dementia Assessment Scale (RUDAS) in a multicultural sample across five Western European countries : diagnostic accuracy and normative data

Background:: With increasing cultural diversity and growing elderly immigrant populations in Western European countries, the availability of brief cognitive screening instruments adequate for assessment of dementia in people from diverse backgrounds becomes increasingly important. The aim of the present study was to investigate diagnostic accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) in a multicultural sample and to calculate normative data as a basis for demographic adjustment of RUDAS scores. Methods:: The study was a prospective international cross-sectional multi-center study. Receiver operating characteristic curve analysis was used to examine diagnostic accuracy. Regression analysis was used to assess the impact of demographic variables. Results:: Data was collected from 341 cognitively intact participants and 80 people with dementia with a wide age- and educational range. Of the 421 included participants, 239 (57%) had immigrant background. The RUDAS had high diagnostic accuracy with an area under the curve (AUC) of 0.93. The optimal cut-off score was <25 (sensitivity 0.80, specificity 0.90). Regression analysis revealed that RUDAS scores were mainly affected by education and were unrelated to data collection site and immigrant status. Education-adjusted normative data was calculated as a basis for education adjustment of RUDAS scores. Applying education-adjusted RUDAS scores slightly but significantly improved diagnostic accuracy with an AUC of 0.95. Conclusion:: We found the RUDAS to have excellent diagnostic properties in our multicultural sample. However, we suggest that RUDAS scores should be adjusted for education to increase diagnostic accuracy and that the choice of cut-off score should be considered based on the clinical context and expected base rate of dementia

Performance of middle-aged and elderly European minority and majority populations on a Cross-Cultural Neuropsychological Test Battery (CNTB)

<p><b>Objective:</b> The aim of this study was to examine test performance on a cross-cultural neuropsychological test battery for assessment of middle-aged and elderly ethnic minority and majority populations in western Europe, and to present preliminary normative data. <b>Method:</b> The study was a cross-sectional multi-center study. Tests in the European Cross-Cultural Neuropsychological Test Battery (CNTB) cover several cognitive domains, including global cognitive function, memory, executive functions, and visuospatial functions. <b>Results:</b> A total of 330 participants were included: 14 Moroccan, 45 Pakistani/Indian Punjabi, 41 Polish, 66 Turkish, and 19 former Yugoslavian minority participants, and 145 western European majority participants. Significant differences between ethnic groups were found on most CNTB measures. However, ethnic groups differed greatly in demographic characteristics and differences in test scores were mainly related to educational differences, explaining an average of 15% of the variance. Preliminary multicultural CNTB normative data dichotomized by education and age were constructed using overlapping cells. Applying this normative data across the whole sample resulted in an acceptable number of participants scoring in the impaired range across all ethnic groups. Factor analyses found the CNTB to have a stable and clinically meaningful factor structure. <b>Conclusions:</b> The CNTB represents the first European joint effort to establish neuropsychological measures appropriate for ethnic minority populations in western Europe. The CNTB can be applied in approximately 60 min, covers several cognitive domains, and appears appropriate for assessment of the targeted populations. However, due to the small sample size in some ethnic groups further studies are needed replicate and support this.</p