Cognitive training for people with mild to moderate dementia (protocol)

This is the final version of the article. Available from Cochrane Collaboration / Wiley via the DOI in this record.The review version is in ORE at: http://hdl.handle.net/10871/36870This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effects of cognitive training on cognitive and non-cognitive outcomes for people with mild to moderate dementia and their caregivers. To compare the effects of cognitive training with those of other non-pharmacological interventions, including cognitive stimulation or rehabilitation. To identify and explore factors related to intervention and trial design that may be associated with the efficacy of cognitive training.Internal sources • Cochrane Incentive Award, UK. External sources • NIHR, UK. This protocol was supported by the National Institute for Health Research (NIHR), via Cochrane Incentive funding Cochrane to the Cochrane Dementia and Cognitive Improvement group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service or the Department of Health • National Health and Medical Research Council of Australia, Australi

Cognitive training for people with mild to moderate dementia (review)

This is the final version. Available from Cochrane Collaboration / Wiley via the DOI in this recordThe protocol version is in ORE at: http://hdl.handle.net/10871/33809Background Cognitive impairment, a defining feature of dementia, plays an important role in the compromised functional independence that characterises the condition. Cognitive training (CT) is an approach that uses guided practice on structured tasks with the direct aim of improving or maintaining cognitive abilities. Objectives To assess effects of CT on cognitive and non-cognitive outcomes for people with mild to moderate dementia and their caregivers. To compare effects of CT with those of other non-pharmacological interventions, including cognitive stimulation or rehabilitation, for people with mild to moderate dementia and their caregivers. To identify and explore factors related to intervention and trial design that may be associated with the efficacy of CT for people with mild to moderate dementia and their caregivers. Search methods We searched ALOIS, the Cochrane Dementia and Cognitive ImprovementGroup Specialised Register, on 5 July 2018. ALOIS contains records of clinical trials identified through monthly searches of several major healthcare databases and numerous trial registries and grey literature sources. In addition to this, we searched MEDLINE, Embase, PsycINFO, CINAHL, LILACS, Web of Science Core Collection, ClinicalTrials.gov, and the World Health Organization's trials portal, ICTRP, to ensure that searches were comprehensive and up-to-date. Selection criteria We included randomised controlled trials (RCTs) that described interventions for peoplewithmild tomoderate dementia and compared CT versus a control or alternative intervention. Data collection and analysis We extracted relevant data from published manuscripts and through contact with trial authors if required.We assessed risk of bias using the Cochrane 'Risk of bias' tool.We divided comparison conditions into active or passive control conditions and alternative treatments. We used a large number of measures and data to evaluate 19 outcomes at end of treatment, as well as 16 outcomes at follow-up in the medium term; we pooled this information in meta-analyses. We calculated pooled estimates of treatment effect using a random-effects model, and we estimated statistical heterogeneity using a standard Chi statistic. We graded the evidence using GradePro. Main results The 33 included trials were published between 1988 and 2018 and were conducted in 12 countries; most were unregistered, parallelgroup, single-site RCTs, with samples ranging from 12 to 653 participants. Interventions were between two and 104 weeks long. We classified most experimental interventions as 'straight CT', but we classified some as 'augmented CT', and about two-thirds as multi-domain interventions. Researchers investigated 18 passive and 13 active control conditions, along with 15 alternative treatment conditions, including occupational therapy, mindfulness, reminiscence therapy, and others. The methodological quality of studies varied, but we rated nearly all studies as having high or unclear risk of selection bias due to lack of allocation concealment, and high or unclear risk of performance bias due to lack of blinding of participants and personnel. We used data from 32 studies in the meta-analysis of at least one outcome. Relative to a control condition, we found moderate-quality evidence showing a small to moderate effect of CT on our first primary outcome, composite measure of global cognition at end of treatment (standardised mean difference (SMD) 0.42, 95% confidence interval (CI) 0.23 to 0.62), and high-quality evidence showing a moderate effect on the secondary outcome of verbal semantic fluency (SMD 0.52, 95% CI 0.23 to 0.81) at end of treatment, with these gains retained in the medium term (3 to 12 months post treatment). In relation to many other outcomes, including our second primary outcome of clinical disease severity in the medium term, the quality of evidence was very low, so we were unable to determine whether CT was associated with any meaningful gains. When compared with an alternative treatment, we found that CT may have little to no effect on our first primary outcome of global cognition at end of treatment (SMD 0.21, 95% CI-0.23 to 0.64), but the quality of evidence was low. No evidence was available to assess our second primary outcome of clinical disease severity in the medium term.We found moderate-quality evidence showing that CT was associated with improved mood of the caregiver at end of treatment, but this was based on a single trial. The quality of evidence in relation to many other outcomes at end of treatment and in the medium term was too low for us to determine whether CT was associated with any gains, but we are moderately confident that CT did not lead to any gains in mood, behavioural and psychological symptoms, or capacity to perform activities of daily living. Authors' conclusions Relative to a control intervention, but not to a variety of alternative treatments, CT is probably associated with small to moderate positive effects on global cognition and verbal semantic fluency at end of treatment, and these benefits appear to be maintained in the medium term. Our certainty in relation to many of these findings is low or very low. Future studies should take stronger measures to mitigate well-established risks of bias, and should provide long-term follow-up to improve our understanding of the extent to which observed gains are retained. Future trials should also focus on direct comparison of CT versus alternative treatments rather than passive or active control conditions.National Institute for Health Research (NIHR)National Health and Medical Research Council of Australi

Future outlook of people living alone with early-stage dementia and their non-resident relatives and friends who support them

Little is known about the experiences of people living alone with dementia in the community and their non-resident relatives and friends who support them. In this paper, we explore their respective attitudes and approaches to the future, particularly regarding the future care and living arrangements of those living with dementia. The study is based on a qualitative secondary analysis of interviews with 24 people living alone with early-stage dementia in North Wales, United Kingdom, and one of their relatives or friends who supported them. All but four of the dyads were interviewed twice over 12 months (a total of 88 interviews). In the analysis, it was observed that several people with dementia expressed the desire to continue living at home for ‘as long as possible’. A framework approach was used to investigate this theme in more depth, drawing on concepts from the existing studies of people living with dementia and across disciplines. Similarities and differences in the future outlook and temporal orientation of the participants were identified. The results support previousresearchsuggestingthat the future outlookofpeoplelivingwithearly-stagedementia can be interpreted in part as a response to their situation and a way of coping with the threats that it is perceived to present, and not just an impaired view of time. Priorities for future research are highlighted in the discussion

U.S. IOOS coastal and ocean modeling testbed: Evaluation of tide, wave, and hurricane surge response sensitivities to mesh resolution and friction in the Gulf of Mexico: IOOS TESTBED-RESOLUTION AND FRICTION

This paper investigates model response sensitivities to mesh resolution, topographical details, bottom friction formulations, the interaction of wind waves and circulation, and nonlinear advection on tidal and hurricane surge and wave processes at the basin, shelf, wetland, and coastal channel scales within the Gulf of Mexico. Tides in the Gulf of Mexico are modestly energetic processes, whereas hurricane surge and waves are highly energetic. The unstructured-mesh, coupled wind-wave and circulation modeling system, SWAN+ ADCIRC, is implemented to generate modeled tidal harmonic constituents and hurricane waves and surge for a Hurricane Ike (2008) hindcast. In the open ocean, mesh resolution requirements are less stringent in achieving accurate tidal signals or matching hurricane surge and wave responses; however, coarser resolution or the absence of intertidal zones decreases accuracy along protected nearshore and inland coastal areas due to improper conveyance and/or lateral attenuation. Bottom friction formulations are shown to have little impact on tidal signal accuracy, but hurricane surge is much more sensitive, especially in shelf waters, where development of a strong shore-parallel current is essential to the development of Ike's geostrophic setup. The spatial and temporal contributions of wave radiation stress gradients and nonlinear advection were charted for Ike. Nonlinear advection improves model performance by capturing an additional 10―20 cm of geostrophic setup and increasing resonant cross-shelf waves by 30―40 cm. Wave radiation stress gradients improve performance at coastal stations by adding an extra 20―40 cm to water levels

Are profiles of social, cultural, and economic capital related to living well with dementia? Longitudinal findings from the IDEAL cohort

Copyright © 2022 Rationale: Research exploring social, cultural, and economic capital among people with dementia is scarce. Objective: We describe levels of social, cultural, and economic capital in people with dementia at baseline and levels of social and cultural capital 12 and 24 months later. We identify groups of people with dementia having different combinations of capital and explore whether the identified groups differ in personal characteristics at baseline and in quality of life (QoL), satisfaction with life (SwL), and well-being over time. Method: Baseline, 12-months, and 24-months data from 1537 people with dementia (age, mean = 76.4 years; SD = 8.5; Alzheimer's Disease = 55.4%) enrolled in the IDEAL cohort were analyzed. Social (interactions with friends, civic participation, social participation, neighborhood trust, social network), cultural (education, cultural participation) and economic (annual income) capital, QoL, SwL, well-being, and personal characteristics were assessed. Results: Compared to people their age, people with dementia reported slightly lower frequency of interactions with friends, social networks and social support, civic and cultural participation, education, and annual income. However, social engagement, cultural participation, and annual income are low among British older adults. Latent profile analysis identified four groups that, based on their levels of social, cultural, and economic capital were named socially and economically privileged (18.0% of participants); financially secure (21.0% of participants); low capital (36.9% of participants); and very low capital (24.1% of participants). Latent growth curve models showed that over time QoL, SwL, and well-being remained largely stable for all groups. Compared to the low capital group, the socially and economically privileged and financially secure groups had higher QoL and well-being whereas the group with very low capital had poorer QoL, SwL, and well-being. Conclusions: New policies and efforts from the government, philanthropic foundations, the voluntary and primary care sectors are needed to address social, cultural, and economic disadvantage among people with dementia.Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) through grant ES/L001853/2. Alzheimer's Society, grant number 348, AS-PR2-16-001

Impact of Psychotic Symptoms and Concurrent Neuropsychiatric Symptoms on the Quality of Life of People With Dementia Living in Nursing Homes

This is the final version. Available on open access from Elsevier via the DOI in this recordOBJECTIVES: The aim of the present study was to determine whether psychotic symptoms in people with dementia (PwD) living in nursing homes were associated with reduced quality of life and to understand the additional impact of other concurrent neuropsychiatric symptoms on QoL. DESIGN: Cross-sectional cohort study (using data from WHELD cohort). SETTINGS AND PARTICIPANTS: 971 PwD living in nursing homes participating in the WHELD study. METHODS: The Neuropsychiatric Inventory-Nursing Home (NPI-NH) version was completed by informant interview. We compared mean differences in proxy-rated QoL scores (DEMQOL-Proxy) for PwD experiencing or not experiencing delusions and for PwD experiencing or not experiencing hallucinations. Backward multiple regression was used to determine the added contributions of agitation (Cohen-Mansfield Agitation Inventory), anxiety (NPI-NH-Anxiety), depression (Cornell Scale for Depression in Dementia), dementia severity (Clinical Dementia Rating-sum of boxes score), pain (Abbey Pain Scale), and antipsychotic prescription. Mediation analysis was conducted for agitation, anxiety, and depression. RESULTS: Presence of both delusions (P < .001, B = -8.39) and hallucinations (P < .001, B = -7.78) was associated with poorer QoL. Both associations remained significant after controlling for other factors. Agitation, anxiety, and depression partially mediated the relationship between each psychotic symptom and QoL. CONCLUSIONS AND IMPLICATIONS: Delusions and hallucinations in PwD are associated with poorer QoL among PwD living in nursing homes. The effects remain significant after adjusting for confounding variables. Direct effects of each symptom maintained significance despite significant mediation by concurrent neuropsychiatric symptoms.Bateman Family Charitable TrustUniversity of ExeterNational Institute for Health Research (NIHR

Executive control in older Welsh monolinguals and bilinguals

Evidence for a bilingual advantage in executive control has led to the suggestion that being bilingual might protect against late-life cognitive decline. We assessed the performance of socially homogeneous groups of older (≥ 60 years) bilingual Welsh/English (n = 50) and monolingual English (n = 49) speakers on a range of executive control tasks yielding 17 indices for comparison. Effect sizes (> .2) favoured monolinguals on 10 indices, with negligible differences observed on the remaining 7 indices. Univariate analyses indicated that monolinguals performed significantly better on two of 17 indices. Multivariate analysis indicated no significant overall differences between the two groups in performance on executive tasks. Older Welsh bilinguals do not show a bilingual advantage in executive control, and where differences are observed, these tend to favour monolinguals. A possible explanation may lie in the nature of the sociolinguistic context and its influence on cognitive processing in the bilingual group

Prevalence and determinants of loneliness in people living with dementia: findings from the IDEAL programme

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordThe IDEAL dataset used in this study was deposited with the UK Data Archive in March 2020. Details on when and how the data can be accessed will be made available on the project website www.idealproject.org.uk TObjective To establish the prevalence and determinants of loneliness among people living with dementia. . Methods Using data from the baseline wave of the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study, we examined the prevalence and predictors of loneliness in 1547 people with mild‐to‐moderate dementia. Loneliness was assessed using the six‐item De Jong Gierveld loneliness scale. Results 30.1% of people with dementia reported feeling moderately lonely and 5.2% severely lonely. Depressive symptoms and increased risk of social isolation were associated with both moderate and severe loneliness. Those living alone were more likely to experience severe loneliness as were those reporting poorer quality of life. Marital status was not associated with loneliness nor were dementia diagnosis or cognitive function. Conclusions This is one of the few large‐scale studies to explore the prevalence of and determinants of loneliness among people living with dementia. Social isolation, depression and living alone were associated with experiencing loneliness. Longitudinal studies are needed to determine the directionality of these associations.Economic and Social Research Council (ESRC

Ethical Surveillance: Applying Deep Learning and Contextual Awareness for the Benefit of Persons Living with Dementia

A significant proportion of the population has become used to sharing private information on the internet with their friends. This information can leak throughout their social network and the extent that personal information propagates can depend on the privacy policy of large corporations. In an era of artificial intelligence, data mining, and cloud computing, is it necessary to share personal information with unidentified people? Our research shows that deep learning is possible using relatively low capacity computing. When applied, this demonstrates promising results in spatio-temporal positioning of subjects, in prediction of movement, and assessment of contextual risk. A private surveillance system is particularly suitable in the care of those who may be considered vulnerable