Efficacy of SSRIs on cognition of Alzheimer's disease patients treated with cholinesterase inhibitors.

Background: This study examines the joint effect on cognition of selective serotonin re-uptake inhibitors (SSRIs) and cholinesterase inhibitors (AChEIs) in depressed patients affected by Alzheimer’s disease (AD) living at home. Methods: The study was conducted in two different outpatient neurological clinics. 338 patients with probable ADwere treated with ChEis (donepezil, rivastigmine and galantamine) as per the clinician’s judgment and were observed for nine months. At study entry, participants underwent a multidimensional assessment evaluating cognitive, functional and psychobehavioral domains. All patients were evaluated at baseline, after one (T1), three (T2) and nine months (T3). Patients were grouped in three different categories (patients not depressed and not treated with SSRIs, patients depressed and treated with SSRIs, and patients depressed but not treated with SSRIs). Results: At baseline 182 were diagnosed as not depressed and not treated with SSRIs, 66 as depressed and treated with SSRIs, and 90 as depressed but not treated with SSRIs. The mean change in MMSE score from baseline to nine months showed that depressed patients not treated worsened in comparison with those not depressed and not treated with SSRIs (mean change −0.8±2.3 vs 0.04±2.9; p = 0.02) and patients depressed and treated with SSRI (mean change −0.8±2.3 vs 0.1±2.5; p = 0.03). Conclusions: In AD patients treated with AChEIs, SSRIs may exert some degree of protection against the negative effects of depression on cognition

Nature of behaviours that challenge in residents living in aged care homes: implications for psychosocial interventions and service development

Background/Aims: Competing theories exist regarding the causes and nature of behaviours that challenge (BC). The present study attempted to provide better insight into these behaviours and determine whether there were any underlying relationships for people living in care homes with and without dementia. Methods: Cross sectional data for 2185 residents living in 63 UK care homes using the Challenging Behaviour Scale were collected. The incidence (i.e. presence/absence) of 25 commonly reported behaviours that challenge staff were determined using dichotomous scoring. Cluster analysis and Mokken scaling were used to examine underlying relationships. Mokken is a method of analysing data to determine whether there is a ‘latent’ structure within a data set. Results: The prevalence of reported BC was 87.5%. Cluster analysis revealed three main clusters: apathy, agitation with internal focus, agitation with active external focus. For seven of the 25 items a hierarchical model emerged, where behaviours at the bottom of the hierarchy tended to occur in the presence of those higher up. Behaviours at the bottom of the hierarchy (dangerous behaviour) were less frequently observed than the items at the top (lack of self-care, verbal aggression). Conclusion: Some common BC may occur in groups and themed clusters. This study has shown that a hierarchical structure of BC in residents may be present. The findings testify to the complexity in the aetiology and treatment of BC and hence the need for focussed high intensity bio-psychosocial interventions to be targeted towards those with high levels of ‘unmet need’. Implications for future research and practice are discussed

A systematic review of neuropsychiatric symptoms in mild cognitive impairment

Mild cognitive impairment (MCI) is a clinical concept proposed as an intermediate state between normal aging and dementia. This condition has multiple heterogeneous sources, including clinical presentation, etiology, and prognosis. Recently, the prevalence and associated features of neuropsychiatric symptoms (NPS) in MCI have been described. We systematically searched the PubMed database (last accessed on August 31, 2008) for articles on NPS in MCI. Included articles used strict selection criteria, and outcome variables were extracted in duplicate; of the 27 articles included, 14 (52%) used prospective cohorts. The global prevalence of NPS in MCI ranged from 35% to 85%. The most common behavioral symptoms were depression, anxiety, and irritability. Hospital-based samples reported a higher global prevalence of NPS than population-based studies; this discrepancy probably reflected differences in demographics, study setting, MCI diagnostic criteria, and behavioral instruments used. Prospective studies showed that NPS, particularly depression, may represent risk factors for MCI or predictors for the conversion of MCI to Alzheimer's disease (AD). NPS are very prevalent in subjects with MCI, displaying a similar pattern of symptoms compared to dementia and AD. Large cohort studies using standardized MCI criteria and behavioral instruments are required to evaluate the prognostic role of NPS in MCI.Mild cognitive impairment (MCI) is a clinical concept proposed as an intermediate state between normal aging and dementia. This condition has multiple heterogeneous sources, including clinical presentation, etiology, and prognosis. Recently, the prevalence and associated features of neuropsychiatric symptoms (NPS) in MCI have been described. We systematically searched the PubMed database (last accessed on August 31, 2008) for articles on NPS in MCI. Included articles used strict selection criteria, and outcome variables were extracted in duplicate; of the 27 articles included, 14 (52%) used prospective cohorts. The global prevalence of NPS in MCI ranged from 35% to 85%. The most common behavioral symptoms were depression, anxiety, and irritability. Hospital-based samples reported a higher global prevalence of NPS than population-based studies; this discrepancy probably reflected differences in demographics, study setting, MCI diagnostic criteria, and behavioral instruments used. Prospective studies showed that NPS, particularly depression, may represent risk factors for MCI or predictors for the conversion of MCI to Alzheimer’s disease (AD). NPS are very prevalent in subjects with MCI, displaying a similar pattern of symptoms compared to dementia and AD. Large cohort studies using standardized MCI criteria and behavioral instruments are required to evaluate the prognostic role of NPS in MC

Topological map of the body in post-stroke patients: lesional and hodological aspects

Objective: It has been repeatedly hypothesized that at least 3 distinct types of body representations do exist: body schema, a representation derived from multiple sensory and motor inputs; topological map of the body, a structural description of spatial relations among the body parts; and body semantics, a lexical-semantic representation. Although several studies have assessed neural correlates of the topological map of the body in healthy participants, a systematic investigation of neural underpinnings of the topological map of the body in brain-damaged patients is still lacking. Method: Here we investigated the neural substrates of topological map of the body in 23 brain-damaged patients, both from a topological and an hodological perspectives, using Voxel Lesion Symptom Mapping and atlas-based track-wise statistical analysis. Besides neuroimaging investigation, consisting of T1-weighted and FLAIR sequences, patients underwent the frontal body-evocation subtest (FBE) to assess the topological map of the body. Results: The present results reveal a large-scale brain network involved in the topological map of the body assessed with FBE, encompassing both regions of primary elaboration and multisensory associative areas, in the temporal, parietal, frontal, and insular cortices. Hodological analysis revealed significant association between processing of the body topological map and the disconnection of the frontomarginal tract. Conclusions: These findings suggest that the topological map of the body is built up basing on both external and internal information that comes from the body and are constantly updated and integrated. The theoretical and clinical relevance of these results is discussed

Morbidity Measures Predicting Mortality in Inpatients:A Systematic Review

OBJECTIVES: Morbidity is an important risk factor for mortality and a variety of morbidity measures have been developed to predict patients' health outcomes. The objective of this systematic review was to compare the capacity of morbidity measures in predicting mortality among inpatients admitted to internal medicine, geriatric, or all hospital wards. DESIGN: A systematic literature search was conducted from inception to March 6, 2019 using 4 databases: Medline, Embase, Cochrane, and CINAHL. Articles were included if morbidity measures were used to predict mortality (registration CRD42019126674). SETTING AND PARTICIPANTS: Inpatients with a mean or median age ≥65 years. MEASUREMENTS: Morbidity measures predicting mortality. RESULTS: Of the 12,800 articles retrieved from the databases, a total of 34 articles were included reporting on inpatients admitted to internal medicine, geriatric, or all hospital wards. The Charlson Comorbidity Index (CCI) was reported most frequently and a higher CCI score was associated with greater mortality risk, primarily at longer follow-up periods. Articles comparing morbidity measures revealed that the Geriatric Index of Comorbidity was better predicting mortality risk than the CCI, Cumulative Illness Rating Scale, Index of Coexistent Disease, and disease count. CONCLUSIONS AND IMPLICATIONS: Higher morbidity measure scores are better in predicting mortality at longer follow-up period. The Geriatric Index of Comorbidity was best in predicting mortality and should be used more often in clinical practice to assist clinical decision making

Funções Executivas e Sintomas de Ansiedade: estudo em idosos sob resposta social

Argumento: O defeito cognitivo, habitualmente, acompanha-se de défice executivo em pessoas de idade avançado. A ansiedade, indicam algumas investigações, é um problema frequente nos idosos. Níveis elevados de ansiedade relacionam-se com pior desempenho cognitivo. A relação entre ansiedade e défice executivo, teoricamente, é evidente, mas, empiricamente, a investigação tem sido inconclusiva. Não se sabe se aumenta ou diminui a ansiedade quando aumenta o défice nas funções executivas. Perceber essa relação é importante para apoiar/refutar a teoria e, assim, contribuir para a clarificação. Objectivo: Conduzimos este estudo transversal para averiguar qual a prevalência dos sintomas ansiosos e do défice executivo em idosos institucionalizados e se o défice executivo se relaciona com os sintomas ansiosos. Metodologia: Utilizando uma amostragem de conveniência, foram inquiridos 74 idosos, com idades compreendidas entre os 65 e os 95 anos. A amostra foi dividida em dois subgrupos: idosos com defeito cognitivo (n = 29) e idosos sem defeito cognitivo (n = 45). As funções executivas foram avaliadas com a Frontal Assessment Battery (FAB), os sintomas ansiosos por meio do Geriatric Anxiety Inventory e o defeito cognitivo através do Mini-Mental State Examination (MMSE). Resultados: A nossa amostra é maioritariamente muito idosa (77% acima dos 75 anos), do sexo feminino (73%), sem companheiro (78,4%) e analfabeta e com baixa escolaridade (83,8%). Os idosos inquiridos apresentam médias significativamente inferiores nas funções executivas e significativamente superiores nos sintomas ansiosos em relação aos valores portugueses de referência e médias.A prevalência do défice executivo foi muito alta (81,1%), assim como dos sintomas ansiosos (82,40%). Não observámos, no entanto, relação entre o défice executivo e os sintomas de ansiedade. Finalmente, verificámos que o grau de escolaridade contribuiu para explicar os resultados nas funções executivas. Conclusão: O défice executivo acompanha-se de sintomas ansiosos, mas não parece haver relação entre os dois problemas. Este estudo deve ser replicado com amostras de idosos não institucionalizados e com escolaridade acima dos quatro anos. / Argument: The elderly who have a cognitive defect usually have executive deficit. According to several studies, anxiety is a common problem in older age. High levels of anxiety are related with poorer cognitive performance. In theory, the relationship between anxiety and cognitive deficit is elucidative, but empirically investigations have been inconclusive. It is not known whether anxiety augments or decreases when executive functioning deficit increases. Understanding that relationship is important in order to support or disprove the theory. Objective: We conducted this cross-sectional study to investigate the prevalence of anxiety symptoms and executive deficits in institutionalized elderly to ascertain if executive deficits relate to anxiety symptoms. Methodology: Using a convenience sample, we inquired 74 elderly, aged from 65 to 95 years old. We divided the sample into two groups: elderly people with cognitive defect (n = 29) and elderly people without cognitive defect (n = 45). We assessed executive functions by using the Frontal Assessment Battery (FAB), the anxiety symptoms assessed by the Geriatric Anxiety Inventory and the cognitive defect using the Mini-Mental State Examination (MMSE). Results: Our sample is mostly very elderly (77% above 75 years old), female, (73%) without a partner (78,4%) and illiterate and with low education (83,8%). The elderly respondents have significantly lower averages in what concerns the executive functions and significantly higher averages in anxiety symptoms compared with Portuguese reference values and averages. The prevalence of executive deficits was very high (81,1%), as well as the anxiety symptoms (82,40%). However, we did not observed any relationship between executive deficits and symptoms of anxiety. Finally, we found that education helps to explain the results in executive functions. Conclusion: The executive deficit is accompanied by anxiety symptoms, but it seems there is no relationship between the two problems. This study should be replicated with samples of non-institutionalized elderly and with education over four years

Effect of therapeutic massage on pain in patients with dementia

Introduction The aim was to investigate whether therapeutic massage was effective in relieving pain in elderly residents with dementia. Methods A randomized controlled study was conducted in an aged care facility. Ten participants with dementia or advanced dementia were allocated to an intervention group or a control group. The intervention group received 10 min of massage (effleurage, kneading, and trigger point therapy) four times per week for 4 weeks. The Pain Assessment in Advanced Dementia scale was used as the outcome measure. Results No significant changes in mean outcome measure scores were found post intervention (Intervention mean = 5.0 ± 3.49; Control mean = 5.2 ± 3.49: t(8) = 0.09, p = 0.93). However, the Intervention Group had a greater magnitude of change (1.200 ± 1.78) when compared to the control group (0.800 ± 2.16). Conclusion Therapeutic massage may provide a useful adjunct to the current pain management plan of patients with dementia. </jats:sec

The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015"

Backround: Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium. Aim: This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients. Methods: Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age &gt; 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment). Results: Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia. Discussion: We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents. Conclusion: Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence

Cognitive and memory training in adults at risk of dementia: A Systematic Review

<p>Abstract</p> <p>Background</p> <p>Effective non-pharmacological cognitive interventions to prevent Alzheimer's dementia or slow its progression are an urgent international priority. The aim of this review was to evaluate cognitive training trials in individuals with mild cognitive impairment (MCI), and evaluate the efficacy of training in memory strategies or cognitive exercises to determine if cognitive training could benefit individuals at risk of developing dementia.</p> <p>Methods</p> <p>A systematic review of eligible trials was undertaken, followed by effect size analysis. Cognitive training was differentiated from other cognitive interventions not meeting generally accepted definitions, and included both cognitive exercises and memory strategies.</p> <p>Results</p> <p>Ten studies enrolling a total of 305 subjects met criteria for cognitive training in MCI. Only five of the studies were randomized controlled trials. Meta-analysis was not considered appropriate due to the heterogeneity of interventions. Moderate effects on memory outcomes were identified in seven trials. Cognitive exercises (relative effect sizes ranged from .10 to 1.21) may lead to greater benefits than memory strategies (.88 to -1.18) on memory.</p> <p>Conclusions</p> <p>Previous conclusions of a lack of efficacy for cognitive training in MCI may have been influenced by not clearly defining the intervention. Our systematic review found that cognitive exercises can produce moderate-to-large beneficial effects on memory-related outcomes. However, the number of high quality RCTs remains low, and so further trials must be a priority. Several suggestions for the better design of cognitive training trials are provided.</p