A detailed exploration of changes in everyday task performance in people with dementia

For most people, everyday tasks, such as tea making, are familiar, routine tasks that are normally performed without effort. A diagnostic feature of dementia, however, is an insidious decline in the ability to perform everyday tasks. Through a series of six studies, I examined how everyday task performance changes in people with dementia and I piloted two behavioural strategies that might enhance memory for everyday tasks in people with dementia. Study 1 developed a detailed error and error-monitoring taxonomy to explore the minutia of everyday task performance in healthy ageing. The study demonstrated that older adults without dementia rarely make errors in everyday tasks, even when conditions are manipulated to reduce cognitive resources. Study 2 documented errors and error-monitoring of everyday task performance in individuals with a developing dementia, using archive data to chart performance change over 5 years. While errors increased with dementia progression, there was no reactive increase in error-monitoring, suggesting a lack of awareness characterises the breakdown of task performance. Study 3a explored the impact of verbally instructing another person how to perform an everyday task on recall of an everyday task. People with dementia were able to do this surprisingly well, appearing to use both visual and motor cues to support recall. Study 3b piloted the impact of verbal self-explanation on everyday task performance, in four people with dementia. Self-explanation did not benefit recall and implementation of a familiar task. Study 4a compared observation with verbal instruction on acquisition of a novel routine. Results showed that people with mild-moderate dementia learned a new routine better under observation compared to verbal instruction. Study 4b tested observational learning of an everyday task over five weeks in three people with dementia. The initial benefit over verbal instruction was sustained, but did not increase over time. These studies constitute a detailed and meticulous exploration of everyday task performance in people with dementia and provide pilot evidence of a potential strategy that could support memory of everyday tasks in people with dementia

Dementia awareness, beliefs and barriers among family caregivers in Pakistan

OBJECTIVES: Dementia research and services in Pakistan are limited. The following was explored in experiences of family caregivers of people with dementia in Pakistan: a) to determine whether culture and religion play a role in caregiving; b) to draw insights on how family caregivers cope, what barriers they face, and what help they would be willing to accept; and c) to determine how these findings could be used to raise awareness and influence public policies in improving the lives of families living with dementia. METHODS: The experiences of family caregivers of people with dementia in Pakistan were explored via semi-structured interviews (10 in Lahore; 10 in Karachi). This was part of a larger qualitative study conducted about dementia in Pakistan. Caregivers interviewed were aged 35-80 (14 female). Most caregivers in the study were educated and affluent. Interviews were conducted in Urdu, translated into English and thematically analysed. RESULTS: Five themes emerged: Knowledge & Awareness; Stigma; Importance of Religion and Duty to Care; Use of Day Care Centres and Home-help; and Barriers. A lack of dementia awareness exists in Pakistan. The religious duty to care for family influenced caregiving decisions. Day care centres and home-help were accessed and viewed positively. The caregivers also wanted extracurricular activities for people with dementia, support groups for caregivers, and better training for healthcare staff. Novel findings included that caregivers felt that dementia should not be stigmatized, and awareness should be raised in Pakistan via TV, radio and social media, but not inside mosques. DISCUSSION: Additional research is necessary to determine if positive views of day care centres and home-help exist more widely. Attitudes and experiences regarding stigma may be different for caregivers of people with more advanced dementia. We recommend raising dementia awareness, allocating more funds to dementia services, and an emphasis on home-based care

Social networks and loneliness in people with Alzheimer's dementia

Objectives Modifiable lifestyle risk factors are of great interest in the prevention and management of Alzheimer's disease (AD). Loneliness and social networks may influence onset of AD, but little is known about this relationship in people with AD. The current study aimed to explore the relationship between loneliness and social networks (social measures) and cognitive and psychopathology decline (AD outcomes) in people with AD. Methods Ninety‐three participants with mild‐moderate AD were recruited from memory clinics, in a cross‐sectional study. Social networks (measured by the Lubben Social Network Scale), feelings of loneliness (measured by De Jong Loneliness Scale), cognition (measured by the Standardized Mini Mental State Examination) and psychopathology (measured by the Neuropsychiatric Inventory) were assessed in an interview setting. Two multiple regressions with Bootstrap were conducted on cognition and psychopathology as outcome variables. Family and Friends subsets of social networks and loneliness were entered as predictors and age, gender and depression as covariates. Results The friendship subset of social networks was significantly related to cognition (independent of age, gender, depression, loneliness and family subset of social network): B = .284, p = .01. Neither loneliness nor social networks predicted psychopathology (ps > .05). Conclusions Maintaining or developing a close friendship network could be beneficial for cognition in people with AD. Alternatively, greater dementia severity may lead to fewer friends. More research on the direction of this relationship in people with AD is needed

Can verbal instruction enhance the recall of an everyday task and promote error-monitoring in people with dementia of the Alzheimer-type?

People with dementia of the Alzheimer-type (DAT) have difficulties with performing everyday tasks and error awareness is poor. Here we investigated whether recall of actions and error monitoring in everyday task performance improved when they instructed another person on how to make tea. In this situation, both visual and motor cues are present, and attention sustained by the requirement to keep instructing. The data were drawn from a longitudinal study recording performance in four participants with DAT, filmed regularly for five years in their own homes, completing three tea-making conditions: performed-recall (they made tea themselves); instructed-recall (they instructed the experimenter on how to make tea); and verbal-recall (they described how to make tea). Accomplishment scores (percentage of task they correctly recalled), errors and error-monitoring were coded. Task accomplishment was comparable in the performed-recall and instructed-recall conditions, but both were significantly better than task accomplishment in the verbal-recall condition. Third person instruction did not improve error-monitoring. This study has implications for everyday task rehabilitation for people with DAT

Dragon movement ecology in Pakistan

We studied the movements and habitat use of the oriental garden lizard (Calotes versicolor) in agricultural landscapes of Pakistan

Error-monitoring in an everyday task in people with Alzheimer-type dementia: observations over five years of performance decline

Research suggests that, although everyday action errors increase significantly with dementia progression, accomplishment of the task remains high, even in severe dementia. We used archive observational data charting progressive decline in everyday task performance to explore error-monitoring over a 5-year period in four people with dementia. None of the participants showed effective error-monitoring during their execution of their established tea-making routine: Over 5 years and into more severe stages of dementia, errors increased, but there was no reactive increase from our participants in error-monitoring. Training to error-monitor routine tasks may be an appropriate target for further study

Experiences of people living with dementia in Pakistan

Stigma around dementia acts as a barrier to timely diagnosis, treatment, and support. The public understanding of dementia has been improving in the UK due to initiatives like Dementia Friends and other national policies. Dementia is less well-recognised in many developing countries, even though the largest future projected increase in dementia is expected to occur in these contexts. In Pakistan there is limited awareness about dementia, and it is often misunderstood to be part of the normal ageing process, caused by lifetime stress, or reflects neglect on the part of family members. Although specialist health services for dementia do exist in Pakistan, they are few in number. This presentation reports on a part of a larger project conducted in Pakistan about understandings of dementia among people who have a diagnosis of mild dementia, their family carers, the general population, and key stakeholders. In this presentation, qualitative data from 20 people with dementia, supported in the interviews by their family carers, will be discussed. It will present their understanding of the condition, the experience of help seeking, and the reactions of family and wider community members. The impact of dementia symptoms on religious obligations will be discussed, drawing out features of dementia that may cause particular distress to Muslims. Recommendations for development of awareness campaigns and policies in Pakistan will be made

Attitudes and knowledge of dementia in Pakistan: perceptions of the general public

Over the coming decades, the prevalence of dementia is expected to rise due to an aging population, and this public health challenge will be particularly challenging in lower and middle-income countries. Pakistan is a typical exemplar which to date has had very little research and policy making to address the challenge of dementia.This presentation reports on a part of a larger project funded by Age International, conducted in Pakistan about understandings of dementia among people who have a mild diagnosis of dementia, their family carers, the general population, and key stakeholders of the society.Utilising specially designed vignettes of dementia patients, this presentation will analyse public attitudes and knowledge of dementia. A series of Focus Group Discussions were completed during 2017 with the public in two metropolitan centres in Pakistan (Lahore and Karachi) (n=40). An induction led thematic analysis was completed. It was identified that many participants had little awareness and knowledge about dementia, which led to incorrect and often harmful perceptions of cause and prognosis of dementia. The responsibility of care was often seen to rest with the family, which can in part be attributed to religious teachings and societal norms, but also lack of formal services. Importantly, participants were able to identify that greater awareness was needed, though this should be accompanied with improved healthcare facilities at the primary care level. This presentation will further highlight the themes identified from the research undertaken in the project and discuss the potential implications for future dementia awareness strategy

Squamate diversity in different croplands of district Chakwal, Punjab, Pakistan

We studied squamate diversity in 5 different croplands (wheat, sorghum, millet, maize and groundnut) of district Chakwal, North Punjab, Pakistan, in February and September, 2013, using area-constrained searches for squamates and line intercept method for vegetation. We recorded 11 squamate species (6 lizards; 5 snakes). Based on diversity index value (H) the highest squamate diversity was recorded from maize (1.91), followed by wheat (1.54), groundnut (1.51), sorghum (1.34) and millet (1.21). We recorded Calotes versicolor versicolor, Ophisops jerdonii and Eutropis dissimilis as most frequently sighted species in all croplands. The multivariate generalized model revealed that sightings of species differed significantly (F(5,40) = 2.89, P < 0.05; Wilk’s Λ = 0.30, Partial η2 = 0.94) among cropland types and their boundary vegetation. The cluster analysis of boundary vegetation produced two main clusters: (1) groundnut and wheat, and (2) sorghum, millet and maize. We concluded that herbs (Parthenium hysterophorus Chenopodium album), shrubs (Calotropis procera, Ziziphus jujube, Gymnosporia royleana), and grasses (Cynodon dactylon, Setaria pumila) along the cropland boundary provided abode for lacertids (O. jerdonii) and skinks (E. dissimilis), while tress (Acacia nilotica, Prosopis juliflora, Ziziphus mauritiana) for agamids (Calotes versicolor). We suggest the inclusion of maintaining cropland boundary vegetation particularly grasses and shrubs in agricultural practices to ensure the conservation of squamate and their habitat

Experiences of dementia caregivers in Pakistan

In Pakistan there is very little awareness of dementia and its symptoms, a lack of formal services and no government policy to support the growing problem. This leads to family caregivers of people with dementia (PwD) not recognising the symptoms, delaying seeking help and being burdened by the care. Furthermore, existing knowledge and attitudes of dementia are heavily influenced by religious and cultural norms. To gain a better understanding of the perceptions of dementia and recognise gaps in services, the present study explored the experiences of family caregivers of PwD. This was part of a larger project funded by Age International in London, conducted in Pakistan about the understandings of dementia among PwD, their family caregivers, the general population, and key stakeholders. Semi-structured interviews were carried out on20 caregivers of PwD in Lahore and Karachi. Thematic analysis was performed on interview transcripts interpreted from Urdu to English. The themes that emerged were in relation to the caregivers’ experiences, dementia knowledge,impact of dementia on their lives, coping skills and support needed. Barriers to seeking help included a lack of awareness about dementia and its symptoms – many attributing the symptoms to stress. Family play a significant role in the care of PwD and the belief that this is the families’ duty is evident. Caregivers highlighted a need for more day centres to keep PwD active and to providecaregivers with some respite. Campaigns to raise awareness of dementia and targeted dementia policies in Pakistan are urgently needed