Efficacy of cognitive-behavioural therapy interventions on reducing burden for caregivers of older adults with a neurocognitive disorder : A systematic review and metaanalysis

Background: By 2025, 34 million people worldwide will be living with Alzheimer's disease or another form of dementia (i.e., neurocognitive disorders). Symptoms of cognitive disorders include memory deficits and executive deficits; these and other symptoms have functional repercussions on daily activities such as doing chores, taking medication and preparing meals. People with neurocognitive disorders often rely on a caregiver to alleviate the impact of their symptoms, but this help has consequences for the caregiver. Indeed, caregivers report subjective burden, depressive symptoms, stress, anxiety and a lower quality of life than noncaregivers. Multiple cognitive-behavioural therapy (CBT) trials have been conducted to reduce these symptoms for caregivers, and two meta-analyses have suggested that this method could be beneficial in reducing depressive symptoms. However, no meta-analysis has been conducted to evaluate the efficacy of this type of intervention on reducing subjective burden. Method: Eligibility criteria for the individual studies were determined using the PICOS strategy recommended by the PRISMA Statement. Articles were selected from PsycNet, MEDLINE, AgeLine and ProQuest Dissertation and Theses for the period from 2000 to 2017. Article selection, data extraction and bias analysis for individual studies was completed by two independent authors who used a consensus procedure when discrepancies occurred. The statistics Q, df, p value, I-square and Tau-squared were computed. Standardized effect sizes (Hedges’s g) were also computed for all studies. Result: A total of 20 articles were included in the systematic review. Statistics suggested there was no significant heterogeneity, and a fixed-effect model was used. Ten studies (N = 200 caregivers) evaluated the efficacy of CBT in reducing subjective burden, and the meta-analysis suggested a significant reduction in subjective burden following CBT. Additionally, 17 studies (N = 437 caregivers) evaluated the efficacy of CBT in reducing depressive symptoms, and the meta-analysis revealed a significant reduction for these caregivers following CBT. Conclusion: CBT for caregivers of individuals with a neurocognitive disorder was beneficial in reducing subjective burden and depressive symptoms but had no impact on stress, anxiety or quality of life

Childhood Socioeconomic Status Does Not Predict Late-Life Cognitive Decline in the 1936 Lothian Birth Cohort

This study examined childhood socioeconomic status (SES) as a predictor of later life cognitive decline. Data came from 519 participants in the Lothian Birth Cohort 1936 (LBC1936) study. SES measures at 11 years of age included parental educational attainment, father’s occupational status, household characteristics and a composite measure of global childhood SES (i.e., a total of low SES childhood indicators). Cognitive abilities were assessed by the Mini-Mental State Exam at ages 69.8, 72.8 and 76.7 years. Most indicators of low childhood SES (i.e., father manual worker, less than secondary school father education, household overcrowding, exterior located toilet, and global childhood SES) did not predict cognitive decline between the ages of 69.8 and 76.7. Participants with less educated mothers showed an increase in cognitive decline (β = −0.132, p = 0.048, and CI = −0.80, −0.00). The relationship between maternal educational attainment and cognitive decline became non-significant when controlling for adult SES (i.e., participant educational attainment and occupation). Adult SES did not mediate the latter relationship. This study provides new evidence that childhood SES alone is not strongly associated with cognitive decline. New knowledge is critical to improving population health by identifying life span stages in which interventions might be effective in preventing cognitive decline

Association between recreational screen time and sleep quality among adolescents during the third wave of the COVID-19 pandemic in Canada

The study objective was to verify whether recreational screen time was associated with sleep quality among adolescents during the third wave of the COVID-19 pandemic in Canada. Data collection took place in four high schools in the region of Chaudière-Appalaches (Quebec, Canada) from the end of April to mid-May 2021. Recreational screen time and sleep quality were measured using the French versions of validated questionnaires specifically designed for adolescents. A total of 258 adolescents (14–18 years; 66.3% girls) answered the online survey. Adolescent boys had a higher total mean recreational screen time (454.3 ± 197.5 vs. 300.5 ± 129.3 min/day, p < 0.0001) and a higher total mean sleep quality score (4.2 ± 0.9 vs. 3.9 ± 0.8, p = 0.0364) compared to girls. Recreational screen time (β = −0.0012, p = 0.0005) and frequency of concurrent screen use (sometimes: β = −0.3141, p = 0.0269; often: β = −0.4147, p = 0.0048; almost always or always: β = −0.6155, p = 0.0002) were negatively associated with sleep quality while being a boy (β = 0.4276, p = 0.0004) was positively associated with sleep quality and age (p = 0.6321) was not. This model explained 16% of the variance in adolescents’ sleep quality. Public health interventions during and after the COVID-19 pandemic should target recreational screen time, concurrent screen use and especially girls to possibly improve sleep quality and promote adolescents’ physical and mental health

Psychosocial correlates of recreational screen time among adolescents

The study objective was to identify the psychosocial correlates of recreational screen time among adolescents. Data collection took place in four high schools from the Chaudière-Appalaches region (Quebec, Canada) from late April to mid-May 2021. A total of 258 French-speaking adolescents (69.8% between 15 and 16 years and 66.3% girls) answered an online questionnaire based on the Reasoned Action Approach. Recreational screen time was measured using the French version of a validated questionnaire. Adolescents reported a mean of 5 h and 52 min/day of recreational screen time. Recreational screen time was associated with being a boy (β = 0.33; p < 0.0001) and intention to limit recreational screen time to a maximum of 2 h/day (β = −0.15; p = 0.0001); this model explained 30% of the variance in behavior. Intention to limit recreational screen time to a maximum of 2 h/day in the next month was associated with attitude (β = 0.49; p < 0.0001), self-identity (β = 0.33; p < 0.0001), being a boy (β = −0.21; p = 0.0109), perceived behavioral control (β = 0.18; p = 0.0016), and injunctive norm (β = 0.17; p < 0.0001); this model explained 70% of the variance in intention. This study identified avenues to design public health interventions aimed at lowering recreational screen time among this population

Loss of MeCP2 in adult 5-HT neurons induces 5-HT1A autoreceptors, with opposite sex-dependent anxiety and depression phenotypes

The 5-HT1A autoreceptor mediates feedback inhibition of serotonin (5-HT) neurons, and is implicated in major depression. The human 5-HT1A gene (HTR1A) rs6295 risk allele prevents Deaf1 binding to HTR1A, resulting in increased 5-HT1A autoreceptor transcription. Since chronic stress alters HTR1A methylation and expression, we addressed whether recruitment of methyl-binding protein MeCP2 may alter Deaf1 regulation at the HTR1A locus. We show that MeCP2 enhances Deaf1 binding to its HTR1A site and co-immunoprecipitates with Deaf1 in cells and brain tissue. Chromatin immunoprecipitation assays showed Deaf1-dependent recruitment of MeCP2 to the mouse HTR1A promoter, and MeCP2 modulated human and mouse HTR1A gene transcription in a Deaf1-dependent fashion, enhancing Deaf1-induced repression at the Deaf1 site. To address the role of MeCP2 in HTR1A regulation in vivo, mice with conditional knockout of MeCP2 in adult 5-HT neurons (MeCP2 cKO) were generated. These mice exhibited increased 5-HT1A autoreceptor levels and function, consistent with MeCP2 enhancement of Deaf1 repression in 5-HT neurons. Interestingly, female MeCP2-cKO mice displayed reduced anxiety, while males showed increased anxiety and reduced depression-like behaviors. These data uncover a novel role for MeCP2 in 5-HT neurons to repress HTR1A expression and drive adult anxiety- and depression-like behaviors in a sex-specific manner

Global prevalence of antidepressant utilization in the community: A protocol for a systematic review

Introduction Antidepressant drugs are the most frequently prescribed medication for mental disorders. They are also used off-label and for non-psychiatric indications. Prescriptions of antidepressants have increased in the last decades, but no systematic review exists on the extent of their use in the community. Methods and analysis We will conduct a systematic review to estimate the prevalence of antidepressant use in the community. We will search for studies published from 1 January 2010 in the Embase and MEDLINE databases using a combination of controlled vocabulary and keywords adjusted for each database without any language restriction. The main inclusion criterion is the presence of prevalence data of antidepressant utilization. Thus, we will include all studies with a descriptive observational design reporting the prevalence of antidepressant use in the community. Study selection (by title/abstract and full-text screening) and data extraction for included studies will be independently conducted by pairs of reviewers. We will then synthesize the data on the prevalence of antidepressant use in individuals living in the community. If possible, we will perform a meta-analysis to generate prevalence-pooled estimates. If the data allows it, we will conduct subgroup analyses by antidepressant class, age, sex, country and other sociodemographic categories. We will evaluate the risk of bias for each included study through a quality assessment using the Joanna Briggs Institute Critical Appraisal tool: Checklist for Studies Reporting Prevalence Data. DistillerSR software will be used for the management of this review. Ethics and dissemination Ethical approval is not required for this review as it will not directly involve human or animal subjects. The findings of our systematic review will be disseminated through publications in peer-reviewed journals, the Qualaxia Network (https://qualaxia.org), presentations at international conferences on mental health and pharmacoepidemiology, as well as general public events. PROSPERO registration number CRD42021247423

Links Between Metabolic and Structural Changes in the Brain of Cognitively Normal Older Adults: A 4-Year Longitudinal Follow-Up

We aimed to longitudinally assess the relationship between changing brain energy metabolism (glucose and acetoacetate) and cognition during healthy aging. Participants aged 71 ± 5 year underwent cognitive evaluation and quantitative positron emission tomography (PET) and magnetic resonance imaging (MRI) scans at baseline (N = 25) and two (N = 25) and four (N = 16) years later. During the follow-up, the rate constant for brain extraction of glucose (Kglc) declined by 6%–12% mainly in the temporo-parietal lobes and cingulate gyri (p ≤ 0.05), whereas brain acetoacetate extraction (Kacac) and utilization remained unchanged in all brain regions (p ≥ 0.06). Over the 4 years, cognitive results remained within the normal age range but an age-related decline was observed in processing speed. Kglc in the caudate was directly related to performance on several cognitive tests (r = +0.41 to +0.43, allp ≤ 0.04). Peripheral insulin resistance assessed by the homeostasis model assessment of insulin resistance (HOMA-IR) was significantly inversely related to Kglc in the thalamus (r = −0.44, p = 0.04) and in the caudate (r = −0.43, p = 0.05), and also inversely related to executive function, attention and processing speed (r = −0.45 to −0.53, all p ≤ 0.03). We confirm in a longitudinal setting that the age-related decline in Kglc is directly associated with declining performance on some tests of cognition but does not significantly affect Kacac

Contributions des cohortes de naissance et de la réserve cognitive sur les trajectoires de vieillissement cognitif

Titre de l'écran-titre (visionné le 5 juin 2023)Le vieillissement cognitif est un processus hautement hétérogène et d'importantes disparités interindividuelles existent au sein de ses trajectoires de déclin. Maintes études ont tenté d'identifier les facteurs pouvant expliquer ces disparités, mais sans y parvenir entièrement. Notamment, des performances cognitives supérieures ainsi que des taux plus lents de déclin cognitif ont été signalés chez les individus âgés présentant une meilleure réserve cognitive, qui réfère à l'adaptabilité des processus cognitifs face aux changements cérébraux permettant aux individus de demeurer cognitivement sains plus longtemps. La réserve cognitive est généralement estimée par des facteurs associés au mode de vie des individus, nommément l'éducation, la complexité de l'occupation professionnelle et le quotient intellectuel verbal. Bien que la réserve cognitive ait été largement étudiée, les résultats quant à son effet sur les trajectoires de déclin cognitif demeurent mitigés. Par ailleurs, des études ont souligné des différences tant dans les performances cognitives que les taux de déclin cognitif entre les cohortes de naissance favorisant celles nées plus récemment. Ainsi, parce que les individus âgés se dont développés dans des contextes sociétaux ne leur ayant pas offert les mêmes opportunités, l'environnement socioculturel, estimé via les cohortes de naissance, pourrait constituer, d'une part, un facteur majeur pouvant potentiellement influencer les facteurs d'estimation de réserve cognitive, et, d'autre part, expliquer les disparités au sein des trajectoires de vieillissement cognitif. Ainsi, les objectifs généraux de la présente thèse étaient d'investiguer les contributions de la réserve cognitive et des cohortes de naissance dans la prédiction des performances cognitives (Chapitre 1) et des trajectoires de déclin cognitif (Chapitre 2) dans quatre domaines (c'est-à-dire, mémoire épisodique verbale, langage et mémoire sémantique, capacités attentionnelles et fonctions exécutives) auprès d'individus âgés de plus de 55 ans. En utilisant les données de l'Alzheimer's Disease Neuroimaging Initiative, quatre cohortes de naissance ont été définies (≤ 1928, 1929-1938, 1939-1945, et ≥ 1946) selon les événements historiques majeurs de la première moitié du 20ᵉ siècle. La réserve cognitive a été estimée à l'aide d'un score combinant l'éducation, la complexité de l'occupation professionnelle et le quotient intellectuel verbal. L'effet de l'âge, du sexe, de l'intégrité de la structure cérébrale (c.-à-d., volume cérébral total, volume total des hyperintensités de la matière blanche) et du fardeau lié aux facteurs de risque vasculaires ont également été examiné. Plus précisément, le premier chapitre de la thèse a montré que les cohortes de naissance plus récentes, une réserve cognitive plus élevée et une structure cérébrale plus saine prédisaient de meilleures performances en matière de mémoire épisodique verbale, de langage et mémoire sémantique, et de capacités attentionnelles. Quant aux fonctions exécutives, seuls une réserve cognitive plus élevée et un volume cérébral total plus important prédisaient une meilleure performance. À score égal de réserve cognitive, les femmes ont obtenu de meilleures performances mnésiques et langagières que les hommes, et ce, dans toutes les cohortes de naissance. Enfin, une réserve cognitive plus élevée prédisait de meilleures performances en mémoire épisodique verbale, uniquement lorsque le volume cérébral total était plus faible. Le deuxième chapitre de la thèse a montré que la réserve cognitive était uniquement associée à un déclin plus lent de la mémoire épisodique verbale, alors que les cohortes de naissance plus récentes prédisaient un déclin cognitif annuel plus lent dans tous les domaines, à l'exception des fonctions exécutives. Cet effet augmentait à mesure que la cohorte de naissance devenait plus récente. Par ailleurs, le déclin cognitif s'est révélé similaire entre les hommes et les femmes, et ce, dans toutes les cohortes de naissance. En somme, les résultats empiriques découlant de cette thèse appuient la pertinence de considérer les cohortes de naissance lors de l'étude des disparités interindividuelles au cours du vieillissement cognitif, en plus d'avoir des retombées quant aux possibles interventions de santé publique, renforçant la pertinence des programmes sociétaux qui favorisent l'accessibilité à une éducation de plus haut niveau et l'offre d'opportunités professionnelles à l'âge adulte. Par ailleurs, l'observation d'effets de cohortes de naissance notables soulève une mise en garde pour tous chercheurs et cliniciens utilisant des mesures cognitives auprès d'une clientèle âgée. La normalisation de tests neuropsychologiques, l'établissement de valeurs seuils, l'interprétation des résultats des tests et la prise de décision clinique sur la base d'évaluations cognitives doivent se faire dans le contexte des effets de cohortes de naissance.Cognitive aging is a highly heterogeneous process, and large inter-individual disparities exist within its trajectories of decline. Many studies have attempted to identify factors that may explain these disparities but have not been entirely successful. Notably, higher cognitive performances and slower rates of cognitive decline have been reported in older individuals with greater cognitive reserve, which refers to the adaptability of cognitive processes to brain changes that allow individuals to remain cognitively healthy longer. Cognitive reserve is generally estimated by factors associated with an individual's lifestyle, namely education, complexity of occupation and verbal intellectual quotient. Although cognitive reserve has been extensively studied, results on its effect on trajectories of cognitive decline remain mixed. Furthermore, studies have highlighted differences in both cognitive performance and rates of cognitive decline between birth cohorts favoring those born more recently. Because older individuals have developed in societal contexts that have not provided them with the same opportunities, the sociocultural environment, as estimated with birth cohorts, could be a major factor that could potentially influence the factors estimating cognitive reserve, and could also explain the disparities within cognitive aging trajectories. Thus, the overall objectives of this thesis were to investigate the contributions of cognitive reserve and birth cohorts in predicting cognitive performance (Chapter 1) and trajectories of cognitive decline (Chapter 2) in four domains (i.e., verbal episodic memory, language and semantic memory, attention capacities, and executive functions) in individuals over the age of 55. Using data from the Alzheimer's Disease Neuroimaging Initiative, four birth cohorts were defined (≤ 1928, 1929-1938, 1939-1945, and ≥ 1946) according to major historical events of the first half of the 20ᵗʰ century. Cognitive reserve was estimated using a score combining education, occupational complexity, and verbal intellectual quotient. The effect of age, sex, brain structural integrity (i.e., total brain volume, total white matter hyperintensities volume), and vascular risk factor burden were also investigated. Specifically, the first chapter of the thesis showed that recent birth cohorts, higher cognitive reserve and healthier brain structure predicted better performance in verbal episodic memory, language and semantic memory, and attention capacities. Better performance in executive functions was predicted only by higher cognitive reserve and larger total brain volume. For the same cognitive reserve score, females performed better in memory and language than males in all birth cohorts. Finally, higher cognitive reserve predicted better performance in verbal episodic memory only when total brain volume was lower. The second chapter of the thesis showed that cognitive reserve was only associated with slower decline in verbal episodic memory, whereas more recent birth cohorts predicted slower annual cognitive decline in all domains except executive functions. This effect increased as the birth cohort became more recent. Moreover, cognitive decline was found to be similar between men and women across all birth cohorts. In sum, the empirical findings from this thesis support the relevance of considering birth cohorts when studying inter-individual disparities in cognitive aging, as well as having implications for potential public health interventions, reinforcing the relevance of societal programs that promote access to higher levels of education and occupational opportunities in adulthood. Also, the observation of notable birth cohort effects raises a cautionary note for all researchers and clinicians using cognitive measures with older patients. Standardization of neuropsychological tests, establishment of cut-off values, interpretation of test results, and clinical decision making based on cognitive assessments must be done in the context of birth cohort effects

Therapeutic factors in the first stage of men’s domestic violence groups

This article reports on the qualitative findings of a Québec study on therapeutic factors (TFs) in three ongoing men’s domestic violence groups. The study’s aim was to discover which TFs are important for male group members in their first stage of the group, and in particular, to explore how these men experienced and described universality. A content analysis was performed on interviews conducted with 72 group members following their third group session. We found that what was most important to the men was the knowledge they acquired about domestic violence, being able to share common concerns, and helping other members. The second part of the article reports on our qualitative analysis of universality, one of the most important TFs: how it was experienced by group members and how it became operational in the group. We believe that the methods of analysis developed in this study – examining symbols, characteristics, processes, and effects of TFs – can contribute to our understanding of the underlying elements of group work as an intervention method