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Alcohol, dementia and cognitive decline in the elderly: a systematic review
- Authors:
- PETERS Ruth, et al
- Journal article citation:
- Age and Ageing, 37(5), September 2008, pp.505-512.
- Publisher:
- Oxford University Press
Evidence from the review and meta-analysis of results from 23 longitudinal studies of people aged 65 and older suggests that small amounts of alcohol may be protective against unspecified incident dementia (risk ratio 0.63) and Alzheimer’s disease (RR 0.57) but not vascular dementia (RR 0.82) or cognitive decline (RR 0.89). However, studies varied, with differing lengths of follow-up, measurement of alcohol intake, inclusion of true abstainers and assessment of potential confounders. The results should therefore be interpreted with caution and, given the ethical objections to randomised placebo-controlled trials in this area, it may never be possible to know for certainty the relationship between alcohol intake and dementia.
Prevalence of clinically significant depressive symptoms in an epidemiologic sample of community-dwelling elders with milder forms of cognitive impairment in Hong Kong SAR
- Authors:
- CHAN Sandra S. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(6), June 2008, pp.611-617.
- Publisher:
- Wiley
Depression and cognitive impairment in later-life have great bearings on public health. The two conditions often co-occur and have mutual implications on short-term risk and long-term prognosis. A two-phase epidemiologic survey on the prevalence of dementia in elders aged 60 and over was conducted in Hong Kong in 2005-06. In the first phase, 6,100 randomly selected community dwelling elders were assessed with a Cantonese version of Mini-Mental State Examination (C-MMSE) and Abbreviated Memory Inventory for Chinese (AMIC), of whom 2,073 were screened positive and invited for second phase cognitive and psychiatric assessment. 35.5% of screen-positive subjects participated in Phase 2 assessment conducted by psychiatrists for diagnosis of dementia. Severity of dementia was determined using Clinical Dementia Rating Scale (CDR). Cornell Scale for Depression in Dementia (CSDD) and a structured bedside cognitive battery were also administered to each subject. The results showed that 1.7% of subjects with CDR 0.5 and 5.9% of subjects with CDR 1 had clinically significant depressive symptoms. Score on CSDD correlated positively with duration of cognitive symptoms, scores on CIRS and CMMSE in linear regression model. In a logistic regression model, male gender, duration of cognitive symptoms, CIRS and CMMSE was associated with increased risk for clinically significant depressive symptoms. It was concluded that in the sample, milder forms of cognitive impairment were associated with increased risk for depression in the presence of other risk factors such as male gender, higher physical illness burden and longer duration of cognitive symptoms.
Mutual support groups: a response to the early and often forgotten stage of dementia
- Authors:
- PEACH Elizabeth, DUFF Gaynor
- Journal article citation:
- Practice: Social Work in Action, 6(2), 1992, pp.147-157.
- Publisher:
- Taylor and Francis
Looks at the establishment of a mutual support group for people who have been given a diagnosis of Alzheimer's Disease or one of the related dementias, who have insight into their memory loss and confusion and are able to express their feelings with regard to this. Reviews the experience of a support group in New Zealand, which concludes that a mutual support group for people with insight into the early stages of dementia is worthwhile and one response to their needs.
The use of everyday technology; a comparison of older persons with cognitive impairments’ self-reports and their proxies’ reports
- Authors:
- JAKOBSSON Elin, et al
- Journal article citation:
- British Journal of Occupational Therapy, 84(7), 2021, pp.446-455.
- Publisher:
- Sage
Introduction: Older persons with cognitive impairment have often been disregarded in providing information on their own perceptions. This study explored the number of relevant everyday technologies and the ability to use everyday technologies as perceived by persons with cognitive impairment in comparison with their proxies’ estimates using the Short Everyday Technology Use Questionnaire. Method: In this cross-sectional study, persons with cognitive impairment (n = 21) and their proxies (n = 21) were interviewed on separate occasions with the Short Everyday Technology Use Questionnaire, which measures the number of relevant everyday technologies and the ability to use everyday technologies. The data were analysed with t-tests, z-comparisons, and Fisher’s exact test. The level of significance was set at p < 0.05. Results: At the group level, no significant differences were found between persons with cognitive impairments’ perceptions and their proxies’ estimates regarding the number of relevant everyday technologies or the ability to use everyday technologies. On the individual level, significant differences were found in the ability measures within four out of the 21 dyads. Conclusion: The persons with cognitive impairment and their proxies verified each other’s responses, providing evidence that persons with cognitive impairment should be the primary source for information about their own everyday technology use. (Edited publisher abstract)
Effects of caregiver-provided individual cognitive interventions on cognition, social functioning and quality of life in older adults with major neurocognitive disorders: a systematic review
- Authors:
- Silva Rosa, et al
- Journal article citation:
- JBI Evidence Synthesis, 18(4), 2020, pp.743-806.
- Publisher:
- Wolters Kulwer
Objective: The objective of this review was to investigate the effectiveness of caregiver-provided individual cognitive interventions for improving cognition, social functioning and quality of life in older adults with major neurocognitive disorders. Introduction: A large number of people with major neurocognitive disorders live in their homes, requiring ongoing community care. Different individual cognitive intervention programs have been explored as a potential approach for implementation by caregivers on a one-to-one basis. These programs have the advantage of being implemented in a home setting and in the real-life context of the older adult, in a society that is increasingly aging and where aging in place is being fostered. Inclusion criteria: This review considered experimental studies that included older adults aged 60 years and over with major neurocognitive disorders who were receiving individual cognitive interventions (e.g. cognitive stimulation, cognitive training or cognitive rehabilitation) provided by their caregivers. The comparator was usual care, wait-list control or alternative therapeutic intervention. The primary outcomes of interest included cognition, social functioning and quality of life. Additionally, behavior, mood and activities of daily living were considered. Methods: A comprehensive search strategy was used to identify relevant published and unpublished studies from January 1995 to March 2018, written in English, Spanish and Portuguese. Studies meeting the inclusion criteria were retrieved and their methodological quality was assessed by two independent reviewers using the JBI critical appraisal checklists for randomized controlled trials and quasi-experimental studies. Quantitative data were extracted using the standardized data extraction tool from the JBI System for the Unified Management, Assessment and Review of Information. Due to the clinical and methodological heterogeneity in the included studies, statistical pooling was not possible. Therefore, findings are presented in a narrative format. Results: Eight randomized controlled trials and two quasi-experimental studies were included, with a total sample of 844 dyads (older adults and caregivers). The number of dyads included in the studies ranged from 16 to 356. Beneficial effects of the caregiver-provided individual cognitive interventions were observed in various cognitive domains, including memory, attention, verbal fluency and problem-solving. Two studies additionally reported the positive impact of the intervention of interest on general cognitive functioning. None of the reviewed studies revealed significant changes in quality of life. Social functioning was not analyzed in any of the included studies. Beneficial effects were also reported in relation to behavior and activities of daily living, despite the low level of evidence. Conclusions: This review responds to a gap in current international literature on the synthesis of evidence on the use of caregiver-provided individual cognitive interventions. The intervention of interest is associated with improvement in cognitive performance, revealing some benefits for the stabilization of neuropsychiatric symptoms and an increase in autonomy in activities of daily living. Further research on the impact of sociodemographic and clinical factors on the intervention effects is needed, as these factors seem to interfere with successful intervention implementation. To reinforce current evidence, the methodological quality of future studies should be improved. (Edited publisher abstract)
The impact of COVID‐19 pandemic on people with mild cognitive impairment / dementia and on their caregivers
- Authors:
- TSAPANOU Angeliki, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, early cite November 2020,
- Publisher:
- Wiley
he novel coronavirus disease (COVID‐19) was first detected in mainland China in December 2019, and soon it spread throughout the world, with multiple physical and psychological consequences across the affected populations. The aim of the current study was to analyze the impact of COVID‐19 pandemic on older adults with Mild Cognitive Impairment (MCI)/dementia and their caregivers as well. Two hundred and four caregivers took part in the study, completing a self‐reported questionnaire about the person with MCI/dementia and their own, since the lockdown period which started in February and ended in May of 2020 in Greece. Results indicated a significant overall decline of the people with MCI/dementia. Further, the domains in which people with MCI/dementia were mostly affected were: communication, mood, movement, and compliance with the new measures. Caregivers also reported a great increase in their psychological and physical burden during this period, where the available support sources were limited. The pandemic threatens to disrupt the basic routines that promote mental and physical health of both people with MCI/dementia and their caregivers. Further measures to protect and provide support to people who suffer and their families are needed. (Edited publisher abstract)
A social model of loneliness: the roles of disability, social resources, and cognitive impairment
- Authors:
- BURHOLT Vanessa, et al
- Journal article citation:
- Gerontologist, 57(6), 2017, pp.1020-1030.
- Publisher:
- Oxford University Press
Purpose of the study: The authors consider the points at which cognitive impairment may impact on the pathway to loneliness for older people, through impeding social interaction with family and friends, or by interfering with judgements concerning satisfaction with relationships. Design and methods: The authors conceptualise a mediation model anticipating that social resources (LSNS-6) will mediate the pathway between disability (Townsend Disability Scale) and loneliness (De Jong Gierveld 6-item scale) and a moderated-mediation model in which the authors hypothesise that cognitive impairment (MMSE) will moderate the association between disability and social resources and between social resources and loneliness. To validate the hypothesised pathways, the authors draw on the CFAS Wales data set (N = 3,593) which is a nationally representative study of community-dwelling people aged 65 and older in Wales. Results: Disability had a significant indirect effect on loneliness through the mediating variable social resources. Cognitive impairment was significantly associated with social resources, but did not moderate the relationship between disability and social resources. Cognitive impairment had a significant impact on loneliness, and moderated the effect of social resources on loneliness. Implications: Social structures can (dis)empower people with cognitive impairment and lead to exclusion from social resources or impact on the social construction of ageing, cognitive impairment, and dementia. The sense of self for an older person with cognitive impairment may be influenced by social norms and stereotypes, or through a temporal social comparison with an “earlier” sense of self. The authors conclude that loneliness interventions should be theoretically informed to identify key areas for modification. (Edited publisher abstract)
Clock drawing test in screening for Alzheimer's dementia and mild cognitive impairment in clinical practice
- Authors:
- VYHNALEK Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(9), 2017, pp.933-939.
- Publisher:
- Wiley
Objectives: The clock drawing test (CDT) is a commonly used brief cognitive measure. The authors evaluated diagnostic accuracy of subjective ratings of CDT by physicians (with/without specialty in cognitive neurology) and neuropsychologists in discriminating amnestic mild cognitive impairment (aMCI), Alzheimer's dementia (AD) and cognitively healthy older adults. They further compared the diagnostic accuracy of subjective categorical ratings with complex scoring of CDT. Methods: Three cognitive neurologists, three neuropsychologists and six neurology residents without experience in cognitive neurology blinded to the diagnosis rated 187 CDTs (50 mild AD, 49 aMCI and 88 cognitively healthy older adults) using a “yes” (abnormal) versus “suspected” versus “no” (normal) classification. The rating suspected was combined with yes or no to obtain two sets of sensitivity estimates. The authors also used a 17-point CDT rating system. Results: When using the categorical rating, neuropsychologists had highest sensitivity (89%) in differentiating patients with mild AD (yes/suspected versus no), followed by neurologic residents (80%) and cognitive neurologists (79%). When differentiating patients with aMCI (yes/suspected versus no), the sensitivity was 84% for neuropsychologists, 64% for cognitive neurologists and 62% for residents. The sensitivity using the complex scoring system was 92% in patients with mild AD and 69% in patients with aMCI. Conclusions: A categorical rating of CDT shows high sensitivity for mild AD even in non-experienced raters. Neuropsychologists outperformed physicians in differentiating patients with aMCI from cognitively healthy older adults (specificity), which was counterbalanced by the lower specificity of their ratings. The diagnostic accuracy was not substantially improved by using complex scoring system. (Edited publisher abstract)
Continence care for people with dementia at home
- Authors:
- DRENNAN Vari M., GREENWOOD Nan, COLE Laura
- Journal article citation:
- Nursing Times, 110(9), 2014, p.19.
- Publisher:
- Nursing Times
This article summarises key findings of the systematic review 'Conservative interventions for incontinence in people with dementia or cognitive impairment, living at home: a systematic review' by Drennan et al. Searches were carried out on a total of 14 databases, 56 relevant studies were retrieved, and three met inclusion criteria. Interventions included an occupational therapist problem solving invervention, visits by a nurse practitioner, and visits by a nurse practitioner with additional information and a telephone helpline. Inclusive evidence was found to recommend any of the interventions for people with dementia living at home. (Original abstract)
The Montessori method in dementia care
- Authors:
- BRENNER Tom, BRENNER Karen
- Journal article citation:
- Journal of Dementia Care, 20(4), July 2012, pp.18-19.
- Publisher:
- Hawker
This article describes how the Montessori method of teaching can be applied to those with dementia. The Montessori Method was developed by Maria Montessori, MD., PhD, over one hundred years ago as a tool to teach children who had learning disabilities. This method was very successful because it is based on muscle memory. Muscle memory is that part of the memory that is used in repetitive muscle movement, for example in remembering how to ride a bike, play a musical instrument or read. Muscle memory (sometimes called procedural memory) tends to be less damaged in people with dementia and Alzheimer’s. Because this procedural or muscle memory system may still be working properly in people who have dementia, the Montessori Method can be used very successfully as a means to reach and engage people with memory loss.