bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving mealtime care for people with dementia: A training intervention for care home staff
Authors: Faraday James , Abley Clare , Exley Catherine , Patterson Joanne
Published: February 2022

Background

More and more people with dementia are living in care homes. Often they depend on care home staff for help with eating and drinking. It is essential that care home staff are able to provide good care at mealtimes. The aim of this intervention development study was to produce a staff training intervention to improve mealtimes for people with dementia.

Method

There were three phases to the study. The first phase was an evidence synthesis of relevant peer‐reviewed and grey literature, using robust systematic review methods. Data were interrogated to identify thematic categories of carer‐resident interaction in mealtime care. The second phase was an ethnography conducted in UK care homes, to explore current practice in mealtime care, and identify good practice. This included over twenty‐five hours of mealtime observations, and twenty‐two semi‐structured interviews with care home staff, family carers, and visiting health and social care professionals. The third phase was a series of co‐development workshops, in which key stakeholders worked together to create a prototype training intervention, informed by evidence from phases one and two.

Result

The training intervention content was selected to promote key components of mealtime care, including empowerment, independence, and social interaction. The delivery methods were designed to employ collaborative learning techniques and interactive activities. Issues of implementation, evaluation and context were considered. This will inform the design of a feasibility study, which will aim to ensure that the intervention is scalable, transferable and sustainable.

Conclusion

Training interventions which are developed using relevant evidence and in collaboration with key stakeholders are more likely to be successful. This intervention development study seeks to demonstrate the value of such an approach. The feasibility study will test the intervention’s acceptability to recipients, and potential to impact practice.
Feasibility and acceptability of a virtual adaptation of mentalizing imagery therapy for Spanish language family dementia caregivers
Authors: Ramirez‐Gomez Liliana A , Johnson Julene K , Stewart Anita L , Meyer Ashley K , Tan Emily R , Mischoulon David , Trina Chang E , Jain Felipe A
Published: February 2022

Background

Spanish speaking family dementia caregivers have limited supportive resources in Spanish, and there are few scientifically validated, culturally acceptable approaches for alleviating their distress. We investigated the feasibility of a Spanish language adaptation of Mentalizing Imagery Therapy (MIT), which provides guided imagery and mindfulness training to reduce depression, increase interpersonal understanding, and promote well‐being.

Methods

12 female Spanish‐speaking dementia caregivers enrolled in a 4‐week virtual MIT program consisting of weekly videoconference group meetings and home practice using audiovisual recordings. Caregivers were 52±8 (mean±SD) years of age [range 38‐61] and had been caregivers for 6±3 years. 60% had no more than a high school education, and MMSE was 27.7±2.0 [range 25‐30]. Validated Spanish‐language questionnaires were administered before and after MIT (at 5 weeks), assessing hedonic well‐being, perceived cognitive function, dispositional mindfulness, and interpersonal support. Depressive symptoms were assessed before each group session and at follow‐up, and satisfaction with MIT components was assessed after MIT. Depressive symptoms were analyzed with a mixed linear model with time as the fixed effect and a random factor for participant. Pre to post questionnaires were analyzed with one‐sided paired t‐tests, hypothesizing pre‐post improvement. Effect sizes pre to post MIT were calculated using Cohen’s d.

Results

Participation in the four weekly group meetings was 100%. Caregivers completed home practice of 4±1 meditation session per week. Satisfaction with MIT reached 19±2 of a possible 20 points. Reduction in depression from baseline was observed by week 3 (d=.7, p=.01) and maintained through follow‐up at 5 weeks (d=.6, p<.005). There were significant pre to post increases in perceived cognitive function (d=.6, p<.05), hedonic well‐being (d=.5, p=.05), dispositional mindfulness (d=.6, p<.05), and interpersonal support (d=.7, p<.05).

Conclusions

Mentalizing Imagery Therapy (MIT) was successfully adapted and culturally tailored for Spanish language family dementia caregivers within a virtual group environment. MIT is feasible and acceptable and may help reduce depressive symptoms and improve subjective well‐being. Larger, randomized controlled trials should determine duration of effects and validate specific efficacy of MIT.
Mid‐life physical activity and late‐life cognitive performance among American Indians in the Strong Heart Study
Authors: Carty Cara L , Noonan Carolyn , Muller Clemma , Suchy‐Dicey Astrid M , Fretts Amanda M , Verney Steven P , Howard Barbara , Buchwald Dedra
Published: February 2022

Background

Research on factors associated with late‐life cognitive performance in diverse racial/ethnic groups is increasingly important due to the growing size and racial diversity of the elder population. American Indian elders suffer disproportionately from health conditions and behaviors that increase the risk of cognitive impairment, such as hypertension, diabetes, smoking, physical inactivity, and obesity. To inform prevention efforts in the growing at‐risk population, a better understanding of the relationships between modifiable cognitive risk factors and cognitive impairment is critical.

Method

Using data on 816 American Indians from the Strong Heart Study, we measured associations between mid‐life physical activity (PA), assessed by questionnaire, and performance on 4 cognitive tests administered ∼21 years later. Cognitive tests assessed general cognitive function, phonemic fluency, verbal learning and memory and processing speed domains. To estimate associations, we used regression models with and without inverse probability weights that accounted for potential attrition bias due to drop out between the PA and cognitive assessments. A subset of participants (n=165) had pedometer PA measured ∼12 years after the questionnaire PA assessment. In separate models, we also estimated associations between average daily steps and cognitive test scores.

Result

Participants had mean ages of 52 years at the questionnaire‐based PA assessment and 73 years at cognitive testing. The pedometer subset was mostly sedentary at the time of measurement with 66% completing <5000 steps/day, on average. Nevertheless, both questionnaire and pedometer measures of PA were positively associated with cognitive performance in later life. Participants in the top quartile of questionnaire‐based PA had Modified Mini‐Mental State examination scores 3.2 (95%CI: 1.5‐4.9) points higher than participants in the lowest quartile. Phonemic fluency scores also trended higher for participants in the top compared to bottom quantiles for both PA measures. We observed no associations between PA and tests assessing verbal learning and memory, or processing speed. Weighted model results were similar to unweighted results, but less precise.

Conclusion

In this cohort of American Indians with relatively low levels of PA, positive associations between mid‐life PA and late‐life cognitive performance were domain‐specific and of modest clinical significance.
Links between acculturation and level and change in cognition among middle‐aged and older Hispanics/Latinos: Findings from the HCHS/SOL and SOL‐INCA
Authors: Stickel Ariana M , Tarraf Wassim , Gonzalez Kevin A , Breton Jordana , Keamy Alexandra J , Morlett Alejandra , Gallo Linda C , Medina Luis D , Cai Jianwen , Pirzada Amber , Daviglus Martha L , Isasi Carmen R , Kaplan Robert , Wassertheil‐Smoller Sylvia , Lamar Melissa , Gonzalez Hector M
Published: February 2022

Background

Hispanics/Latinos in the United States vary widely in their levels of acculturation (adoption of Anglo‐American culture) which may have implications for cognitive functioning in older age. We aimed to characterize the relationships of acculturation with cognition and cognitive change among diverse U.S. Hispanics/Latinos.

Method

Selected Hispanics/Latinos (unweighted n=5,901; ages 50+ years) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were enrolled in the Study of Latinos ‐ Investigation of Neurocognitive Aging (SOL‐INCA) ancillary study. Three measures of acculturation were collected at baseline (Short Acculturation Scale for Hispanics (SASH) – Social and Language subscales (Marin et al., 1987) and MESA Acculturation score (Kandula et al., 2008). On all measures higher scores reflect greater acculturation. Cognition was measured at two time‐points, on average, 7‐years apart. Global cognition based on a composite measure from learning and memory, executive functioning, and processing speed tests at the second testing was the main outcome of interest in addition to change in global scores. Survey linear regressions were used to separately model the associations between acculturation measures (quartiles) and cognitive outcomes (z‐scores), controlling for baseline age, sex, education, Hispanic/Latino background, field center, income, marital status, and insurance status.

Result

Average age of the target population was 63.3 ± 8.3(SD) years, 55% were female, 39% reported less than high school education, and 43% were currently uninsured. Adjusting for covariates, the least acculturated (lowest quartile) according to the SASH had lower global cognition compared to all other groups (all p‐values<0.01; Social subscale: b=0.10; SE=0.03, b=0.15; SE=0.03, and b=0.13; SE=0.03, for the 2nd, 3rd, and 4th quartiles respectively; Language subscale: b=0.15; SE=0.03, b=0.12; SE=0.03, and b=0.23; SE=0.03). Individuals with the lowest MESA acculturation quartile had lower global cognition relative to those with scores in the highest quartile only (b=0.13; SE=0.04; p<0.01). None of the acculturation indices were associated with global cognitive change. Associations with domain specific cognitive outcomes were largely similar in pattern.

Conclusion

Acculturation may be indicative of baseline differences in cognition rather than risk for cognitive change. Alternatively, acculturation‐based distinctions in cognition may be related to differences in familiarity with testing environments or approaches to cognitive tasks.
Systematic review of the current psychosocial interventions for people with moderate to severe dementia
Authors: Hui Esther K , Tischler Victoria , Wong Gloria HY , Lau WY Tiffany , Spector Aimee E
Published: February 2022

Background

Dementia, a global epidemic, currently affects 40 to 50 million individuals worldwide. There are currently limited effective treatments for moderate to severe dementia, and most treatments focus on reducing symptoms rather than improving positive factors. It is unclear if improvements are not possible due to disease severity. This review examines the efficacy of the current psychosocial interventions for people with moderate to severe dementia, focusing on improving cognition and quality of life to evaluate what treatments are working and whether improvements are possible.

Method

A systematic search was conducted using six key databases to identify psychosocial interventions for people with moderate to severe dementia, measuring cognition or quality of life in randomized controlled trials (RCTs), published between 2000 and 2020.

Result

The search identified 4193 studies, and 74 articles were assessed for full‐text review. Fourteen RCTs were included and appraised with the Physiotherapy Evidence Database Scale. The included RCTs were moderate in quality.

Conclusion

Aromatherapy and reminiscence therapy showed the strongest evidence in improving quality of life. There was some evidence that aerobic exercise enhanced cognition, and a multi‐component study improved quality of life. However, a quality assessment, using pre‐specified criteria, indicated many methodological weaknesses. While we found improvements in cognition and quality of life for moderate to severe dementia, results must be interpreted with caution. Future interventions with rigorous study designs are a pressing need and required before we can recommend specific interventions.
Studying the relation between cognition and frailty: How can frailty be assessed using existing data?
Authors: Boekholt Melanie , Nowossadeck Sonja , Michalowsky Bernhard , Hoffmann Wolfgang , Thyrian Jochen René
Published: February 2022

Background

Frailty, as a measurement of biological age, opposed to calendrical age, got a lot of recognition in geriatric research over the last 20 years. There is little knowledge about the association between impaired cognition and frailty whether it is correlational, due to similar calendrical age ranges, or causal. There is a need for frailty research with cognitively impaired people. Since establishing evidence with analyses of primary data are time‐consuming and expensive, secondary data might hold promising chances.

Method

Data of n=485 people with dementia from an intervention study with dementia patients (DelpHi‐MV), conducted in Germany, was used. We tested and analyzed different approaches on measuring frailty.

Result

Using a deficit‐cumulating index as a base, while incorporating the phenotype frailty, we were able to build a feasible index with sufficient internal consistency and inter item correlation. A visual comparison of density distributions with a sample of people with the same frame criteria (age, community dwelling) but without mandatory dementia shows that the statistical distribution of frailty within the samples is similar. There was a slight shift to higher values in our sample of cognitively impaired people and a distinct difference in the density of medium to high values between both samples.

Conclusion

The distribution of frailty supports the presumption of a relationship between cognition and frailty. It was in principal similar in both samples, with only slight differences. Based on this now created index we will be able to conduct further research on questions such as: To what extent does an intervention influence frailty in the respective study population? Is frailty a risk factor, a moderating or a mediating factor for the success of an intervention? Is the relationship between cognitive impairments and frailty correlational or causal?
Brain amyloid load and cognitive trajectories in older individuals at risk for dementia
Authors: Hossain Gazi Saadmaan , Hall Anette , Ngandu Tiia , Kemppainen Nina , Rinne Juha O. , Kivipelto Miia , Solomon Alina
Published: February 2022

Background

Most studies have so far investigated the cognitive performances and amyloid status on brain PET scans in cognitively normal, cognitively impaired, or individuals with dementia. In this study associations between brain amyloid status and changes in cognitive performance over time in an at‐risk older general population without dementia or substantial cognitive impairment were evaluated.

Method

Forty‐eight individuals from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) main study participated in the 11C‐Pittsburgh compound B (PiB)‐positron emission tomography (PET) exploratory sub‐study. Participants were categorized as amyloid+ or amyloid– after baseline PET scans were assessed visually by two experienced readers. A comprehensive cognitive Neuropsychological Test Battery (NTB) was used to assess cognitive performance at baseline, 12‐ and 24‐month follow‐up. The Prospective and Retrospective Memory Questionnaire was used to measure subjective cognitive complaints (SCCs) during the study. Changes in cognitive functions during the 2‐year study were compared across baseline amyloid groups using mixed effects regression models with maximum likelihood estimation.

Result

The mean age for all participants (n=48) was 71.4 years, and 22 participants (45%) were female. At baseline, 20 participants (42%) had amyloid+ PET scans and amyloid positivity was associated with lower NTB executive function (estimate = ‐0.38, 95% CI= ‐0.70 – ‐0.05, p=0.03). Interaction terms between baseline amyloid+ status and time were significant for NTB total score (estimate=‐0.10, 95% CI= ‐0.20 – ‐0.01, p=0.04) and NTB memory score (estimate = ‐0.18, 95% CI= ‐0.34 – ‐0.03, p=0.02). No significant associations were observed between amyloid positivity and change in NTB executive function score or NTB processing speed score. Furthermore, amyloid status was not significantly related to SCCs.

Conclusion

Results from this study suggest that positive amyloid status is likely to reduce cognitive abilities over time. Interestingly, in this very early at‐risk stage before the onset of substantial impairment or dementia, amyloid status was related to poorer trajectories in global cognition and memory over time, but not to subjective cognitive complaints. However, future studies with larger sample sizes and longer follow up period will be needed to further investigate the impact of amyloid accumulation.
The association between physical activity and brain integrity is partly mediated by cardiovascular mechanisms
Authors: Felisatti Francesca , Gonneaud Julie , Palix Cassandre , Mézenge Florence , Landeau Brigitte , Chocat Anne , Quillard Anne , Devouge Eglantine Ferrand , Sayette Vincent De , Vivien Denis , Chetelat Gaël , Poisnel Géraldine
Published: February 2022

Background

Physical activity (PA) has been associated with decreased risk of dementia, but the mechanisms underlying this association remain to be determined. One hypothesis is that PA might reduce cardiovascular risk factors (CVRFs), which in turn would benefit brain health. Our objective was to assess the role of CVRFs in the association between PA and neuroimaging markers of brain integrity.

Method

Baseline data of 134 cognitively unimpaired older adults (mean age: 69) from the Age‐Well cohort were analyzed. They underwent a PA questionnaire, CVRFs collection (systolic blood pressure, body mass index [BMI], current smoker status, HDL‐cholesterol, total cholesterol, and insulin), and multimodal neuroimaging (structural and diffusion MRI, FDG‐ ]and Florbetapir‐PET). A global measure of brain integrity was obtained for each neuroimaging modality by extracting the averaged signal across the whole gray matter (GM), or white matter for diffusion. Correlations were first conducted to assess the association between PA, CVRFs, and each neuroimaging modality. Multiple regression and mediation analyses were then performed to test whether the associations found between PA and neuroimaging were mediated by CVRFs.

Result

Higher PA was associated with higher global GM volume and FDG metabolism, but not with amyloid deposition or white matter integrity. Higher PA was also associated with lower insulin levels and BMI, but not with the other CVRFs. Lower insulin and BMI were related to higher GM volume, but not to FDG metabolism. Adjusting for insulin and BMI (separately), the association between PA and FDG metabolism remained unchanged while the association with GM volume did not. When adding insulin and BMI in the same model, BMI was the only significant predictor of GM volume. This was confirmed by a mediation analysis.

Conclusion

PA is specifically associated with greater brain volume and FDG metabolism in older adults. While the association between PA and FDG metabolism appears to be independent from CVRFs, the link with GM volume is mediated by changes in BMI and insulin, with BMI driving the effects. Our results suggest that maintenance of a healthy BMI through PA could help preventing disturbed insulin metabolism usually observed in aging, thus promoting brain health.
The impact of the COVID‐19 pandemic in exacerbating dementia risk factors in a high‐risk Alzheimer’s disease population: Study of a cohort with Down syndrome
Authors: Idris Mina , Saini Fedal
Published: February 2022

Background

The COVID‐19 public health crisis and introduction of strict regulations have presented new challenges for people with Down syndrome (DS) and dementia in the UK. Social and cognitive deprivation together with poor mental health are risk factors for dementia. This study aimed to explore the impact of lockdown on well‐being in a population with DS who are already at high‐risk for developing dementia.

Method

98 individuals with DS were interviewed over the phone about how COVID‐19 and restrictions have affected their daily life, mental and physical health as well as attitude to participating in research. 50 interviews were conducted for younger adults (YA) aged 18‐35 and 48 with older adults (OA) aged 36+ and basic statistics were calculated.

Result

Since the start of the pandemic, two participants have been diagnosed with dementia and three are under investigation for dementia. Five were diagnosed with dementia prior to the pandemic, three of whom have experienced symptoms worsening. A third of the total cohort reported worsening of general health, although not directly caused by a COVID infection. 44% of YA and 32% of OA reported a negative psychological impact, while almost all experienced a significant change in their daily activities with only 47% returning to their physical or social activities at the end of the initial lockdown. Regarding outlook on research participation, over 80% of individuals stated they would still be happy to participate in research in person and 75% would also find research conducted over video call to be a feasible option.

Conclusion

The pandemic has had a negative impact on physical and mental health of a large proportion of individuals with DS which in turn may potentially affect dementia risk in this already vulnerable group. Although no causal relationship can be established from this study, the aforementioned worsening in health may have partially resulted from the social isolation, reduced physical and cognitive stimulation recorded in this cohort.
Epidemiological spread models of Parkinson’s disease support the prion‐like role of alpha‐synuclein
Authors: Dagher Alain , Tremblay Christina , Rahayel Shady , Abbasi Nooshin , Abdelgawad Alaa , Zheng Ying‐Qiu , Misic Bratislav , Luk Kelvin C.
Published: February 2022

Background

Parkinson’s disease (PD) is a progressive neurodegenerative condition marked by brain atrophy in multiple cortical and subcortical regions. It is now known to be caused by the prion‐like propagation of misfolded alpha‐synuclein, supporting Braak’s hypothesis. The pattern of neurodegeneration is now thought to be explained by a combination of brain connectivity and local vulnerability.

Method

We used MRI and clinical data from the Parkinson Progression Markers Initiative to map the progression of brain atrophy over one, two and four years and related it to brain functional and structural connectivity, cell type expression and gene ontology enrichment analyses. We use two methods to measure atoprhy: cortical thickness measures and deformation based morphometry. We will compare these results to pathology in wild‐type mice sacrificed at different time‐points after injection of alpha‐synuclein preformed fibrils. In both cases we use a spreading model inspired by infectious‐disease epidemiology to map the propagation of misfolded alpha‐synuclein. This Susceptible‐Infectious‐Recovered (SIR) model assumes that alpha‐synuclein molecules become misfolded, propagate along the connectome, and cause tissue damage when they accumulate.

Result

1) The pattern of brain atrophy in de novo PD is compatible with a propagating process with an epicenter in the substantia nigra. 2) The SIR model recapitulates the observed atrophy pattern, and supports connectivity‐based propagation. 3) In addition, the SIR model suggests that brain areas with higher alpha‐synuclein concentration appear to be more susceptible to injury but also more likely to act as disease propagators. 4) Progression over four years is also explained by connectivity. 5) Gene ontology analyses suggest that synapses are especially targeted by neurodegeneration. 6) Studies in mice, where the injection site of alpha‐synuclein preformed fibrils is determined by the investigator, also confirm the connectivity by local vulnerability model.

Conclusion

Human and animal studies support the Braak hypothesis of a “toxic agent” propagating from the brainstem to the cortex, accounting for the stereotyped progression of PD manifestations. Data from gene expression studies and animal experiments confirm the important role of prion‐like alpha‐synuclein in PD pathogenesis.
New applications of diffusion model based prediction of pathological brain alterations: Introducing amyloid‐tau interactions
Authors: Raj Ashish , Anand Chaitali
Published: February 2022

Background

Alzheimer’s disease involves widespread and progressive deposition of misfolded protein tau. There is mounting evidence for “prion‐like” trans‐neuronal transmission, whereby proteins misfold, triggering subsequent misfolding of adjacent same‐species proteins, which spread along white matter projections. It is not well understood how tau and amyloid beta interact, and how their subsequent spread lead to stereotypical progression in the Alzheimer brain.

Method

Here we present a major advancement of our previously established Network Diffusion Model (Raj et al. Neuron 2012) that includes three key processes: a) Tau monomer seeding and production in the entorhinal cortex, and Ab monomer seeding in metabolically active areas. b) Interaction between Ab and tau, whereby Ab facilitates production of tau, or both facilitate each other. c) Both species then undergo network spread via our prior Network‐Diffusion model, whereby anatomic connections govern the rate at which two distant but connected brain regions can transfer pathologic species. This extended joint Ab‐tau model was thoroughly tested on empirical group‐averaged regional data (MRI‐derived atrophy, AV45‐PET for Ab and AV1451‐PET for tau) from ADNI‐3 (Table 1).

Result

The extended NDM model exhibits all hallmarks of tau and amyloid progression seen in human patients (Figure 1), accurately capturing the spatial distribution of empirical regional atrophy, Ab and tau (Table 2). Figure 1 shows evolution of the joint model with (middle column) and without amyloid‐facilitation of tau (right). Remarkably, the introduction of a 1‐way directed Aβ to tau influence recapitulated the concept of amyloid‐facilitated tauopathy, and was critical to the models’ success. In comparison, the non‐interacting model was significantly worse, while the 2‐way interaction model (bidirectional influence between tau and Ab) was essentially the same (see Table 2).

Conclusion

This in silico exposition of the “pas de deux” of co‐evolving proteins supports a key role for an amyloid‐facilitated‐tau rather than the classic amyloid‐cascade or pure‐tau hypotheses, and helps explain known but poorly understood aspects of AD (Figure 2).
Rate‐limiting processes of tau aggregate accumulation in Alzheimer's disease
Authors: Meisl Georg , Zuo Yukun , Allinson Kieren , Rittman Timothy , DeVos Sarah L. , Sanchez Justin S , Xu Catherine K. , Duff Karen E. , Johnson Keith A. , Rowe James B. , Hyman Bradley T. , Knowles Tuomas , Klenerman David
Published: February 2022

Background

Both the replication of tau aggregates and their spreading throughout the brain are implicated in the progression of Alzheimer’s disease (AD). However, the rates of these processes are unknown and the identity of the rate‐determining process in humans has therefore remained elusive. Using a mathematical framework based on chemical kinetics, we are able to answer these questions by analysis of experimental data from AD patients.

Method

Our minimal mathematical model of aggregate spreading and replication enables us to determine the rates of spreading and replication from measurements of tau seeds and aggregates across brain regions. Simulations based on this model show clearly distinct patterns of tau distributions when the behaviour is limited by either replication or spreading (Fig 1). We analysed several already existing datasets from in vitro seeding experiments, tau pathology in P301S transgenic mice, and histochemical post‐mortem as well as 2‐year longitudinal tau PET data in humans (Fig 2).

Result

Across mice and human data, we found that the overall rate of accumulation of tau in cortical regions is limited not by the rate of tau spreading between brain regions but by the rate of local replication within a brain region. In human post‐mortem data, low levels of tau seeds were present already throughout the cortex at Braak stage 3, where effective replication of those initial seeds rather than inter‐regional spreading was the rate limiting factor for further tau accumulation. The rate of replication determined from these data corresponds to a doubling of the number of seeds only every ∼5 years, which was well in line with the our analysis of tau accumulation from longitudinal tau PET data in AD patients. This rate is orders of magnitude slower than that measured for purified tau in vitro, quantifying the efficiency of innate cellular mechanisms curtailing tau seed replication.

Conclusion

Based on these findings, we believe that limiting local replication constitutes the most promising strategy to control tau accumulation during AD, after Braak stage 2. Our results provide a framework for the determination of the identity and the rates of the key steps controlling disease‐associated aggregation processes within living organisms.
Knowledge, confidence, attitudes and beliefs of physiotherapists and physiotherapy students working with people with dementia: A mixed‐methods systematic review
Authors: Quick Stephen , Snowdon David A , Lawler Katherine , McGinley Jennifer , Soh Sze Ee , Callisaya Michele L
Published: February 2022

Background

Clinical care for people with dementia as a primary diagnosis, or as a co‐morbidity, can be complex. Physiotherapists play a key role in the care of people living with dementia in multiple settings. The aim of this systematic review is to understand the attitudes, beliefs, knowledge and confidence of physiotherapists and physiotherapy students when working with people with dementia.

Method

This was a mixed‐methods systematic review that included qualitative and quantitative studies. Participants were physiotherapists working in any clinical specialty (e.g. gerontology, orthopaedic, neurological, cardio‐respiratory), and physiotherapy students who had completed at least one clinical placement. If studies investigated physiotherapist and physiotherapy students’ knowledge, confidence, attitudes or beliefs on working with a general population of older adults, they were excluded. The phenomena of interest and context were attitudes, beliefs, knowledge and confidence when working with people with dementia in any setting. Eleven databases were searched. Data synthesis followed a convergent integrated approach according to Joanna Briggs Institute methodology for mixed methods systematic reviews.

Result

15 studies were eligible for inclusion (9 quantitative and 6 qualitative studies). There were 5 key themes: rehabilitation potential (variable outcomes, poor potential), challenges in dementia care (communication, behaviour, cognition, risk, stress and burnout), education in dementia practice (inadequate training and knowledge, importance of experience), specialised area of practice (complexity of presentation, nuance of care, importance of time, holistic approach) and unsupportive systems (environment, time, risk aversion). One code, lack of desire to provide dementia care, did not contribute to any themes.

Conclusion

Physiotherapists and physiotherapy students have low levels of knowledge and confidence in several areas important to working with people with dementia. With higher levels of knowledge and confidence associated with more positive attitudes and beliefs, dementia education needs of physiotherapists at all levels needs to be addressed.
Neuroimaging in neurodegeneration: A global diversity problem
Authors: Adams Hieab H.H. , Vilor‐Tejedor Natalia , van Beek Annemieke , Evans Tavia E.
Published: February 2022

Background

Research investigating neuroimaging within neurodegenerative diseases is currently lacking in many ethno‐racial groups. Whilst some racially diverse studies are being carried out within North America many still question its generalizability to global populations. Initiatives are being instigated within South America, and data within Asia is more frequently being involved in larger collaborations, however Africa is falling behind. Often research into neuroimaging of neurodegenerative diseases within under‐represented groups is difficult due to numerous barriers, such as MRI accessibility, funding, infrastructure, misconceptions and lack of geriatric neurologists.

Method

To fully understand the current research investigating neuroimaging within neurodegenerative diseases, a large literature review focusing on structural imaging was conducted. Additionally, a large global initiative has been set up to overcome the lack of diversity within this field‐ the uncovering neurodegenerative insights through ethnic diversity (UNITED) consortium. The UNITED consortium aims to bring together‐ and support‐ groups investigating neuroimaging of neurodegenerative diseases, such as Alzheimer’s disease. A pilot study was undertaken to investigate feasibility of meta‐analysing heterogeneous data‐ often a limitation within neuroimaging. Four samples from the UNITED consortium were included, with over 25,000 individuals from population‐based and case‐control designs, to investigate reproducibility of association studies in imaging biomarkers, and explore under‐represented ethnic groups.

Result

The literature review yielded over 28,000 abstracts which were screened. It was found that the majority of research currently published uses samples from North America and Europe, with a high use of ADNI data, further highlighting the need for such initiatives as the UNITED consortium. The preliminary pilot results displayed that reproducible results were seen from heterogeneous samples, highlighting the feasibility of neuroimaging collaborations. Subgroup meta‐analyses suggest this that large collaboration will aid in teasing out differences and similarities in under‐represented groups that we are currently lacking.

Conclusion

There is an urgent need for more diversity and global research within neuroimaging of neurodegeneration. This will further reveal insights into complex neurodegenerative disorders and provide more adequate and personal care to individuals around the globe. Multi‐site collaborations, such as the UNITED consortium, have a lot of potential to produce reliable and more generalizable results pertaining to this.
Developing a protocol for neuroimaging to investigate brain ageing and dementia in collaboration with aboriginal Australian communities
Authors: Lavrencic Louise , Broe Gerald A. , Daylight Gail , Delbaere Kim , Draper Brian , Duma Stephen , Fulham Michael , Hill Thi Yen , Lasschuit Danielle , Piguet Olivier , Poulos Lauren , Rae Caroline , Timbery Alison , Radford Kylie
Published: February 2022

Background

Dementia rates in Aboriginal Australians are 3‐5 times higher than in the broader Australian population, and among the highest rates reported globally. Existing evidence suggests that dementia types are similar to those found in non‐Indigenous Australian populations. Neuroimaging, however, has not been previously available in any study of dementia in this population to support or inform clinical diagnoses.

Method

This study extends our epidemiological work, and arose from extensive community consultation and engagement. This engagement included a pilot MRI study (n=14), community planning survey, and guidance from an Aboriginal and Torres Strait Islander Steering Committee. The neuroimaging sub‐study is a prospective, cross‐sectional non‐interventional study. Participants first complete a comprehensive interview and diagnostic assessment as part of the Koori Growing Old Well study. Consenting participants with cognitive decline (diagnosis of cognitive impairment or dementia; n=40) and age/sex‐matched healthy controls (n=40) aged 60+ will undergo MR, FDG PET‐CT and PiB PET‐CT scans. An additional n=120 participants >55 years will be recruited to an MR scan‐only condition.

Result

Pilot work and consultation showed acceptability of neuroimaging with partnering Aboriginal communities, including 74% of planning survey participants (n=213) indicating that neuroimaging should be included in future dementia studies (Lavrencic et al., 2020, Int Psychogeriatr). Older Aboriginal people living in New South Wales, Australia are currently being recruited; n=20 have undergone PET‐CT and MR scans to date (expected study completion by 2023). Outcome analyses will compare cognitive decline and healthy control groups on a range of measures including amyloid burden, regional glucose metabolism, hippocampal atrophy/volume and vascular indices on MR. Associations between amyloid burden and vascular pathology will be examined for cases of possible/probable Alzheimer’s disease. Correlations between MR measures and early life stress, adult adversity, cognitive function, and clinically diagnosed cognitive impairment will be investigated.

Conclusion

Our study will, for the first time, investigate functional and anatomical neuroimaging in older Aboriginal Australians and inform dementia prevention, diagnosis and policy for Aboriginal Australians. It will also contribute to the wider literature on vascular risk in the pathogenesis of AD, with associated biomedical and social risk factors across the lifespan of Aboriginal Australians.
Telemedicine in French memory clinics during Covid‐19 crisis
Authors: Morin Alexandre , Pressat‐Laffouilhere Thibault , Sarazin Marie , Lagarde Julien , Roue‐Jagot Carole , Paquet Claire , Cognat Emmanuel , Dumurgier Julien , Pasquier Florence , Lebouvier Thibaud , Ceccaldi Mathieu , Godefroy Olivier , Martinaud Olivier , Grosjean Julien , Zarea Aline , Maltête David , Wallon David
Published: February 2022

Background

In early 2020, COVID‐19 outbreak struck France leading to a national lockdown between March 17th and May 11th. While standard in‐person medical consultation was complicated, telemedicine dramatically expanded. In order to evaluate the impact of this unpreceded situation on clinical practice and use of psychoactive drug in dementia care, we conducted a nationwide clinical prospective and retrospective study.

Method

During the lockdown period, telemedicine patients’ demographic and clinical data were retrospectively collected from 7 French memory clinics (telemedicine cohort). Clinical diagnoses, treatment changes, cognitive modifications since last consultations and living conditions during the lockdown were systematically retrieved.

In Rouen site, we also included patients only reached by a secretary to propose a postponed visit after lockdown (no‐telemedicine cohort) and patients seen in 2019 during the same period of the year (Rouen‐2019).

The primary outcome was any change in psychoactive drug and a specific analysis on sedative treatment increase was the secondary outcome, defined as any increase in the prescriptions of antipsychotics or benzodiazepines.

Result

The telemedicine cohort included 874 patients (73 from Rouen), while no‐telemedicine control cohort and Rouen‐2019 cohorts included respectively 86 and 234 patients (table 1). In the telemedicine cohort, treatments were modified for 10.7% of the patients with more treatment modification among the patients living with a relative (+5.8% (CI95% [0.2%; 11.4%] p=0.04) and among the patients with Alzheimer’s disease (+12.2% (CI95% [7.1%; 17.3%] p<0.001). When comparing therapeutic strategies in 2020 and 2019 for Rouen site, 24.6% of the patients had their treatment modified in 2020 and 12.4% in 2019. That difference was however not statically significant with an adjusted percentage difference of ‐4% (CI95% [‐10.8%; 3.4%] p=0.27, including the telemedicine and no‐telemedicine cohorts for 2020.

Conclusion

Telemedicine seems to have had only minor negative impacts on clinical practice in memory clinics.
ATN classification in dementia with Lewy bodies: Association with clinical profile, cognitive decline and survival
Authors: van de Beek Marleen , Ooms Floor A.H. , Ebenau Jarith L. , Barkhof Frederik , Scheltens Philip , Teunissen Charlotte E. , van Harten Argonde C. , van der Flier Wiesje M , Lemstra Afina W.
Published: February 2022

Background

The ATN framework has been developed to characterize biological processes within the Alzheimer’s disease (AD) continuum. Since AD pathology often coincides with dementia with Lewy Bodies (DLB), we aimed to examine the distribution of ATN profiles in DLB and associate ATN‐profiles in DLB to prognosis.

Method

We included 192 DLB patients from the Amsterdam Dementia Cohort (68±7yrs, 19%F, MMSE: 24±3, DAT‐SPECT abnormal: 104/114). Patients were classified according to the ATN framework, using CSF Aβ1‐42 (A), CSF p‐tau (T) and medial temporal atrophy scores (N). Categories were compared on presence of clinical symptoms and demographics. To yield sufficient power for longitudinal analyses, the eight profiles were combined into four categories: normal AD biomarkers (A‐T‐N‐, reference), non‐AD pathologic change (A–T–N+/A–T+N–/A–T+N+), amyloid‐only (A+T‐N‐) and amyloid‐plus (A+T–N+/A+T+N–/A+T+N+). We used linear mixed models to analyze decline in MMSE (follow‐up 3±2yrs for n=137). We assessed differences in mortality using Cox proportional‐hazards models.

Result

Fifty (26%) DLB patients had normal AD biomarkers (A‐T‐N‐), 36 (19%) had non‐AD pathologic change (A‐T+N‐: 10%/A‐T‐N+: 6%/A‐T+N+: 3%) and 106 (55%) were classified within the AD‐continuum (A+T‐N‐: 20%/A+T+N‐: 16%/A+T‐N+: 10%/A+T+N+: 9%)(figure 1). A+T+N+ patients were older and less often had RBD symptoms. Compared to patients with normal AD biomarkers, those with amyloid‐only had steeper decline in MMSE (β±SE=‐0.82±0.28, p=0.005), while amyloid‐plus was associated to higher mortality rate (HR: 1.85[1.09‐3.13]). Cognitive decline and mortality did not differ between non‐AD pathologic change and normal AD biomarkers (figure 2‐3).

Conclusion

In our DLB cohort, we found clinically relevant associations between ATN categories and disease manifestation. Patients within the AD‐continuum had steeper cognitive decline (especially amyloid‐only) and shorter survival (amyloid‐plus). Individuals with non‐AD pathologic change did not differ from those with normal AD biomarkers in clinical presentation, decline or survival. Implementing the ATN framework within DLB patients could aid in subtyping patients based on underlying biological processes and provide targets for future treatment strategies, e.g. AD modifying treatment.
Covid‐19 pandemic: A curse and a blessing for informal dementia caregivers — A qualitative study
Authors: Taneska Marija
Published: February 2022

Background

Caring for a relative or friend who lives with dementia is a complex and demanding process that affects the quality of life and the well‐being of the informal caregivers. Many previous studies show that informal dementia caregivers experience high levels of stress, psychological burden, and depression due to the demands of caregiving which include changes in one's personal and professional life, self‐neglect, and withdrawal from pleasurable activities. The COVID‐19 pandemic drastically changed people's lives and everyday interactions and the limited number of studies on this topic shows that it introduced additional challenges for dementia caregivers. These challenges include protecting themselves and the person they care for from infection, managing the behavioural and psychological symptoms of the disease, introducing changes in everyday routines, dealing with quarantine or isolation.

Method

The aim of this study was to gain a better insight into the experiences of informal dementia caregivers during the COVID‐19 pandemic. Semi‐structured interviews were conducted in the period of July‐September with nine participants from different countries and the data were analyzed using inductive thematic analysis resulting in extraction of five themes.

Results

The results show that informal caregivers experience worsening of the behavioural and psychological symptoms of the person they care for, limited access to the institutions and the person they care for, fear of infection but also more free time for looking after the person with dementia.

Conclusion

This was one of the first qualitative research aimed to understand the unique experiences of informal dementia caregivers during the COVID‐19 pandemic, and the first research ever that has included caregivers from North Macedonia. The results show that informal dementia caregivers experience additional burden and challenges due to the COVID‐19 pandemic which adds to their existing psychological distress. This can further compromise their health and well‐being, and result in lower quality of life for them and the person with dementia and requires more focused attention from the relevant medical and social services. It should also be taken into consideration when constructing policies for dementia management and formal support during the times of the pandemic.
Dementia friendly community outreach improves research participation and dementia resource utilization among African Americans
Authors: Lucas John A , Robinson Maisha T , Bergeron Caroline D. , Willis Floyd B , Parfitt Francine C , Fudge Michelle R , Wainwright Jolita D , Graff‐Radford Neill R
Published: February 2022

Background

African Americans are at greater risk of Alzheimer’s disease (AD) and AD‐related dementia (ADRD). They are also less likely to access dementia resources or participate in dementia research. The National Alzheimer’s Project Act (NAPA) calls for special attention to dementia‐related health disparities in high risk groups. Identifying effective tools to improve rates of dementia resource utilization and research participation by African Americans is essential to achieving dementia health equity.

Method

Two neighborhoods of Jacksonville, FL, defined by zip codes, were the focus of this study. Both zip codes have a large population of African American residents per 2010 US Census, and a history of hosting outreach activities by our Alzheimer’s Disease Research Center (ADRC). In one neighborhood, we modified the NAPA Dementia Friendly (DF) America toolkit to serve as a model of outreach. The second neighborhood served as a control (CON), in which we maintained our traditional outreach model of community‐based lectures. Primary outcome measures were: (1) enrollment in ADRC center‐related studies and (2) phone call volumes from individuals seeking dementia resource information. The outcomes in the DF and CON neighborhoods were compared via Fisher’s exact test to those in other zip codes in Jacksonville (OT).

Result

In the 18 months following implementation of the DF intervention, 54 African Americans enrolled in ADRC‐related research (19 DF, 3 CON, 32 OT), compared to 21 during the 18 months prior (2 DF, 0 CON, and 19 OT). The increase in DF residents enrolling in research following the intervention was statistically significant (p =0 .02) relative to OT residents. The increase observed in the CON residents was not statistically significant (p=1.0) compared to OT residents. Call volumes from African Americans increased from 13 prior to program implementation (all from OT) to 62 calls after implementation (22 DF, 1 CON, 39 OT). The increase among DF residents seeking information following the intervention was statistically significant (p =0.008) whereas the increase was not significant in the CON residents (p=0.54).

Conclusion

Results suggest that the NAPA DFA can be leveraged to improve dementia resource utilization and research participation among community‐dwelling African Americans.