pinecone/core-2020-05-10-deduplication huggingface dataset:
Interferon-ß regulates the production of IL-10 by toll-like receptor-activated microglia

Pattern recognition receptors, such as toll-like receptors (TLRs), perceive tissue alterations and initiate local innate immune responses. Microglia, the resident macrophages of the brain, encode TLRs which primary role is to protect the tissue integrity. However, deregulated activation of TLRs in microglia may lead to chronic neurodegeneration. This double role of microglial responses is often reported in immune-driven neurologic diseases, as in multiple sclerosis (MS). Consequently, strategies to manipulate microglia inflammatory responses may help to ameliorate disease progression. In this context, the anti-inflammatory cytokine interleukin (IL)-10 appears as an attractive target. In this study, we investigated how activation of microglia by TLRs with distinct roles in MS impacts on IL-10 production. We found that activation of TLR2, TLR4, and TLR9 induced the production of IL-10 to a greater extent than activation of TLR3. This was surprising as both TLR3 and IL-10 play protective roles in animal models of MS. Interestingly, combination of TLR3 triggering with the other TLRs, enhanced IL-10 through the modulation of its transcription, via interferon (IFN)-beta, but independently of IL-27. Thus, in addition to the modulation of inflammatory responses of the periphery described for the axis TLR3/IFN-beta, we now report a direct modulation of microglial responses. We further show that the presence of IFN-gamma in the microenvironment abrogated the modulation of IL-10 by TLR3, whereas that of IL-17 had no effect. Considering the therapeutic application of IFN-beta in MS, our study bears important implications for the understanding of the cytokine network regulating microglia responses in this setting.Portuguese Foundation for Science and Technology (FCT), Grant/Award Numbers: SFRH/BD/88081/2012 and SFRH/BPD/72710/2010; FEDER - Competitiveness Factors Operational Programme (COMPETE), Grant/Award Numbers: POCI-01-0145-FEDER-007038 and NORTE-01-0145-FEDER-000013; Norte Portugal Regional Operational Programme, PORTUGAL 2020, European Regional Development Fund (ERDF), Grant/Award Number: NORTE 2020; FCT-ANR, Grant/Award Number: FCT-ANR/BIM-MEC/0007/2013; FEDER - Fundo Europeu de Desenvolvimento Regional; COMPETE 2020 - Operacional Programme for Competitiveness and Internationalisation (POCI), Portugal 2020; Institute for Research and Innovation in Health Sciences, Grant/Award Number: POCI-01-0145-FEDER-007274info:eu-repo/semantics/publishedVersio
A comparison of the effects of Snoezelen and reminiscence therapy on the agitated behaviour of patients with dementia

This is the accepted version of the following article: A comparison of the effects of Snoezelen and reminiscence therapy on the agitated behaviour of patients with dementia, International Journal of Geriatric Psychiatry, 2004, 19 (11), PP. 1047–1052 which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1002/gps.1208/abstractBackground : \ud
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Behavioural disturbance, such as agitation, is a common feature of dementia, and causes significant problems and distress for carers. Snoezelen is increasingly used with people who have dementia, but there is limited evidence of its efficacy.\ud
Objective : \ud
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This crossover randomised controlled study aimed to evaluate the effect of Snoezelen on the mood and behaviour of patients with dementia, in comparison to the effect of an established and accepted intervention, reminiscence therapy.\ud
Methods : \ud
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Twenty patients with dementia and significant agitated behaviour, received three sessions each of Snoezelen and reminiscence. The effects were assessed using measures of observed agitated behaviour and heart rate over the course of the sessions, and mood and behaviour during the sessions.\ud
Results : \ud
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Both interventions had a positive effect. Snoezelen was no more beneficial than reminiscence in terms of effecting a significant reduction in agitated behaviour or heart rate. There was considerable variation in the way individuals responded to each intervention. Snoezelen may have a more positive effect than reminiscence, but due to the observed differences between the interventions being small, and the small number of subjects, this advantage was not demonstrated statistically.\ud
Conclusions : \ud
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Further research, with larger numbers of subjects, and an appropriate control is required to establish the benefits of Snoezelen for people at different stages of dementia, and to identify any benefits additional to those derived from increased staff attention.Peer-reviewedPost-print1926
Predicting the onset of major depressive disorder and dysthymia in older adults with subthreshold depression: a community based study

16) but no DSM mood disorder from a longitudinal study among a large population based cohort aged between 55 and 85 years in The Netherlands. Of these subjects, 31 (20.1%) developed a mood disorder (major depression and/or dysthymia) at three-year or six-year follow-up. We examined risk factors and individual symptoms of mood disorder as predictors of onset of mood disorder. Results Two variables were found to be significant predictors in both bivariate and multivariate analyses: eating problems and sleep problems. The incidence of mood disorders differed strongly for different subpopulations, varying from 9% (for those not having any of the two risk factors) to 57% (for those having both risk factors). Conclusions It appears to be possible to predict to a certain degree whether a subject with subthreshold depression will develop a mood disorder during the following years
Psychological treatment of late-life depression:a meta-analysis of randomized controlled trials

SUMMARY Background Older meta-analyses of the effects of psychological treatments for depression in older adults have found that these treatments have large effects. However, these earlier meta-analyses also included non-randomized studies, and did not include newer high-quality randomized controlled trials. Methods We conducted a meta-analysis of randomized studies on psychological treatments for depression in older adults. Results Twenty-five studies were included, of which 17 compared a psychological intervention to a control condition (mainly waiting list and care-as-usual control groups). The quality of the included studies varied. Psychological treatments have moderate to large effects on depression in older adults (standardized mean effect size d¼0.72). Heterogeneity was very low. No differences were found between individual, group or bibliotherapy format, or between cognitive behavioral therapy and other types of psychological treatment. The effects were comparable in studies where depression was defined according to diagnostic criteria, and those in which depression was measured with self-rating questionnaires. Conclusion Although the quality of many studies was not optimal, the results of this meta-analysis support the results of earlier meta-analyses, which also included non-randomized studies. Psychological treatments are effective in the treatment of depression in older adults
Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents

OBJECTIVE: To compare the diagnostic accuracy of an outcome measurement scale of the Minimum Data Set of the Resident Assessment Instrument for nursing homes (MDS/RAI-NH), the Cognitive Performance Scale (CPS) and the Mini-Mental State Exam (MMSE) for the detection of cognitive impairment. The Cambridge Examination for Mental Disorders of the Elderly - Revised (CAMDEX-R) was used as the reference standard. STUDY DESIGN AND SETTING: This study was part of a larger prospective study (QUALIDEM) involving a diagnostic procedure and two-year follow-up on the quality of primary care for demented patients. CAMDEX-R and MDS/RAI-NH were administered to 198 residents, aged 65 or more, living in 42 low and high care institutions for aged people. MAIN OUTCOME MEASURES: Indicators of diagnostic accuracy: sensitivity, specificity, predictive values, likelihood ratios, odds ratio and area under receiver operating characteristics curve (AUC). RESULTS: The CAMDEX-based prevalence of cognitive impairment was 75%. The diagnostic values of a CPS score of two or more for the detection of cognitive impairment were: sensitivity = 0.81; specificity = 0.80; PPV = 0.92; NPV = 0.57. The diagnostic values of a MMSE score of less than or equal 23 were: sensitivity = 0.97; specificity = 0.59; PPV = 0.88; NPV = 0.85. For CPS, the area under the receiver operating characteristic (ROC) curve was 0.87 (95% CI, 0.81-0.91), and not significantly different (p = 0.63) from the MMSE score, 0.88 (0.83-0.93). CONCLUSIONS: CPS and MMSE demonstrated similar performance to detect cognitive impairment in nursing home residents. Copyright (c) 2006 John Wiley & Sons, Ltd.status: publishe
Construction and validation of a patient- and user-friendly nursing home version of the Geriatric Depression Scale.

Objective To construct a patient- and user-friendly shortened version of the Geriatric Depression Scale (GDS) that is especially suitable for nursing home patients. Methods The study was carried out on two different data bases including 23 Dutch nursing homes. Data on the GDS (n¼410), the Mini Mental State Examination (n¼410) and a diagnostic interview (SCAN; n¼333), were collected by trained clinicians. Firstly, the items of the GDS-15 were judged on their clinical applicability by three clinical experts. Subsequently, items that were identified as unsuitable were removed using the data of the Assess project (n¼77), and internal consistency was calculated. Secondly, with respect to criterion validity (sensitivity, specitivity, area under ROC and positive and negative predictive values), the newly constructed shortened GDS was validated in the AGED data set (n¼333), using DSM-IV diagnosis for depression as measured by the SCAN as ‘gold standard’. Results The eight-item GDS that resulted from stage 1 showed good internal consistency in both the Assess data set (a¼0.86) and the AGED dataset (a¼0.80). In the AGED dataset, high sensitivity rates of 96.3% for major depression and 83.0% for minor depression were found, with a specificity rate of 71.7% at a cut-off point of 2/3. Conclusion The GDS-8 has good psychometric properties. Given that the GDS-8 is less burdening for the patient, more comfortable to use and less time consuming, it may be a more feasible screening test for the frail nursing home population
Cognitive impairment in older people: future demand for long-term care services and the associated costs

Background Projections are presented of future numbers of older people with cognitive impairment (CI) in England, their demand for long-term care (LTC) services and future costs of their care. The sensitivity of the projections to factors that are likely to affect future LTC expenditure is explored. These factors include future numbers of older people, prevalence rates of CI, trends in household composition, informal care provision, care service patterns and unit costs.  Methods A macrosimulation (or cell-based) model was developed to produce the projections, building on an earlier PSSRU model. Base case assumptions are made about trends in key factors expected to impact on future LTC expenditure, and variant assumptions about the key factors are introduced to test for sensitivity.  Results Expenditure on LTC services for older people with CI is projected to rise from 0.60% of Gross Domestic Product (GDP) (£5.4 billion) in 2002 to 0.96% of GDP (£16.7 billion) in 2031, under base case assumptions. Under variant assumptions, the projection for 2031 ranges from 0.83% to 1.11% of GDP. These figures do not include the opportunity costs of informal care.  Conclusions Sensitivity analysis shows that projected demand for LTC is sensitive to assumptions about the future numbers of older people and future prevalence rates of CI and functional disability. Projected expenditure is also sensitive to assumptions about future rises in the real unit costs of services
The process of definitive institutionalization of community dwelling demented vs non demented elderly: data obtained from a network of sentinel general practitioners

OBJECTIVE: The aim of the present study was to investigate the differences between characteristics of community dwelling demented and non demented elderly and their caregivers at the moment of definitive institutionalization. METHODS: The study is a cross-sectional analysis performed on data obtained from a Network of Sentinel General Practitioners. RESULTS: Older demented patients with several concomitant diseases were mainly placed because of unmanageable behavioral disturbances. Strikingly, these dementia patients were more often confronted with a time delay in definitive institutionalization due to their high care dependence. Although burden in the dementia family caregivers was an important motivation for definitive institutionalization, it did not seem to be a motive in the final institutionalization circumstances. CONCLUSIONS: Behavioral disturbances are independently of caregiver burden, professional support, or a spousal relationship the main direct reason for institutionalization of community dwelling demented elderly. The way caregivers feel supported might play the key role in the final placement decision.status: publishe
Factors related to perceived quality of life in patients with Alzheimer's disease: the patient's perception compared with that of caregivers

Aims To compare care recipient and caregiver perceptions of quality of life in patients (QoL-p) with Alzheimer"s disease (AD). To identify associated factors, and the concordances-discrepancies. Method Cross-sectional analytic study of 236 patients and their carers using the Quality of Life in Alzheimer"s Disease(QoL-AD) scale, socio-demographic data and clinical examination. Results Patients scored the QoL-AD more favourably than did caregivers (34.4 vs 31.3, p<0.001). Cognitive deterioration did not affect the perception of QoL-AD (rho¼ 0.05, p¼0.394). The neuropsychiatric symptoms was associated with a negative perception of the QOL-AD in both patients (rho¼ 0.22, p<0.01) and caregivers (rho¼ 0.47, p<0.001). Greater functional autonomy was associated with a better perception of the QOL-AD in patients (rho¼0.17, p<0.01) and even more so in caregivers (rho¼0.56, p<0.001). In carers, burden (rho¼ 0.56, p<0.001) and mental health (rho¼0.31, p<0.001) were inversely associated with the QoL-AD. QoL-AD scores of both patients and caregivers were higher for men, married subjects, those who lived with their spouse and those living in their own home. When the carer was a spouse both patients and caregivers scored the QoL-AD higher than when the carer was a son or daughter (35.5 vs 33.4 and 33.7; 32.9 vs 30.5 and 27.7, p<0.001). Conclusions Patients have a better perception of QoL-p. Caregivers give a more negative evaluation of neuropsychiatric symptoms, but have a more positive view of functional autonomy. Carers who are spouses have a better perception of QoL-p than do carers who are sons or daughters
Patients' attitudes of dementia screening across the Atlantic

BACKGROUND:

Dementia is a common and growing global public health problem. It leads to a high burden of suffering for society with an annual cost of $100 billion in the US and $10 billion in the UK. New strategies for both treatment and prevention of dementia are currently being developed. Implementation of these strategies will depend on the presence of a viable community or primary care based dementia screening and diagnosis program and patient acceptance of such a program.
OBJECTIVE:

To compare the acceptance, perceived harms and perceived benefits of dementia screening among older adults receiving their care in two different primary health care systems in two countries.
DESIGN:

A Cross-sectional study.
SETTING:

Primary care clinics in Indianapolis, USA and Kent, UK.
PARTICIPANTS:

A convenience sample of 245 older adults (Indianapolis, n = 125; Kent, n = 120).
OUTCOMES:

Acceptance of dementia screening and its perceived harms and benefits as determined by a 52-item questionnaire (PRISM-PC questionnaire).
RESULTS:

Four of the five domains were significantly different across the two samples. The UK sample had significantly higher dementia screening acceptance scores (p < 0.05); higher perceived stigma scores (p < 0.05); higher perceived loss of independence scores (p < 0.01); and higher perceived suffering scores (p < 0.01) than the US sample. Both groups perceived dementia screening as beneficial (p = 0.218). After controlling for prior experience with dementia, acceptance and stigma were marginalized.
CONCLUSIONS:

Older adults attending primary care clinics across the Atlantic value dementia screening but have significant concerns about dementia screening although these concerns differed between the two countries. Low acceptance rates and high rates of perceived harms might be a significant barrier for the introduction of treatment or preventive methods for dementia in the future
Evidence for an association of the big five personality factors with recurrence of depressive symptoms in later life

SUMMARY Objectives Although it is well known that recurrence of late-life depression is very common, little is known about the characteristics of older people who are vulnerable for recurrence. In order to identify characteristics of those who are at risk, the present study aimed to investigate the strength of the associations of the big five personality factors with recurrence in later life. Secondly, we studied whether there are gender and age differences in the strength of these associations. Methods Using data from the longitudinal aging study Amsterdam (LASA) a subsample with clinically relevant depressive symptoms at one or more of the first three LASA-cycles, but who had recovered at the fourth cycle, was approached to participate in a fifth cycle to determine recurrence (n¼92). Respondents completed self-report questionnaires on personality (NEO-FFI) and depression (CES-D). By means of logistic regression analyses the associations between the Big Five and recurrence of depression at fifth cycle was investigated. Results 58 (63%) had a recurrence of depressive symptoms. A high level of neuroticism was significantly associated with recurrence. No gender differences or age-related differences in strength of the associations of personality with recurrence were found. Conclusion In later life, neuroticism still is associated with the recurrence of depression. Efforts to prevent recurrence of late-life depression should focus on those with high levels of neuroticism and future research should aim at further unravelling the association between depression and personality in later life
Brief problem-solving treatment in primary care (PST-PC) was not more effective than placebo for elderly patients screened positive of psychological problems

Objectives To evaluate whether screening followed by brief problem-solving treatment by primary care doctors (PST-PC) could improve health-related quality of life (HRQOL) and reduce consultation rates in the elderly. Design A single-blind randomized placebo controlled trial (RCT). Setting Two government funded primary care clinics in Hong Kong. Participants Two hundred and ninety nine Chinese patients aged 60 years or over, with positive screening scores for psychological problems by the Hospital Anxiety and Depression Scale (HADS). Interventions One hundred and forty nine subjects were randomized to receive brief PST-PC from primary care doctors (treatment) and 150 to group video-viewing (placebo). All subjects were followed up by telephone at 6, 12, 26 and 52 weeks. Main Outcome Measures Changes in SF-36 HRQOL scores, HADS scores and monthly consultation rates were compared within and between groups. Results Study completion rates were 69-71%. There was significant improvement in the SF-36 role-emotional (RE) and mental component summary (MCS) scores at week 6 in the PST-PC group but not in the placebo group. Several SF-36 scores improved significantly in the placebo (video) group at week 6-52. Mixed effects analysis adjusting for baseline values and cofounders did not show any difference in any of the outcomes between the PST-PC and placebo (video) groups. Conclusions Screening followed by brief PST-PC was associated with a short-term improvement in HRQOL in Chinese elderly patients screened positive of psychological problems, but the HRQOL benefit was not greater than those found in the placebo group who participated in group-viewings of health education videos. © 2009 John Wiley & Sons, Ltd.postprin
Impact of Ambient Bright Light on Agitation in Dementia

Objective
To evaluate the effect of ambient bright light therapy on agitation among institutionalized persons with dementia.

Methods
High intensity, low glare ambient lighting was installed in activity and dining areas of a state psychiatric hospital unit in North Carolina and a dementia-specific residential care facility in Oregon. The study employed a cluster-unit crossover design involving four ambient lighting conditions: AM bright light, PM bright light, All Day bright light, and Standard light. Sixty-six older persons with dementia participated. Outcome measures included direct observation by research personnel and completion by staff caregivers of the 14-item, short form of the Cohen-Mansfield Agitation Inventory (CMAI).

Results
Analyses of observational data revealed that for participants with mild/moderate dementia, agitation was higher under AM light (p=0.003), PM light (p<0.001), and All Day light (p=0.001) than Standard light. There also was a trend toward severely demented participants being more agitated during AM light than Standard light (p=0.053). Analysis of CMAI data identified differing responses by site: the North Carolina site significantly increased agitation under AM light (p=0.002) and PM light (p=0.013) compared with All Day light while in Oregon, agitation was higher for All Day light compared to AM light (p=0.030). In no comparison was agitation significantly lower under any therapeutic condition, in comparison to Standard lighting.

Conclusions
Ambient bright light is not effective in reducing agitation in dementia and may exacerbate this behavioral symptom