REL@X: SENSORY AND VIRTUAL IMMERSION TO REDUCE THE ANXIETY OF PATIENTS CONSULTING FOR THE FIRST TIME IN NICE MEMORY CENTER

Abstract

Background: Neuropsychiatric symptoms (NS) such as agitation, physical aggression, shadowing and vocalizations are common in individuals with dementia compromising their quality of life and safety. NS have been associated with more time spent care-giving, high level of distress among caregivers and greater mortality among people with dementia. Although pharmacological interventions are frequently used to manage such symptoms, they can lead to adverse effects or even add to mortality. Some non-pharmacological approaches have been shown to be safe and to reduce NS. In the present investigation we describe a ran-domized clinical trial, using the Tailored Activity Program Outpatient version (TAP-O) in a Brazilian sample, to test the efficacy of an activity program to reduce NS in patients with dementia and their caregivers burden. TAP-O version was adapted from original TAP (home intervention). Methods: Patients with dementia and their caregivers were randomized to intervention (TAP-O method) or control group (psychoeducative method). TAP-O is a method involving eight sessions in an outpatient service conducted by occupational therapists who train caregivers in using meaningful activities at home, as part of their daily care routines. Outcome measures were obtained by Neuropsychiatric Inventory – Clinician Rating Scale (NPI-C) and Zarit Scale to measure NS in patients and caregiver burden, respectively. Results:A total of 21 dyads (individuals with dementia and their caregivers) were included. Most of patients were female (76.2%) with mean age of 78.7 (SD ¼ 5.8), and most of caregivers were family members (71.4%). Eleven patients were randomized to experimental intervention (TAP-O) and ten to control group. Patients from experimental group presented significant decrease in symptoms of hallucination (p¼0.008), anxiety (p¼0.03), and sleep disorder (p¼0.04) compared to the control group. Regarding the caregiver burden, measured by Zarit, it was possible to detect a statistically significant decrease in the experimental group (p¼0.003). Conclusions: These preliminary findings suggest that TAP-O may be clinically relevant, such as original TAP (home version) for the NS in patients with demen-tia and burden of their caregivers. Background: Elevated plasma total homocysteine (tHcy) is associated with increased risk of cardiovascular disease, stroke and de-mentia. Results of clinical trials using B-vitamins to reduce the cognitive risks attributed to tHcy have been inconsistent. A high prevalence of hyperhomocysteinemia and of cognitive impairment in kidney transplant recipients makes them a convenient population in which to evaluate this question. Methods: We evaluated whether B-vitamin therapy to lower tHcy would prevent cognitive-decline in a cohort of stable kidney transplant recipients. The study was a longitudinal ancillary of the FAVORIT trial-a randomized, placebo controlled trial of high-dose B vitamins to reduce cardio-and cerebrovascular events in clinically stable kidney transplant recipients with elevated tHcy. 584 subjects from 18 sites across North America were assessed annually for up to 5 years (mean 3.3 years) using a standardized neuropsychological test battery. Efficacy was analyzed on an intention-to-treat basis using end-of-trial data. Subgroup analyses included stratification for baseline plasma B-vitamin and tHcy concentrations. Results: At baseline, cognitive impairment was prevalent with 61% of participants falling more than one standard deviation below published norms for at least one cognitive test. Fewer than 1% of participants had insufficient plasma folate < 5 ng/ml or vitamin B12 < 148 pmol/L. However, 44.6% had plasma B6 concentrations < 30 nmol/L. At follow-up, psychomotor speed and memory scores were modestly but significantly better in the B-vitamin supplement group than in controls (p0.05). There was no interaction between baseline tHcy, B-vitamin status and treatment on the cognitive outcomes. Conclusions: High-dose B-vitamin supplementation provided modest benefit for cognitive function in our cohort of kidney transplant recipients with elevated baseline tHcy. Since nearly all participants were folate and vitamin B12 sufficient at baseline, the potential cognitive benefits of folate and B12 supplementation in individuals with poor B-vitamin status remains to be determined. Background: Rel@x project aims at reducing the level of anxiety and to improve positive emotions in patients coming for the first time in consultation at Nice Memory Center. This is supposed to reduce errors due to stress in neuropsychological tests, and also allows to study emotion regulation capabilities of patients with and without cognitive impairment. To these aims, Rel@x project developed a multisensorial relaxing environment including virtual reality, music and odors. Methods: In the present study, we included 50 participants with (N¼25) and without (N¼25) mild cognitive impairment. Patients were immersed in a realistic universe then in a fantasy world on an island, and during this