Cognitive Disabilities Research Articles

THE USE OF THE “TIME TRAVEL” PARADIGM OF ALZHEIMER’S DISEASE FOR FAMILY CARE PARTNER EMPOWERMENT

Abstract This study describes how family carers are taught the Time Travel model of Alzheimer’s Disease (AD). As persons with AD experience cognitive, emotional, social, physical and functional time travel, families can learn to join them on their journey. Stage models (e.g., Reisberg and associates FAST and GDS) of AD clarify how changes through time occur using stage markers. Yet the disease is non-linear. Persons with AD don’t travel neatly in stages but fluctuate in recall of names, faces and events. They migrate in a non-linear downward spiral fluctuating back and forth through time, revisiting people, places, events and traumas of their distant past. Time Travel apps and other life history data are available to provide real person-centered care that’s time appropriate. Families are trained to connect in the approximate time frame in which the person has traveled. Hence, care partners are taught time appropriate communication and interventions (e.g., activities, pictures, music etc.) to respond to challenging behaviors. The Models use with family carers empowers them to validate their loved ones’ approximate time frame they are in. Family carers are inspired to become “best friends” of AD persons by understanding how this cognitive disability works. When a lady with travels to age 20 in her mind but sees an 80-year-old face in the mirror, she demands the person leave the bathroom. This behavior is puzzling to families. Time Travel model explains how this works driving care planning, redesigns (e.g., mirrors) and activities, and supports validation therapy, “Best Friends” and other pedagogy.

AGEISM IS NOT A CATCH-ALL: THE INTERRELATEDNESS OF AGEISM AND ABLEISM

Abstract Ageism represents discrimination based on age, while ableism represents discrimination toward people with disabilities. Given the natural occurrence of physical decline accompanying aging, it is essential to explore how prejudice toward disability intersects with fear about aging. 913 individuals responded to a survey on ageism and ableism. Multiple regression with internalized ageism as the criterion variable was significant F(7, 705) = 81.71, p <.001. Overall, the regression model explained 44.8% of the variance in internalized ageism with significance for age (t(705) = -5.45, p < .001), relational ageism (t(705) = 11.72, p < .001), affinity for older people (t(705) = -2.77, p = .006), ableism for physical disability (t(705) = 6.88, p < .001), and ableism for cognitive disability (t(705) = -2.86, p = .004), Multiple regression with relational ageism as the criterion variable was significant F(7, 705) = 88.12, p <.001. Overall, the regression model explained 46.7% of the variance in relational ageism with a significant for affinity for older people (t(705) = -3.80, p < .001), internalized ageism (t(705) = 11.72, p < .001), relational ableism (t(705) = 6.73, p < .001), ableism for cognitive disability (t(705) = 2.15, p = .007), and ableism for sensory disability (t(705) = -2.78, p = .006). Examining the intersection between ageism and ableism represents the next critical juncture to increasing our understanding of developing effective anti-ageism interventions that address the root anxieties influencing attitudes about aging.

Impact of education and employment status on cognitive and physical disability in multiple sclerosis patients

Multiple sclerosis (MS) is the most common cause of non-traumatic disability in the young. Socioeconomic status – education and employment - are environmental factors that may influence MS genesis and disease course. We evaluate the impact of education and employment on cognitive and physical disability in a Romanian cohort of people with MS (pwMS). We analyzed data from 111 pwMS in our clinic. Isaacs set test (IST) and EDSS (Expanded Disability Status Scale) were used to evaluate cognition and physical function. Comparison of means and linear regression were used to characterize the relationship between education/employment and cognitive/physical evaluations. Individuals who fit in the ‘high’ education category had higher IST scores as compared to less educated subjects. Employed patients had significantly better IST scores. Linear regression showed that education can predict cognitive (p<.05, B=0.256, CI 0.042-0.469) and physical disability (p<.001, B= -0.43, 95% CI -0.607 to -0.264). EDSS scores were significantly lower in the ‘high education’ and employed groups. While the relationship between these factors is not yet fully comprehended, asking simple questions about one’s socioeconomic status could represent useful tools in evaluating and managing pwMS.

Non-lesional white matter changes depicted by q-space diffusional MRI correlate with clinical disabilities in multiple sclerosis

BackgroundWe previously developed an optimized q-space diffusional MRI technique (normalized leptokurtic diffusion [NLD] map) to delineate the demyelinated lesions of multiple sclerosis (MS) patients. Herein, we evaluated the utility of NLD maps to discern the white matter abnormalities in normal-appearing white matter (NAWM) and the abnormalities' possible associations with physical and cognitive disabilities in MS. MethodsWe conducted a retrospective observational study of MS patients treated at our hospital (Jan. 2012 to Dec. 2022). Clinical and MRI data were collected; Processing Speed Test (PST) data were obtained when possible. For a quantitative analysis of the NLD maps, we calculated the NLD index as GVROI/GVREF, where GV is a mean grayscale value in the regions of interest (ROIs) and the reference area (REF; cerebrospinal fluid). ResultsOne hundred-one individuals with MS were included. The lower corpus callosum and non-lesional WM NLD index were associated with worse Expanded Disability Status Scale (EDSS) and PST scores. The NLD indexes in the corpus callosum (p < 0.0001) and non-lesional white matter (p < 0.0001) were significantly reduced in progressive MS compared to relapsing-remitting MS. We categorized MS severity as moderate/severe (EDSS score ≥ 4 points) and mild (EDSS score < 4 points). The NLD indexes in the corpus callosum (p < 0.0001) and non-lesional white matter (p < 0.0001) were significantly lower in the moderate/severe MS group compared to the mild MS group. ConclusionThe NLD map revealed abnormalities in the non-lesional white matter, providing valuable insights for evaluating manifestations in MS patients.

Preventing amyloid-β oligomerization and aggregation with berberine: Investigating the mechanism of action through computational methods

Neurological disorders (NDs) have become a major cause of both cognitive and physical disabilities worldwide. In NDs, misfolded proteins tend to adopt a β-sheet-rich fibrillar structure called amyloid. Amyloid beta (Aβ) plays a crucial role in the nervous system. The misfolding and aggregation of Aβ are primary factors in the progression of Alzheimer's disease (AD). Inhibiting the oligomerization and aggregation of Aβ is considered as an effective strategy against NDs. While it is known that berberine analogs exhibit anti-Aβ aggregation properties, the precise mechanism of action remains unclear. In this study, we have employed computational approaches to unravel the possible mechanism by which berberine combats Aβ aggregation. The introduction of berberine was observed to delay the equilibrium of Aβ16–21 oligomerization. Initially, within the first 10 ns of simulation, β-sheets content was 12.89 % and gradually increased to 22.19 % within the first 20 ns. This upward trend continued, reaching 32.80 %. However, berberine substantially reduced the formation of β-sheets to 1.36 %. These findings decipher the potency of berberine against Aβ16–21 oligomerization, a crucial step for β-sheet formation. Additionally, a remarkable decrease in total number of hydrogen bonds was found in the presence of berberine. Berberine also led to a slight reduction in the flexibility of Aβ16–21, which may be due to the formation of a more stable structures. This study offers valuable insights at the mechanistic level, which could prove beneficial in the development of new drugs to combat NDs.

A Facility-Level Analysis of Nursing Home Compare's Five-Star Rating and Maryland's Family Satisfaction with Care Survey.

Nursing facilities care for individuals with cognitive and/or physical disabilities. Poor quality is associated with greater disease and mortality. Quality comprises many factors and different stakeholders value different factors. This study aimed to compare two care quality frameworks, one based on observable factors and one on family satisfaction. We merged publicly available 2021 Maryland nursing facility data. The Maryland Health Care Commission surveys long-term care residents' family satisfaction across seven domains. Centers for Medicare and Medicaid Services' (CMS) 5-star ratings aggregate inspections, staffing, and quality measures. We used univariate and bivariate statistics to compare the frameworks. The data set included 220 facilities and 4,610 survey respondents. The average facility rating was 7.70/10 and overall 77% of respondents would recommend the facility. Eighty-six percent of respondents from 5-star facilities, 79% from 4-star facilities, and 76% from 3-star facilities would recommend the facility compared to 65% from 1-star facilities (p < .001, p < .01, and p < .05, respectively). Four or 5-star facilities received significantly higher ratings (8.33, p < .001; 7.75, p < .05, respectively) than 1-star facilities (7.07). Our results corroborated earlier findings of strong associations between CMS ratings and satisfaction at the extremes of the 5-star system. These associations are inconsistent across family-reported domains. This suggests overlap between the frameworks. CMS ratings address care quality; family satisfaction measures quality of life and care quality. High satisfaction is associated with high care quality and quality of life; lower satisfaction is associated with lower care quality.

Level Of Patient’s Satisfaction with Physical Therapy Services in Public and Private Hospitals

Background: Physical therapy, a non-pharmacological intervention, plays a crucial role in aiding patients to improve disabilities and enhance their daily functional activities. Evaluating patient satisfaction is pivotal in understanding the efficacy of interaction and knowledge transfer between healthcare providers, particularly physical therapists, and their patients. Objective: This study aimed to assess the level of patient satisfaction with physical therapy services in public and private hospital settings in Gujrat, Pakistan. Methods: The study included 340 participants, selected through a non-probability convenience sampling technique from hospitals in Gujrat. The study encompassed patients from all conditions within the domain of physical therapy, who had attended at least one session of treatment. Exclusion criteria were set for patients with mental retardation, Parkinson’s disease, and cognitive disabilities. A 12-item MedRisk questionnaire was employed to evaluate patient satisfaction levels with physical therapy services. Results: The participant group comprised 141 males (41.5%) and 199 females (58.5%), with a mean age of 42.10 years (SD=15.80). Regarding the hospital setting, 177 participants received therapy in public hospitals, while 163 were treated in private hospitals. Satisfaction levels varied, with 9 participants (2.6%) reporting strong dissatisfaction, 159 (46.8%) expressing moderate satisfaction, and 172 (50.6%) indicating strong satisfaction. Specifically, in public hospitals, 9 participants were strongly dissatisfied, 113 moderately satisfied, and 55 strongly satisfied. In contrast, in private hospitals, no participants were strongly dissatisfied, 46 were moderately satisfied, and 117 were strongly satisfied. The statistical significance was marked with a p-value of 0.000. Conclusion: The study concluded that there was a higher level of satisfaction with physical therapy services in private hospitals compared to public hospitals in Gujrat. This finding underscores the need for continual improvement and evaluation of patient care standards in different healthcare settings.

Digital participation in traumatic brain injury: scoping review about assessment tools for computer-mediated communication

BackgroundIndividuals with chronic traumatic brain injury (TBI) are often affected by communication disorders which might have an impact on their social participation. Due to possible cognitive and communicative disabilities, as well as impairments of social cognitive skills, individuals with TBI have been observed to exhibit difficulties in maintaining and establishing social relationships, resulting in a greater risk of social isolation. This applies to both in-person as well as computer-mediated communication (CMC), which is considered an integral part of everyday life. Research on digital participation in the TBI population has focused on the possible challenges and barriers, but also on the benefits of CMC for social interactions. Guidelines from professional societies recommend questionnaires and checklists for assessing restrictions of communicative participation (e.g., ASHA, INCOG). However, there is no overview of whether the available instruments can capture digital aspects of participation or social media use in TBI.AimIn this scoping review, following the PRISMA criteria, we aimed to provide an overview over currently available instruments that help assess CMC use as a measure of digital participation in the TBI population.MethodThe databases Web of Science Core Collection, Ovid, PsycInfo and Psyndex were screened for publications between the years 2013 and 2023 with relevant search terms referring to social participation, assessment tools, CMC and the target group, in order to find suitable tools to assess digital participation in individuals with TBI. In a multistage selection process following the PRISMA criteria, the instruments found were examined in terms of items that assess digital participation. The outcome of the review is an overview of the status quo of potentially available instruments that capture aspects of CMC.ResultsFollowing a screening on title/abstract and full-text level, a total of 10 studies could be identified that present assessment tools that evaluate CMC use as a measure of digital participation in the TBI population. Said studies were analyzed and compared in terms of content according to the selected parameters.ConclusionDigital participation is an important aspect of everyday lives for individuals with TBI. Therefore, CMC should be an integral part of rehabilitation. The existing appropriate questionnaires uncovered in the current study should therefore be applied routinely to detect impairments in CMC and digital participation. Overall, however, there is still a great need for research in the field of CMC, both regarding methods for measuring digital participation disorders as well as resources.Systematic Review Registrationhttps://www.germanistik.uni-muenchen.de/forschung/proj_gl/review_participation_tbi.pdf.

A quantitative analysis of human rights-related attitude changes towards people with mental health conditions and psychosocial, intellectual, or cognitive disabilities following completion of the WHO QualityRights e-training in Ghana

BackgroundDespite growing recognition of essential human rights, people with mental health conditions and psychosocial, intellectual, or cognitive disabilities’ rights are known to be frequently violated in mental healthcare worldwide, with common use of coercive practices and limited recognition of people’s right to exercise their legal capacity and make decisions for themselves on treatment and other issues affecting them. To tackle this issue, Ghana adopted the WHO QualityRights Initiative in 2019. This aims to introduce a right-based, person-centred recovery approach within the mental health care system, protecting and promoting the rights of people with mental health conditions, psychosocial, cognitive, and intellectual disabilities in the healthcare context and community.MethodsE-training (capacity-building) was provided in Ghana across a broad array of stakeholder groups including healthcare professionals, carers, and people with lived experience. The training covered legal capacity, coercion, community inclusion, recovery approach, service environment, and the negative attitudes commonly held by stakeholder groups; it was completed by 17,000 people in Ghana as of December 2021. We assessed the impact of the e-training on attitudes through comparing trainees’ pre- and post-questionnaire responses on 17 items, each measured on a 5-point Likert scale (strongly disagree to strongly agree), such that higher scores indicated negative attitudes towards persons with mental health conditions and psychosocial disabilities as rights holders. Analyses were conducted on two main groups: matched pairs (417 pairs of baseline and follow-up questionnaire responses matched to a high degree of certainty), and the unmatched group (4299 individual completed questionnaire responses).ResultsWe assessed the impact of the WHO QualityRights e-training on attitudes: training resulted in highly significant attitude changes towards alignment with human rights, with scores changing by approximately 40% between baseline and follow-up. In particular, attitude changes were seen in items representing treatment choice, legal capacity, and coercion. This change was not affected by age, gender, or background experience.ConclusionsThe QualityRights e-training programme is effective in changing people’s (especially healthcare professionals’) attitudes towards people with mental health conditions and psychosocial, intellectual, or cognitive disabilities: this is a step towards mental healthcare being more with human rights-based worldwide.

Making evidence-based practice actionable in the social service context: experiences and implications of workplace education

PurposeResearch and experience show that evidence-based practice (EBP), i.e. using the best available knowledge in daily professional work, is difficult to achieve in social services. The purpose of this study is to understand the development of organizational EBP learning processes in daily work through workplace education for staff and managers of supported homes for people with cognitive disabilities. The authors examine how the EBP model and new knowledge are understood and made actionable in the workplace, applying theories of organizational learning.Design/methodology/approachThe authors used empirical material collected from an EBP workplace education pilot in Sweden, as well as documents on national EBP implementation in Swedish social services. Before the pilot, a focus group interview was conducted with regional senior managers. Participating managers and staff were individually interviewed two to three years after the pilot.FindingsThe study illustrates how knowledge-based action emerged from education where EBP was interpreted, understood, reflected on, and tested, supported by codified EBP tools in the work context. The participants, when supervised, and when observing and questioning their own behaviors in practice, contributed to double-loop learning (DLL) processes. Codification of EBP knowledge into useful tools and socialization processes during education and workplace meetings was crucial in developing individual and group DLL and knowledge-based actions.Originality/valueThe bottom-up approach to EBP development and the adaptive contextual learning at the workplace gave new insights into organizational learning in social service workplaces.

Navigating Sex-Specific Disease Dynamics in Incident Dementia.

Dementia is among the leading causes of cognitive and functional loss and disability in older adults. Past studies suggested sex differences in health conditions and progression of cognitive decline. Existing studies on the temporal trajectory of health conditions for patient characterization after dementia diagnosis are scarce and ambiguous. Thus, there's limited and unclear research on how health conditions change over time after a dementia diagnosis. To this end, we aim to analyze the shift in medical conditions and examine sex-specific changes in patterns of chronic health conditions after dementia diagnosis. We centered our analysis on a 15-year window around the point of dementia diagnosis, encompassing the 5 years leading up to the diagnosis and the 10 years following it. We introduce (i) MedMet, a network metric to quantify the contribution of each medical condition, and (ii) growth and decay function for temporal trajectory analysis of medical conditions. Our experiments demonstrate that certain health conditions are more prevalent among females than males. Thus, our findings underscore the pressing need to examine differences between men and women, which could be important for healthcare utilization after a dementia diagnosis.

Importance of individual dietary factors for cognitive performance in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, FINGER

AbstractBackgroundFinnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a randomized trial that showed beneficial effect on cognition with a 2‐year multidomain lifestyle intervention. One of the four multidomain intervention components was diet and we have earlier shown that overall adherence to the FINGER dietary intervention goals was associated with better cognition. Here our aim is to investigate how the individual components of the dietary adherence score are associated with cognitive performance during the 2‐year period.MethodThe FINGER cohort included 1259 individuals at risk of dementia aged 60‐77 years at baseline, randomized into the multidomain intervention (n = 631) or the control group (n = 628). They underwent extensive data collection annually (total of 3 assessments), including detailed neuropsychological test battery (NTB) and a 3‐day food record. Adherence to dietary intervention was evaluated on 9 items based on dietary recommendations: intake of saturated fat, polyunsaturated fat, sucrose, fiber, protein, alcohol, vegetables, fruits, and fish. Data analyses were completed with mixed‐effects regression.ResultThe goal for low alcohol intake was inversely associated with cognition at baseline, but no other dietary items showed cross‐sectional associations. Reaching the goal for saturated fat, fiber, vegetables, fruits, and fish predicted better cognitive change at two years (p &lt;0.05 for goal*time each). Results were similar when continuous variables rather than dichotomized goals were investigated. Intake of polyunsaturated fats additionally predicted better cognitive change and vegetable intake showed positive cross‐sectional association with cognition. There were no significant interactions with the study group.ConclusionSix out of nine FINGER dietary goals predicted a favorable cognitive change over time, indicating that a dietary pattern adherence with general dietary recommendations is beneficial for brain health. However, alcohol intake goal, i.e. lower alcohol intake, was associated with worse cognition; and cut‐offs for polyunsaturated fats based on the recommendations appeared suboptimal. The FINGER dietary adherence score should be compared with food‐based dietary patterns like Mediterranean Diet to investigate if nutrient intakes should be better taken into account when analyzing diet in relation to cognitive performance.

Health care service use in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) during an extended follow‐up period

AbstractBackgroundFinnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a randomized trial aiming to prevent cognitive decline with a 2‐year multidomain lifestyle intervention. Beneficial effects were detected not only in cognition, but also for co‐morbidity, as reported earlier. Aim of this work was to investigate, if the multidomain intervention also had an impact on the health care use and to evaluate possible cost‐effectiveness of the interventions in terms of health care costs.MethodThe FINGER trial recruited a population‐based cohort of 1259 at‐risk individuals aged 60‐77 living in six areas of Finland. They were randomized into a multidomain lifestyle intervention consisting of diet, exercise, cognitive training and vascular risk management (n = 631) or a regular health advice (control) (n = 628) group for two years and followed on average for 8 years. Health care use was obtained from nationwide registers where all primary and specialized care visits are recorded. We calculated days spent in hospital, ambulatory visits, outpatient visits in hospitals and primary care, and home care. Costs will be evaluated based on national reference prices.ResultAltogether 99% of the population used some health care services and 66% were hospitalized at least for one day during the 8 years. 128 (10%) participants died during the follow‐up. Preliminary data indicated that the intervention group spent less days in the hospital, but there were no differences in outpatient visits. Further analyses are ongoing to evaluate the costs related to these visits.ConclusionMultidomain lifestyle intervention which is effective in prevention of cognitive decline can also help in reducing health care use at least in terms of hospital stays.

Integrating Students with Disabilities at the “Nicolae Bălcescu” Land Forces Academy of Sibiu

Abstract In 2010 Romania ratified the provisions stipulated in the Convention on the Rights of Persons with Disabilities. Various studies have highlighted the lack of opportunities, in almost all the domains of social life, for those that struggle with physical or cognitive disabilities, despite the fact that with adjustments, which sometimes require minor investments or just a change of mentality, they could become valuable resources for society. Our paper focuses on the manner in which the education of the students with disabilities can be facilitated at the “Nicolae Bălcescu” Land Forces Academy. Even though at present, in Romania, the military recruitment criteria do not permit the admission of students with disabilities for various reasons of security, numerous modalities can be found to integrate and to employ them, especially due to the endowment of the Academy and to the rapid advancement of technology.

Energy poverty and functional disability nexus: Empirical evidence from Ghana

Energy poverty in developing low- and middle-income economies continues to persist, especially in sub-Saharan Africa. However, empirical studies that examine the channels through which it impacts well-being indicators remain scanty. The growing occurrence of functional disabilities in hearing, vision, mobility, communication, self-care, and cognition, therefore, provides an untapped means of examining the energy poverty and well-being nexus. Against this backdrop, this study uses data from the 10 % microdata of Ghana's recent Population and Housing Census to analyze a modified multidimensional energy poverty for 835,695 households. Underpinned by the capability framework, the structural equation modeling technique was employed to examine the nexus between energy poverty and functional disability. The findings reveal significant positive impact of energy poverty on functional disability and notably, geographical, gender, and age-group differences. Also, a high incidence of modified multidimensional energy poverty was found with greater intensity among rural residents, savanna zone inhabitants, elderly people, and female-headed households. These findings reveal the policy relevance and urgency to alleviate energy poverty to check functional decline and promote household well-being.

Association between physical function and neuroimaging measures in a 2‐year multidomain lifestyle randomized controlled trial

AbstractBackgroundThis exploratory study investigated associations between physical function and neuroimaging biomarkers: brain magnetic resonance imaging (MRI) and Pittsburgh compound B‐positron emission tomography (PiB‐PET) measures during the 2‐year Finnish Geriatric Intervention Study to prevent cognitive impairment and disability (FINGER).MethodFINGER targeted 60–77‐year‐old general population at‐risk and without dementia or substantial cognitive impairment. Measures of physical function (activities of daily living (ADL), hand grip strength, physical performance, Fried’s frailty phenotype index and self‐rated health) from baseline and 2‐year visits were used. Baseline neuroimaging measures, MRI (hippocampus, total gray matter volumes, Alzheimer’s disease (AD) signature cortical thickness) were available for 115‐132 participants and PiB‐PET (composite score) for 44‐48 participants. Linear and logistic regressions were used to test the cross‐sectional associations and the impact of baseline imaging measures on changes in physical function. Models were adjusted for site, sex and education.ResultCross‐sectionally, higher ADL were associated with higher hippocampus volume (β = 0.18 p = 0.048), total gray matter volume (β = 0.15 p = 0.005) and AD signature cortical thickness (β = 0.25 p = 0.006) while stronger hand grip and was associated with higher total gray matter volume (β = 0.20 p = 0.041) significantly. Baseline imaging measures were associated with changes in physical function: higher baseline hippocampus volume was associated with maintenance/improvement in the ADL (OR = 0.56 p = 0.039) while lower hippocampus at baseline predicted poorer physical performance over time (OR = 1.66 p = 0.036).ConclusionHigher brain integrity is associated with better physical function while lower baseline brain integrity predicts poorer physical function over time.

FC47: To use or not to use? Multiple perspectives on residents’ alcohol and tobacco use in residential care facilities

Objectives:Residential care facilities (RCFs) provide 24/7 care to older adults with cognitive and/or physical disabilities. RCFs aim to provide person-centred care (PCC) to enhance the quality of life (QoL) of residents. Residents are dependent on their environment to fulfil their needs and wishes, such as drinking alcohol or smoking tobacco. Although alcohol and tobacco use can be experienced as a part of QoL in the final phase of life and the motivation to quit these substances is low, it can cause severe health problems in older adults. In RCFs this may cause a dilemma between the QoL of individual residents and the health and safety problems of all residents. This study aims to explore multiple perspectives on alcohol and tobacco use within the RCF.Methods:A qualitative research design was chosen, and semi-structured interviews were conducted. A various sample was purposively selected in two organizations on two types of units (psychogeriatric units and units providing care for residents with mainly physical disabilities): residents who use alcohol and/or tobacco and those who do not. Subsequently, four of these 16 residents were invited to participate in an in-depth case study. To explore the dynamics of the social environment, both formal and informal caregivers were invited to participate.Results:Residents are satisfied with their current use and value their autonomy regarding alcohol and tobacco use. Residents acknowledge that their use could cause a nuisance to others. Multiple caregivers are involved in their use and residents experience dependency on these caregivers to smoke tobacco or drink alcohol. There was limited interaction between the residents and their (in)formal caregivers and amongst the caregivers on this topic. Moreover, caregivers tended to act from their own perspectives, based on their professional expertise, knowledge, and attitudes towards residents’ alcohol and tobacco use.Conclusion:A dilemma arises between protecting residents from the adverse (health) outcomes of alcohol and tobacco use and sustaining their QoL by optimizing their autonomy. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health, and safety risks for all.

Alzheimer’s disease genetic risk score and neuroimaging biomarkers in the FINGER multidomain lifestyle randomized controlled trial

AbstractBackgroundA comprehensive genetic risk score (GRS) for Alzheimer’s disease (AD‐GRS) was recently developed based on 83 genome‐wide significant variants (Bellenguez et al. Nat Genet. 2022), excluding APOE. This study investigated AD‐GRS and APOE4 in relation to neuroimaging biomarkers in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER).MethodFINGER included at‐risk individuals without dementia from the general population, aged 60‐77 years. Participants were randomized to either 2‐year multidomain lifestyle‐based intervention or regular health advice. At baseline, 132 participants underwent MRI scans, of which 48 also underwent PET scans (PiB/FDG). Two years later, 112 and 39 repeated their scans, respectively. MRI measures included hippocampus, total gray matter and white matter lesion volumes, and cortical thickness. Composite indices were calculated for PiB and FDG uptake values. We report preliminary results from linear regressions (standardized β‐coefficients, p‐values).ResultAt baseline, higher AD‐GRS tended to relate to lower hippocampus volume (β = ‐0.15, p = 0.07) and FDG‐PET index (β = ‐0.23, p = 0.08); this remained after APOE adjustment. APOE4 was associated with lower hippocampus volume (β = ‐0.27, p = 0.001) and higher PiB‐PET index (β = 0.48, p = 0.001). Overall, AD‐GRS was not related to the 2‐year change in neuroimaging measures, while APOE4 was related to decreasing hippocampus (β = ‐0.27, p = 0.01) and total gray matter (β = ‐0.25, p = 0.01) volumes, and cortical thickness (β = ‐0.28, p = 0.003). There were no significant interactions of AD‐GRS or APOE4 with randomization group in relation to neuroimaging changes. However, in analyses stratified by AD‐GRS (below vs above median), there was less PIB index increase in intervention vs control in the higher AD‐GRS group (β = ‐0.60, p = 0.03); no intervention control‐difference was found in the lower AD‐GRS group (β = 0.04, p = 0.86). In analyses stratified by APOE4, PIB index tended to increase less in intervention vs control in non‐carriers (β = ‐0.38, p = 0.078), with no intervention‐control difference in carriers (β = 0.05, p = 0.89).ConclusionUnlike APOE4, AD‐GRS was not related to 2‐year change in AD‐related neuroimaging measures. AD‐GRS and APOE4 may also have very different impact on potential intervention effects on amyloid, i.e. less accumulation in the higher‐risk group (AD‐GRS) vs lower‐risk group (APOE). However, these exploratory findings need to be verified in larger studies.

The Correlation Between Serum Level of Interleukin-17A with Cognitive Impairment and Disability in Multiple Sclerosis Patients

The Correlation Between Serum Level of Interleukin-17A with Cognitive Impairment and Disability in Multiple Sclerosis Patients

Higher glucose parameters at baseline are related to hippocampal volume decline after a 2‐year multidomain lifestyle intervention to prevent cognitive decline in people at risk of developing Alzheimer’s disease: Exploratory results from the FINGER study

AbstractBackgroundLifestyle interventions for preventing cognitive decline have provided promising results in older at‐risk individuals. Two modifiable risk factors are insulin resistance and diabetes mellitus, since they’ve been associated with higher risk of cognitive decline. However, it remains unclear if healthy individuals with higher normal glucose levels are free from suffering the negative effect of pathological glucose values on brain and cognition. The Oral Glucose Tolerance Test (OGTT) is a sensitive measurement for non‐detected glucose metabolism disorders and might be related with changes in brain structure and cognition. In this study we hypothesised that changes in glucose parameters will be associated with brain structural changes.Method1.259 participants of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) were included [Table 1]. A sample of 132 participants had brain MRI scans, and 47 also underwent PiB‐PET and FDG‐PET scans. Global GMv, hippocampal volumes, WMHv and cortical thickness measurements were analysed to assess the association between brain structural changes and glucose homeostasis. AD‐signature composites were also calculated from FDG‐PET and PiB‐PET scans data for the analysis. SPSS was used for linear regression models.ResultsBaseline AUC‐OGTT, 120min‐OGTT and fasting glucose were negatively associated (p&lt;0.05) with 2‐year change in hippocampal volume [Table 2]. A negative association was also found between baseline AUC and change in FDG‐PET‐AD‐composite (p = 0.028). Three negative associations were additionally found at baseline between AUC‐OGTT and cortical thickness (p = 0.015), fasting glucose and total GMv (p = 0.015), and HbA1c and FDG‐PET‐AD‐composite (p = 0.033) [Table 3]. Interestingly, a positive association was found in a smaller sample (n = 38) between the TyG index and change in PiB‐PET‐AD‐composite (0.014). No associations were found between glucose parameters and the remaining imaging data.ConclusionIn a sample of participants at risk for dementia, baseline higher measures of peripheral glucose metabolism such as AUC‐OGTT and 120min‐OGTT glucose were related to greater decline in hippocampal volume, irrespective of the randomisation group and after considering abnormal glucose metabolism. These results suggest that glucose homeostasis might have an impact on brain structure in participants with higher normal glucose parameters measurements.