Dementia-related Illnesses Research Articles

Actuales retos diagnósticos a partir de un análisis de características Sociodemográficas de 2453 pacientes de una Clínica de Memoria y Cognición

Introducción y objetivo : al programa de la Clínica de Memoria del Hospital Universitario San Ignacio (CM PUJ-HUSI) en Colombia, consultan, cada vez más pacientes con estadíos más tempranos de demencia. Estos plantean un reto para distinguir no solo entre los tipos de demencia, sino también entre las condiciones que pueden compartir algunas características con las enfermedades demenciales. A partir de un estudio descriptivo se analizan las variables sociodemográficas, resultados de la valoración y diagnóstico por consenso de los pacientes que asistieron por primera vez al programa y se proponen los retos diagnósticos actuales.
 Materiales y métodos: se realiza un estudio descriptivo de corte transversal de los pacientes que asisten por primera vez a la CM PUJ-HUSI desde septiembre de 1996 hasta mayo del 2014.
 Resultados: aunque el diagnóstico más frecuente sigue siendo la demencia tipo Alzheimer (43,45%), el diagnóstico de la demencia frontotemporal ha ido en aumento (de 5,49 a 11,5%), con una disminución de los diagnósticos psiquiátricos (de 14,31 a 7,7%). Las escalas aplicadas para la evaluación de los pacientes se encuentran, en diferentes proporciones, alteradas en todos los grupos de pacientes, incluyendo aquellos considerados normales.
 Conclusiones: hubo evidencia de cambios significativos en el tipo de pacientes remitidos a la CMPUJ-HUSI que generan dificultad en establecer un diagnóstico definitivo, principalmente en enfermedades neurodegenerativas (EN) o demencia de inicio temprano (DIT). Se establece la necesidad de utilizar herramientas diagnósticas más precisas como las entrevistas e instrumentos que den cuenta de variables de conducta, comportamiento o cognición social.

Does self-directed learning address gaps in nursing student knowledge of Alzheimer’s disease?

ABSTRACT In the past two decades, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from age-related Alzheimer’s disease (AD) have increased. Future nurses will be caring for the rapidly escalating number of older adults facing increased AD risk, yet nursing students’ knowledge has been shown to be limited regarding the age-related disease of Alzheimer’s (and the most common dementia type) (Aljezawi et al., 2022; Mattos et al., 2015). In this pilot study, a quasi-experimental approach was used to examine undergraduate baccalaureate nursing students’ basic knowledge about AD among two cohorts (N = 146). Testing occurred following an assigned self-directed learning activity as a means of providing the most current information regarding dementia. Pearson correlation and t-tests were applied in comparing student results in pre- and posttest surveys and investigating possible correlations between sociodemographic variables. Students in the 2020 group scored lower on ten of the thirty test items than the earlier 2018 cohort, suggesting that the method of self-directed learning, despite offering the most recent information, may be inadequate. To prepare nursing students to care for the increasing numbers of older adults at risk for Alzheimer’s disease, curricula that are inclusive of the most recent advances in science surrounding dementia-related illnesses, and supplemented by faculty lectures, is recommended. This requires faculty themselves to be knowledgeable of the most recent advances in dementia risk, prevention, detection and management.

Brain Exercising Games With Consumer-Grade Single-Channel Electroencephalogram Neurofeedback: Pre-Post Intervention Study.

BackgroundThe aging population is one of the major challenges affecting societies worldwide. As the proportion of older people grows dramatically, so does the number of age-related illnesses such as dementia-related illnesses. Preventive care should be emphasized as an effective tool to combat and manage this situation.ObjectiveThe aim of this pilot project was to study the benefits of using neurofeedback-based brain training games for enhancing cognitive performance in the elderly population. In particular, aiming for practicality, the training games were designed to operate with a low-cost consumer-grade single-channel electroencephalogram (EEG) headset that should make the service scalable and more accessible for wider adoption such as for home use.MethodsOur training system, which consisted of five brain exercise games using neurofeedback, was serviced at 5 hospitals in Thailand. Participants were screened for cognitive levels using the Thai Mental State Examination and Montreal Cognitive Assessment. Those who passed the criteria were further assessed with the Cambridge Neuropsychological Test Automated Battery (CANTAB) computerized cognitive assessment battery. The physiological state of the brain was also assessed using 16-channel EEG. After 20 sessions of training, cognitive performance and EEG were assessed again to compare pretraining and posttraining results.ResultsThirty-five participants completed the training. CANTAB results showed positive and significant effects in the visual memory (delayed matching to sample [percent correct] P=.04), attention (median latency P=.009), and visual recognition (spatial working memory [between errors] P=.03) domains. EEG also showed improvement in upper alpha activity in a resting state (open-eyed) measured from the occipital area (P=.04), which similarly indicated improvement in the cognitive domain (attention).ConclusionsOutcomes of this study show the potential use of practical neurofeedback-based training games for brain exercise to enhance cognitive performance in the elderly population.

COVID-19: Review of a 21st Century Pandemic from Etiology to Neuro-psychiatric Implications.

COVID-19 is a severe infectious disease that has claimed >150,000 lives and infected millions in the United States thus far, especially the elderly population. Emerging evidence has shown the virus to cause hemorrhagic and immunologic responses, which impact all organs, including lungs, kidneys, and the brain, as well as extremities. SARS-CoV-2 also affects patients’, families’, and society’s mental health at large. There is growing evidence of re-infection in some patients. The goal of this paper is to provide a comprehensive review of SARS-CoV-2-induced disease, its mechanism of infection, diagnostics, therapeutics, and treatment strategies, while also focusing on less attended aspects by previous studies, including nutritional support, psychological, and rehabilitation of the pandemic and its management. We performed a systematic review of >1,000 articles and included 425 references from online databases, including, PubMed, Google Scholar, and California Baptist University’s library. COVID-19 patients go through acute respiratory distress syndrome, cytokine storm, acute hypercoagulable state, and autonomic dysfunction, which must be managed by a multidisciplinary team including nursing, nutrition, and rehabilitation. The elderly population and those who are suffering from Alzheimer’s disease and dementia related illnesses seem to be at the higher risk. There are 28 vaccines under development, and new treatment strategies/protocols are being investigated. The future management for COVID-19 should include B-cell and T-cell immunotherapy in combination with emerging prophylaxis. The mental health and illness aspect of COVID-19 are among the most important side effects of this pandemic which requires a national plan for prevention, diagnosis and treatment.

Lifelong Learning

The struggles faced by elder learners suffering from age-related cognitive decline are often overlooked by instructional designers. However, existing educational theories that already inform learning strategy development for other populations should also help establish instructional methods used to help elder learners. In this article, cognitive load theory frames an exploration of proposed means to slow or counteract the effects of age-related cognitive decline in elder learners. Attention is given to the ways in which multimedia learning methods adhering to certain principles of cognitive load theory can increase available working memory capacity. Evidence is provided to show that cognitive load theory-based practices can also facilitate one’s activation of prior knowledge and betters one’s attentional control. Additionally, elder learners benefit from tasks that include worked examples and goal-free problems, whereas conventional, goal-oriented problems impose greater extraneous load on an already taxed working memory. The outcomes of the present analysis can also be applied to stroke victims’ rehabilitation plans and may offer implications for individuals suffering from other brain injuries, attention deficit-hyperactivity disorder, or dementia-related illnesses.

Nursing students' knowledge about Alzheimer's disease.

Every 66 seconds a U.S. resident develops Alzheimer's disease (AD). Future nurses will be caring for the rapidly escalating number of adults turning 65, yet information regarding nursing students' knowledge about the age-related disease of Alzheimer's is limited. The purpose of this study was to examine 102 Florida baccalaureate nursing students' basic and advanced AD knowledge. A descriptive design using two AD knowledge measures and analysis using paired samples t-test were employed. Although the setting was a region of the U.S. with the highest percentage of older adults, knowledge deficits regarding age-related Alzheimer's disease were striking. Students' basic knowledge was significantly higher than their advanced AD knowledge (t(101) = 2.28, p = .027). Only 31% of students identified that high cholesterol may increase risk. Just 20% of students correctly answered that exercise does not prevent AD. About 25% correctly responded that the average life expectancy after the onset of AD is 6-12 years. Only 2% of nursing students correctly identified that persons with AD experience stress from disease-related symptoms. Overall, less than 50% of students correctly answered any item on the measure designed for use among health care providers. To better prepare nursing students to care for the increasing numbers of older adults facing risk of AD, updated curricula targeting dementia-related illnesses are essential. Information is offered regarding current state of the science resources of benefit to faculty, students, and practicing nurses, such as experiential learning and Hartford Institute of Geriatric Nursing collaborative programs.

Twenty years of home-based palliative care in Malappuram, Kerala, India: a descriptive study of patients and their care-givers

BackgroundThe well lauded community-based palliative care programme of Kerala, India provides medical and social support, through home-based care, for patients with terminal illness and diseases requiring long-term support. There is, however, limited information on patient characteristics, caregivers and programme performance. This study was carried out to describe: i) the patients enrolled in the programme from 1996 to 2016 and their diagnosis, and ii) the care-giver characteristics and palliative care support from nurses and doctors in a cohort of patients registered during 2013–2015.MethodsA descriptive study was conducted in the oldest community-based palliative clinic in Kerala. Data were collected from annual patient registers from 1996 to 2016 and patient case records during the period 2013–2015.ResultsWhile 91% of the patients registered in the clinic in 1996 had cancer, its relative proportion came down to 32% in 2016 with the inclusion of dementia-related illness (19%) cardiovascular accidents (17%) and severe mental illness (5%).Among patients registered during 2013–15, the median number of home visits from nurses and doctors in 12 months were five and one respectively. In the same cohort, twelve months’ post-enrolment, 56% of patients died, 30% were in continuing in active care and 7% opted out. Those who opted out of care were likely to be aged < 60 years, received one or less visit annually from a doctor or have a serious mental illness. 96% of patients had a care-giver at home, 85% of these care-givers being female.ConclusionsThe changing dynamics over a 20-year period of this palliative care programme in Kerala, India, highlights the need for similar programmes to remain flexible and adapt their services in response to a growing global burden of Non Communicable Diseases. While a high death rate is expected in this population, the high proportion of patients choosing to stay in the programme suggests that home-based care is valued within this particular group. A diverse range of clinical and psycho-social support skills are required to assist families and their caregivers when caring for a cohort such as this one.

Abstract 18245: Palmitic Acid-induced Endothelial Dysfunction in Human Leptomeningeal and Adipose Arterioles

Introduction: Epidemiologic data show strong link between cardiovascular risk factors and dementia-related illnesses (DRI) such as Alzheimer’s disease (AD) with evidence that the earliest changes in AD involve vascular dysfunction. The mechanisms behind vascular impairment in DRI remain poorly understood, and lack of a human model to study them impedes progress towards a cure. Aim: The aim of the study is to determine the effects of acute exposure to palmitic acid (PA), a saturated fatty acid implicated in atherosclerosis, on endothelium-dependent and smooth muscle dependent function in human leptomeningeal arterioles (LMA) and peripheral adipose tissue arterioles (AA). Methods: LMA from cadavers of brain donors (post-mortem interval 3.3±0.4 hours; 2 with mild cognitive impairment, 1 Parkinson's disease, 1 Lewy body dementia) and abdominal subcutaneous AA from living subjects with no vascular disease undergoing routine surgery were isolated, cannulated and pressurized. Following preconstriction with endothelin-1, baseline (control) dilation response to acetylcholine and papaverine was measured. Arterioles were then exposed to 1 hour of PA (150 μM) and a second dilation response was measured. Results: (see Figure) PA decreased dilator response to acetylcholine in both LMA and AA (PA-induced change in dilator response to acetylcholine 10-4M: -28.1±6.8 % for LMA and -33.8±7.4% for AA, both p&lt;0.05 versus baseline control). There was no significant reduction in dilator response to papaverine. The changes in dilator response with PA versus control were not different between LMA and AA. Conclusions: Acute exposure to PA induced endothelial dysfunction in human leptomeningeal arterioles suggesting a potential mechanism for vascular dysfunction that could contribute to AD. Similarity in response to saturated fatty acid between LMA and AA suggests that AA, which is easier to obtain, may be a novel surrogate human model to study brain microvascular function.

Strategies for research recruitment and retention of older adults of racial and ethnic minorities.

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.4 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Strategies for Research Recruitment and Retention of Older Adults of Racial and Ethnic Minorities" found on pages 14-23, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until April 30, 2018. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVE 1. Identify strategies and barriers for the recruitment and retention of older adults of racial and ethnic minorities in cognitive aging research. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. The numbers of Hispanic and African American older adults in the United States are expected to increase by 86% and more than 31%, respectively. African American and Hispanic American individuals are more likely than Caucasian individuals to have chronic health conditions, and researchers have argued that these health disparities may contribute to their higher rates of dementia-related illnesses. The current article explores strategies to improve participation in cognitive aging research by older adults, particularly minority older adults. The cultural aspects of cognitive aging are examined, especially the role of stigma and stereotype threat. The perceptions of cognitive aging of African American and Hispanic older adults are also described. Specific strategies are presented that have been successfully implemented to improve recruitment and retention in research targeting minority older adults. Strategies that yielded retention of minority older adults included advertising and marketing a randomized clinical trial, media relations, intervention tailoring, and adaptation of psychometric instruments.

Moving and handling: support for residents with dementia

The majority of residents in care homes have a dementia-related illness. Moving and supporting people with memory problems can be challenging but Melanie Sturman-Floyd advises careful risk assessment and training to minimise injury risks to employees

Editorial: Epidemiologic Reviews 2013--Special Issue on the Epidemiology of Aging

The papers in this volume (1–13 )r eflect substantial and diverse epidemiologic research activity on some of the major health problems of older people. When the call for papers was announced, no particular themes within this vast field of the epidemiology of aging were suggested or encouraged. This led to a series of reviews covering a breadth of modern and important topics. These topics touch many disciplines that dovetail with the science of aging, including evaluating putative social and biological risk factors for age-related change and survivorship, identifying biological processes and modern biomarkers of aging, and exploring aging outcomes in older populations, such as the issue of multimorbidity among older Americans and military veterans in Canada and other countries. Several papers review risk factors for altered cognitive function and dementia-related illnesses. Although firm conclusions are not always possible given the state of the science, important directions for moving forward are offered. The preventive potential of these works is always close to the surface. The papers also encompass some of the general themes and challenges of population aging research. The importance of life-course concepts in the epidemiology of aging is present in several reports. For example, the report by Dahl and Hassing (2) finds an association of midlife obesity and late-life cognitive function. Other reports also address the problem of accurately identifying early life exposures that predict late-life age-related changes. The incorporation of modern biological indicators of aging and survivorship, such as genetic and genomic factors (13) and telomere length (9), reflects the importance of molecular approaches to the long-standing quest for biomarkers of the progression of age-related change, biomarkers that are precise and robust across populations. As these biomarkers are validated, they will take their places as useful prognostic factors for personalized medicine. However, to be useful, such biomarkers need to be generally independent of untoward environmental exposures and the variety of diseases that are prevalent in older populations, a common problem noted in the report by Salive (6). Other reports in this volume denote the great variation in health and function among older populations, highlighting the challenges for defining preventive approaches for older persons that can reach large segments of this very heterogeneous group. Although new methodological approaches are always welcome, collectively this collection of review papers bespeaks the active international activity in population aging and points to directions in understanding aging mechanisms; defining potential biological, clinical, and social intervention studies to enhance successful aging; and providing more targeted, efficient, and effective approaches to delivering health services to older persons. The epidemiology of aging is alive and well!

Compromised visually guided motor control in individuals with Alzheimer’s disease: Can reliable distinctions be observed?

Identifying the multitude of deficits associated with dementia-related illnesses such as Alzheimer’s disease (AD) presents a significant challenge for many health care facilities, particularly as current screening procedures may lack the sensitivity to highlight all the relative functional deficits within these populations. Although quick assessment screening tools, such as the Mini Mental State Exam (MMSE), have been the mainstay in screening patients worldwide, there are limitations to their ability in identifying visuomotor (VM) impairment. Thus, the primary objective of this research was to evaluate the presence and level of VM ability/deficits in healthy normal controls (NC) and populations with AD. The research also aimed to demonstrate that a VM measure can be utilized successfully in a busy health care setting. Results showed a clear distinction between the AD and NC groups on the VM measure. Large effect size differences were observed between groups, particularly as the VM task progressed through its varying conditions. In addition, this novel VM assessment measure demonstrated good presentation and speed and was appropriate for frontline staff in a primary healthcare setting to undertake further examination of an individual’s overall visually guided ability/control.

Social Commitment Robots and Dementia

In 2010, approximately 500,000 Canadians suffered from a dementia-related illness. The number of sufferers is estimated to double in about 25 years. Due to this growing demographic, dementia (most frequently caused by Alzheimer's disease) will increasingly have a significant impact on our aging community and their caregivers. Dementia is associated with challenging behaviours such as agitation, wandering, and aggression. Care providers must find innovative strategies that facilitate the quality of life for this population; moreover, such strategies must value the individual person. Social commitment robots - designed specifically with communication and therapeutic purposes - provide one means towards attaining this goal. This paper describes a study in which Paro (a robotic baby harp seal) was used as part of a summer training program for students. Preliminary conclusions suggest that the integration of social commitment robots may be clinically valuable for older, agitated persons living with dementia in long-term care settings.

Promoting Cognitive Health and Vitality: A Review of Clinical Implications

To maintain cognitive health and vitality, multidimensional cognitive structures must be developed and preserved. With a focus on patient education and health promotion, nurses in general, and geriatric nurses in particular, can proactively address concerns and fears that their patients have about dementia-related illnesses through strategies geared at promoting cognitive health and sustaining abilities. A clinical review of the research literature on the topic of cognitive health revealed the transdisciplinary nature of research on this topic. Effective strategies identified for promoting cognitive health and vitality are categorized as follows: prevention and management of chronic conditions, nutrition, physical activity, mental activity, and social engagement. Current research findings on the promotion of cognitive health and vitality are explored, and research-based implications for geriatric nursing practice are discussed.

Surviving Dementia as a carer

This article highlights the issues and problems that carers must face when looking after someone with a dementia related illness. Many carers become seriously depressed, isolated or even marginalised and the demands of the caring role can cause many physical, mental and emotional health problems that if not addressed can lead to complete mental breakdown and ultimately ‘burnout’. The key to surviving as a carer is in developing an understanding of the nature of dementia, together with a realistic attitude to the never ending workload and then to adopt effective coping strategies. This involves accessing and accepting help from many sources; these include cognitive behaviour therapy, complementary practitioners, joining a support group, maximising income and developing a healthy lifestyle. A number of practical suggestions are made that will help a carer maintain physical and mental well-being; some simple tried and tested pleasurable activities are also recommended. The ultimate key to survival is maintaining a sense of humour. Although written primarily for carers, this article will also be of interest to healthcare professionals involved in dementia care. A comprehensive list of relevant addresses and telephone numbers is included.

End-of-life decision making for nursing home residents with dementia.

To describe families' decision-making processes, both cognitive and affective, regarding end-of-life treatments for nursing home residents with moderately severe to very severe dementia. Naturalistic inquiry provided the framework for this descriptive, qualitative study. Four focus groups were conducted in selected nursing homes, in the central part of the United States for a qualitative study. Twenty-eight family members of residents with moderately severe to severe dementia shared their decision-making experiences. Open-ended questions were asked in each focus group. Data were analyzed using content analysis. Five themes were identified that describe the context of decision making: emotional effect, insult-to-life story, two faces of death, values and goals regarding end-of-life treatments, and the unrecognized trajectory of dying. Family members made decisions in an emotional climate of overwhelming burden and guilt, because their loved one's life had been robbed of personhood, the changes associated with decline from a dementia-related illness were unrecognized as part of a trajectory of dying, death was both a tragedy and a blessing. Family members had poignant, unresolved emotional needs stemming from their loved one's illness and nursing home placement. Participants were unprepared to make end-of-life treatment decisions and lacked the informational and emotional support of a consistent provider to help with decisions. Family members need assistance in processing difficult and painful emotions, understanding the trajectory of disease, what decisions might impede a natural death, and comfort or palliative care options.

Use of nursing homes in the care of persons with severe mental illness: 1985 to 1995.

The study examined patterns of care for persons with mental illness in nursing homes in the United States from 1985 to 1995. During that period resident populations in public mental hospitals declined, and legislation aimed at diverting psychiatric patients from nursing homes was enacted. Estimates of the number of current residents with a mental illness diagnosis and those with a severe mental illness were derived from the 1985 and 1995 National Nursing Home Surveys and the 1987 and 1996 Medical Expenditure Surveys. Trends by age group and changes in the mentally ill population over this period were assessed. The number of nursing home residents diagnosed with dementia-related illnesses and depressive illnesses increased, but the number with schizophrenia-related diagnoses declined. The most substantial declines occurred among residents under age 65; more than 60 percent fewer had any primary psychiatric diagnosis or severe mental illness. These findings suggest a reduced role for nursing homes in caring for persons with severe mental illness, especially those who are young and do not have comorbid physical conditions. Overall, it appears that nursing homes play a relatively minor role in the present system of mental health services for all but elderly persons with dementia.

Wandering Behavior and Attempted Exits Among Residents Diagnosed with Dementia-Related Illnesses: A Qualitative Approach

ABSTRACT Exiting attempts and wandering behavior among residents diagnosed with dementia-related illnesses were investigated. Residents were exposed to three test conditions: a mini-blind that concealed the view from the door, a cloth panel that concealed the panic bar of the door, and both the mini-blind and the cloth panel. During these test conditions, qualitative observations were conducted in addition to recording the attempted exits. The purpose of this paper is to present the qualitative findings in relationship to a model developed. The findings suggests that residents seemed to exit due to goal-orientation, exit-seeking behaviors, and attraction to the panic bar.

Family observations of everyday cognitive impairment in dementia

The observations made by family members of cognitive impairment and decline serve an important role in the description of dementia-related illnesses such as Alzheimer's disease. A common clinical practice is to interview the family and informally gather information about the severity and history of intellectual impairment such as memory disorder and aphasia. The present study introduces a method to formalize this information gathering using an inventory that allows a family member to rate the presence and severity of the everyday manifestations of dementia. Results of initial psychometric studies of the rating scale indicate that a family member can make reliable judgments of everyday cognitive impairment. Observér ratings such as these should significantly enhance diagnostic efforts when they are used in conjunction with neuropsychological tests and in cases in which the demented person cannot participate in a full neuropsychological evaluation.