Medicine and Health Sciences Commons^™

Building Capacity For Dementia Care In Latin America And The Caribbean, Francisco J. Gonzalez, Ciro Gaona, Marialcira Quintero, Carlos A. Chavez, Joyce Selga, Gladys E. Maestre

School of Medicine Publications and Presentations

Latin America and the Caribbean (LAC) have limited facilities and professionals trained to diagnose, treat, and support people with dementia and other forms of cognitive impairment. The situation for people with dementia is poor, and worsening as the proportion of elderly in the general population is rapidly expanding. We reviewed existing initiatives and provided examples of actions taken to build capacity and improve the effectiveness of individuals, organizations, and national systems that provide treatment and support for people with dementia and their caregivers. Regional barriers to capacity building and the importance of public engagement are highlighted. Existing programs need to …

Self-Reported Memory Complaints: Implications From A Longitudinal Cohort With Autopsies, Richard J. Kryscio, Erin L. Abner, Gregory E. Cooper, David W. Fardo, Greg A. Jicha, Peter T. Nelson, Charles D. Smith, Linda J. Van Eldik, Lijie Wan, Frederick A. Schmitt

Sanders-Brown Center on Aging Faculty Publications

OBJECTIVE: We assessed salience of subjective memory complaints (SMCs) by older individuals as a predictor of subsequent cognitive impairment while accounting for risk factors and eventual neuropathologies.

METHODS: Subjects (n = 531) enrolled while cognitively intact at the University of Kentucky were asked annually if they perceived changes in memory since their last visit. A multistate model estimated when transition to impairment occurred while adjusting for intervening death. Risk factors affecting the timing and probability of an impairment were identified. The association between SMCs and Alzheimer-type neuropathology was assessed from autopsies (n = 243).

RESULTS: SMCs were …

Motoric Cognitive Risk Syndrome: Multicountry Prevalence And Dementia Risk, Joe Verghese, Cedric Annweiler, Emmeline Ayers, Nir Barzilai, Olivier Beauchet, David A Bennett, Stephanie A Bridenbaugh, Aron S Buchman, Michele L Callisaya, Richard Camicioli, Benjamin Capistrant, Somnath Chatterji, Anne-Marie De Cock, Luigi Ferrucci, Nir Giladi, Jack M Guralnik, Jeffrey M Hausdorff, Roee Holtzer, Ki Woong Kim, Paul Kowal, Reto W Kressig, Jae-Young Lim, Susan Lord, Kenichi Meguro, Manuel Montero-Odasso, Susan W. Hunter, Mohan L Noone, Lynn Rochester, Velandai Srikanth, Cuiling Wang

Physical Therapy Publications

OBJECTIVES: Our objective is to report prevalence of motoric cognitive risk syndrome (MCR), a newly described predementia syndrome characterized by slow gait and cognitive complaints, in multiple countries, and its association with dementia risk.

METHODS: Pooled MCR prevalence analysis of individual data from 26,802 adults without dementia and disability aged 60 years and older from 22 cohorts from 17 countries. We also examined risk of incident cognitive impairment (Mini-Mental State Examination decline ≥4 points) and dementia associated with MCR in 4,812 individuals without dementia with baseline Mini-Mental State Examination scores ≥25 from 4 prospective cohort studies using Cox models adjusted …

Obesity And Diabetes Cause Cognitive Dysfunction In The Absence Of Accelerated Β-Amyloid Deposition In A Novel Murine Model Of Mixed Or Vascular Dementia, Dana M. Niedowicz, Valerie L. Reeves, Thomas L. Platt, Katharina Kohler, Tina L. Beckett, David K. Powell, Tiffany L. Lee, Travis R. Sexton, Eun Suk Song, Lawrence D. Brewer, Caitlin S. Latimer, Susan D. Kraner, Kara L. Larson, Sabire Özcan, Christopher M. Norris, Louis B. Hersh, Nada M. Porter, Donna M. Wilcock, Michael Paul Murphy

Sanders-Brown Center on Aging Faculty Publications

Mid-life obesity and type 2 diabetes mellitus (T2DM) confer a modest, increased risk for Alzheimer's disease (AD), though the underlying mechanisms are unknown. We have created a novel mouse model that recapitulates features of T2DM and AD by crossing morbidly obese and diabetic db/db mice with APP^ΔNL/ΔNLx PS1^P264L/P264L knock-in mice. These mice (db/AD) retain many features of the parental lines (e.g. extreme obesity, diabetes, and parenchymal deposition of β-amyloid (Aβ)). The combination of the two diseases led to additional pathologies-perhaps most striking of which was the presence of severe cerebrovascular pathology, including aneurysms and small …

Self-Reported Head Injury And Risk Of Late-Life Impairment And Ad Pathology In An Ad Center Cohort, Erin L. Abner, Peter T. Nelson, Frederick A. Schmitt, Steven R. Browning, David W. Fardo, Lijie Wan, Gregory A. Jicha, Gregory E. Cooper, Charles D. Smith, Allison M. Caban-Holt, Linda J. Van Eldik, Richard J. Kryscio

Sanders-Brown Center on Aging Faculty Publications

Aims: To evaluate the relationship between self-reported head injury and cognitive impairment, dementia, mortality, and Alzheimer's disease (AD)-type pathological changes. Methods: Clinical and neuropathological data from participants enrolled in a longitudinal study of aging and cognition (n = 649) were analyzed to assess the chronic effects of self-reported head injury. Results: The effect of self-reported head injury on the clinical state depended on the age at assessment: for a 1-year increase in age, the OR for the transition to clinical mild cognitive impairment (MCI) at the next visit for participants with a history of head injury was 1.21 and 1.34 …

Strategies For Sustaining Self Used By Family Caregivers For Older Adults With Dementia, Margaret J. Bull

College of Nursing Faculty Research and Publications

The negative health consequences of caring for an older adult family member with dementia are well documented. However, not all family caregivers experience these negative health consequences. The purposes of this study were to describe strategies family caregivers use to help them continue to provide care for an older family member with dementia despite challenges and describe these family caregivers’ resilience and psychological distress. A mixed methods design was used with a narrative approach dominant and standardized scales for resilience and psychological distress used to enhance the description of the sample. Data were collected through telephone interviews with 18 family …

Results And Lessons Learned From A Nurse Practitioner-Guided Dementia Care Intervention For Primary Care Patients And Their Family Caregivers, Richard H. Fortinsky, Colleen Delaney, Ofer Harel, Karen Pasquale, Elena Schjavland, John Lynch, Alison Kleppinger, Suzanne Crumb

Articles - Patient Care

Older adults with dementia care needs often visit primary care physicians (PCPs), but PCP dementia care limitations are widely documented. This study tested the value of employing a nurse practitioner (NP) with geropsychiatric expertise to augment PCP care for newly and recently diagnosed patients and family caregivers. Twenty-one dyads received the NP intervention; 10 dyads were controls. Outcomes included patient neuropsychiatric symptom and quality of life changes, and caregiver depression, burden, and self-efficacy changes. Intervention acceptability by patients, caregivers, and PCPs was determined. No outcome differences were found; however, the NP intervention was deemed highly satisfactory by all stakeholders. Patients …

Clinical Trials And Late-Stage Drug Development In Alzheimer’S Disease: An Appraisal From 1984 To 2014, L. S. Schneider, F. Mangialasche, S. Andreasen, H. Feldman, E. Giacobini, R. Jones, V. Mantua, P. Mecocci, L. Pani, B. Winblad, M. Kivipelto

Human Clinical Trials Collection

The modern era of drug development for Alzheimer's disease began with the proposal of the cholinergic hypothesis of memory impairment and the 1984 research criteria for Alzheimer's disease. Since then, despite the evaluation of numerous potential treatments in clinical trials, only four cholinesterase inhibitors and memantine have shown sufficient safety and efficacy to allow marketing approval at an international level. Although this is probably because the other drugs tested were ineffective, inadequate clinical development methods have also been blamed for the failures. Here, we review the development of treatments for Alzheimer's disease during the past 30 years, considering the drugs, …

Biological Basis For Cerebral Dysfunction In Schizophrenia In Contrast With Alzheimer’S Disease, Rodrigo O. Kuljis, Luis V. Colom, Leonel E. Rojo

Health & Biomedical Sciences Faculty Publications and Presentations

Schizophrenia and Alzheimer’s disease are two disorders that, while conceptualized as pathophysiologically and clinically distinct, cause substantial cognitive and behavioral impairment worldwide, and target apparently similar – or nearby – circuitry in regions such as the temporal and frontal lobes.We review the salient differences and similarities from selected historical, nosological, and putative mechanistic viewpoints, as a means to help both clinicians and researchers gain a better insight into these intriguing disorders, for which over a century of research and decades of translational development was needed to begin yielding treatments that are objectively effective, but still very far from entirely satisfactory. …

Evaluation Of The Jewish Community Housing For The Elderly Memory Support Initiative, Joan Hyde

Gerontology Institute Publications

Jewish Community Housing for the Elderly (JCHE) is a large, multi-campus organization that houses and serves 1,500 residents (80 market rate and 1,420 low income). The average age is 80 years old, with one-third of residents 85 and older. Three quarters of the residents are not native English speakers. Through HUD and other funding, JCHE offers a range of supports to these residents, including translators, interpreters and staff with language and cultural competence, meals, transportation and, through their Service Coordinators, facilitation of resident access to government benefits, home care and other services.

According to the Alzheimer’s Association’s 2012 special report …

Remembering Through Music: Music Therapy And Dementia, Melissa Owens

Case Studies from Age in Action

Educational Objectives

1. Define music therapy and its benefits with older adults with dementia and related disorders/ diseases.

2. Describe active and passive music therapy interventions and strategies for older adult populations.

3. Identify the ways a non-musician can use music to engage older adults and mitigate some symptoms of dementia.

Non-Pharmacological Management Of The Behavioral And Psychological Symptoms Of Dementia, Chito O. Uyanwune

Doctor of Nursing Practice (DNP) Projects

The focus of this change in practice implementation project is to emphasize and encourage the use of non-pharmacological interventions as the first line intervention in managing the Behavioral and Psychological Symptoms of Dementia (BPSD) among nursing home residents. A sample of nurses (N = 14) and nursing assistants (N = 11) working in two local nursing homes participated in an educational intervention about dementia care. Two hundred and one charts were reviewed of the residents of both homes for antipsychotic use. Regardless that one home seems very organized, is using less antipsychotic than the other home compared to their bigger …

The Global Obesity Epidemic Is Related To Stroke, Dementia And Alzheimer's Disease, Ian J. Martins

Research outputs 2014 to 2021

The global epidemic in obesity and diabetes has affected individuals in both the developing and developed world with the global death rate (63%) related to chronic diseases with 35% attributed to cardiovascular disease and stroke, 21 % to cancer and 12 % to chronic respiratory disease. The interest in connections between the global stroke epidemic, dementia and Alzheimer’s disease (AD) has increased with hypertension, smoking, diabetes, obesity, poor diet, physical inactivity, atrial fibrillation, excessive alcohol consumption, abnormal lipid profile and psychosocial stress/depression implicated in their pathogenesis. The connection between stroke and AD is possibly related to the low adiponectin and …

Effect Of Doll Therapy In Managing Challenging Behaviors In People With Dementia: A Systematic Review, Ritin Fernandez, Bronwyn Arthur, Richard Fleming, Cecile Perrin

Faculty of Science, Medicine and Health - Papers: part A

Background:Challenging behaviors among people with dementia are frequently treated with pharmacological interventions, with antipsychotic medications being the treatment of choice. Concerns with the use of these medications include the risk of mortality, their side effects and their effectiveness in managing the challenging behaviors. Various non-pharmacological approaches have been implemented to manage the challenging behaviors; however there has been no review undertaken to investigate the effects of doll therapy in the management of challenging behaviors among people with dementia. Objectives:The overall objective of this study was to undertake a systematic review of the effects of doll therapy on challenging behaviors (including …

Barriers To Qualitative Dementia Research: The Elephant In The Room, John Carmody, Victoria Traynor, Elena Marchetti

Faculty of Science, Medicine and Health - Papers: part A

As our population is aging, the global prevalence of dementia is rising. Recent extensive reviews of the dementia literature highlight a clear need for additional qualitative research to address the experiences of people with dementia and their carers. To date, the vast majority of published dementia research is quantitative in nature and, perhaps not surprisingly, attracts the bulk of government funding. In contrast, qualitative dementia research is poorly resourced and less frequently published. Although a myriad of factors are responsible for this dichotomy, we propose that inadequate funding represents the "elephant in the room" of dementia research. In this article, …

Percen: A Cluster Randomized Controlled Trial Of Person-Centered Residential Care And Environment For People With Dementia, Lynn Chenoweth, Ian Forbes, Richard Fleming, Madeleine King, Jane Stein-Parbury, Georgina Luscombe, Patricia Kenny, Yun-Hee Jeon, Marion Haas, Henry Brodaty

Faculty of Science, Medicine and Health - Papers: part A

Background: There is good evidence of the positive effects of person-centered care (PCC) on agitation in dementia. We hypothesized that a person-centered environment (PCE) would achieve similar outcomes by focusing on positive environmental stimuli, and that there would be enhanced outcomes by combining PCC and PCE. Methods: 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified, then randomized to one of four intervention groups: (1) PCC; (2) PCE; (3) PCC +PCE; (4) no intervention. People with dementia, over 60 years of age and consented were eligible. Co-outcomes assessed pre and four months …

Betsy: A Case Study Of A Client With Down's Syndrome And Dementia, Cheryl D. Schlamb, Christine D. Moriconi

Nursing Faculty Publications

No abstract provided.

Anxiety Symptoms, Cerebral Amyloid Burden And Memory Decline In Healthy Older Adults Without Dementia: 3-Year Prospective Cohort Study, Robert H. Pietrzak, J C. Scott, Alexander Neumeister, Yen Ying Lim, David Ames, Kathyrn A. Ellis, Kara Harrington, Nicola T. Lautenschlager, Cassandra Szoeke, Ralph Martins, Colin L. Masters, Victor L. Villemagne, Christopher C. Rowe, Paul Maruff

Research outputs 2014 to 2021

Although beta-amyloid, anxiety and depression have been linked cross-sectionally to reduced memory function in healthy older adults without dementia, prospective data evaluating these associations are lacking. Using data from an observational cohort study of 178 healthy older adults without dementia followed for 3 years, we found that anxiety symptoms significantly moderated the relationship between beta-amyloid level and decline in verbal (Cohen's d = 0.65) and episodic (Cohen's d = 0.38) memory. Anxiety symptoms were additionally linked to greater decline in executive function, irrespective of beta-amyloid and other risk factors. These findings suggest that interventions to mitigate anxiety symptoms may help …

Management Of Behavioural Change In Patients Presenting With A Diagnosis Of Dementia: A Video Vignette Study With Australian General Practitioners, M Jiwa, P Nichols, P Magin, G Pagey, X Meng, R Parsons, V Pillai

Medical Papers and Journal Articles

Objective: To test the impact of feedback on the proposed management of standardised patients presenting with behavioural change with a diagnosis of dementia in Australian primary care.

Materials and methods: A video vignette study was performed with Australian general practitioners (GPs) in 2013. Participants viewed six pairs of matched videos depicting people presenting changed behavior in the context of a dementia diagnosis in two phases. In both phases GPs indicated their diagnosis and management. After phase 1, GPs were offered feedback on management strategies for the patients depicted. Analyses focused on identification of change in management between the two phases …

Preventing Dysfunctional Behaviors Of Those With Dementia Based On The Progressively Lowered Stress Threshold Model, Mary Chrabaszcz

Doctor of Nursing Practice (DNP) Projects

Abstract

Dementia is a disease that impacts millions of people worldwide. Amongst the complications of this disease are behaviors that affect not only the individual with dementia but also their caregivers. These behaviors can be challenging especially for formal caregivers and it is important that they are taught how to prevent them. Long-term care facilities are the perfect settings for this type of education. For this reason, an educational program, including a needs assessment, PowerPoint presentation, and on-site support, was brought to a locked, assisted-living unit of Jewish Geriatric Services in Longmeadow, Massachusetts. The educational program was inspired and supported …