Assessing the impact and social perception of self-regulated music stimulation with patients with Alzheimer's disease

Change in the psychological self in people living with dementia: A scoping review

Alterations in one's sense of self are often considered a significant psychological symptom of dementia. However, the self is not a unified construct; it consists of a set of closely connected, yet substantive, manifestations which might not be equally impacted by dementia. Recognising the multidimensional nature of the self, the current scoping review aimed to explore the nature and scope of the evidence demonstrating change in the psychological self in people living with dementia. Adopting a cognitive psychological framework, a hundred and five (105) quantitative and qualitative studies were reviewed, and findings were organised into three main types of self-manifestations: high-order manifestations, functional aspects of the self, and foundational manifestations. Overall, the results show that although there are alterations in some of these different manifestations of the self, these do not imply a global loss of selfhood. Despite notable cognitive changes during dementia, it seems that preserved aspects of self may be enough to compensate for potential weakening of some self-processes such as autobiographical recall. Better understanding alterations in selfhood is key to addressing psychological symptoms of people living with dementia, such as feelings of disconnection and reduced agency, and may inform new pathways for dementia care interventions.

Benefits in Alzheimer's Disease of Sensory and Multisensory Stimulation

Alzheimer's disease (AD) is a serious neurodegenerative disease, which seriously affects the behavior, cognition, and memory of patients. Studies have shown that sensory stimulation can effectively improve the cognition and memory of AD patients, and its role in brain plasticity and neural regulation is initially revealed. This paper aims to review the effect of various sensory stimulation and multisensory stimulation for AD, and to explain the possible mechanism, so as to provide some new ideas for further research in this field. We searched the Web of Science and PubMed databases (from 2000 to October 27, 2020) for literature on the treatment of AD with sensory and multisensory stimulation, including music therapy, aromatherapy, rhythmic (e.g., visual or acoustic) stimulation, light therapy, multisensory stimulation, and virtual reality assisted therapy, then conducted a systematic analysis. Results show these sensory and multisensory stimulations can effectively ameliorate the pathology of AD, arouse memory, and improve cognition and behaviors. What's more, it can cause brain nerve oscillation, enhance brain plasticity, and regulate regional cerebral blood flow. Sensory and multisensory stimulation are very promising therapeutic methods, and they play an important role in the improvement and treatment of AD, but their potential mechanism and stimulation parameters need to be explored and improved.

Virtual Reality as a Technological-Aided Solution to Support Communication in Persons With Neurodegenerative Diseases and Acquired Brain Injury During COVID-19 Pandemic

The COVID-19 poses an ongoing threat to lives around the world and challenges the existing public health and medical service delivery. The lockdown or quarantine measures adopted to prevent the spread of COVID-19 has caused the interruption in ongoing care and access to medical care including to patients with existing neurological conditions. Besides the passivity, isolation, and withdrawal, patients with neurodegenerative diseases experience difficulties in communication due to a limited access to leisure opportunities and interaction with friends and relatives. The communication difficulties may exacerbate the burden on the caregivers. Therefore, assistive-technologies may be a useful strategy in mitigating challenges associated with remote communication. The current paper presents an overview of the use of assistive technologies using virtual reality and virtual body ownership in providing communication opportunities to isolated patients, during COVID-19, with neurological diseases and moderate-to-severe communication difficulties. We postulate that the assistive technologies-based intervention may improve social interactions in patients with neurodegenerative diseases and acquired brain injury-thereby reducing isolation and improving their quality of life and mental well-being.

A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT

BACKGROUND

People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision.

OBJECTIVES

To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes.

DESIGN

The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible.

SETTING

Nursing homes in England providing care for people with dementia.

PARTICIPANTS

Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff.

INTERVENTION

Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement.

MAIN OUTCOME MEASURES

The two contender primary outcome measures were Comfort Assessment in Dying - End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data - health economic outcomes, medication/service use and intervention activity.

RESULTS

Phase 1 (realist review; 86 papers) identified that a key intervention component was the activities enabling the development of moments of connection. In phase 2, refinement of the intervention enabled the production of a user-friendly 16-page A4 booklet. In phase 3, eight nursing homes were recruited. Two homes withdrew before the intervention commenced; four intervention and two control homes completed the study. Residents with advanced dementia (n = 32) were recruited in intervention (n = 18) and control (n = 14) homes. Informal carers (total, n = 12: intervention, n = 5; control, n = 7) and 97 staff from eight sites (intervention, n = 75; control, n = 22) were recruited over a 6-month period. Recruitment is feasible. Completion rates of the primary outcome questionnaires were high at baseline (100%) and at 4 weeks (96.8%). The Quality of Life in Late Stage Dementia was more responsive to change over 24 weeks. Even where economic data were missing, these could be collected in a full trial. The intervention was acceptable; the dose varied depending on the staffing and physical environment of each care home. Staff and informal carers reported changes for the person with dementia in two ways: increased social engagement and greater calm. No adverse events related to the intervention were reported.

CONCLUSIONS

A subsequent definitive trial is feasible if there are amendments to the recruitment process, outcome measure choice and intervention specification.

FUTURE WORK

In a full trial, consideration is needed of the appropriate outcome measure that is sensitive to different participant responses, and of clear implementation principles for this person-centred intervention in a nursing home context.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN14948133.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 6. See the NIHR Journals Library website for further project information.

Tablet-based intervention to foster music-related hand responses and positive engagement in people with advanced Alzheimer’s disease

Purpose

Music stimulation is considered beneficial for people with advanced Alzheimer’s disease. The purpose of this paper is to assess a tablet-based program to promote music-related hand responses and positive engagement (e.g. singing or moving the body with the music) in people with advanced Alzheimer’s disease.

Design/methodology/approach

The program was implemented with 20 participants according to a non-concurrent multiple baseline design across participants. The participants were provided with a tablet whose screen worked as a sensor. During the intervention, sensor activations by hand responses led the tablet to present 10 s segments of preferred songs; an absence of sensor activation led the tablet to produce a prompt.

Findings

The participants’ mean frequencies of hand responses (i.e. sensor activations) per 5 min session increased from mostly zero during baseline to between about 9 and 20 during the intervention. The mean percentages of observation intervals with participants’ positive engagement increased from 0 to 12 during the baseline to between 13 and 55 during the intervention. The differences between baseline and intervention data were statistically significant for all participants.

Originality/value

A tablet-based program, such as that used in this study, may help people with advanced Alzheimer’s disease develop specific music-related responses and positive engagement.

Improving living and dying for people with advanced dementia living in care homes: a realist review of Namaste Care and other multisensory interventions

BACKGROUND

Seventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might work, on what outcomes, and in what circumstances.

METHODS

This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories, and their validation with a purposive sample of stakeholders. Twenty stakeholders - user/patient representatives, dementia care providers, care home staff, researchers -took part in interviews and/or workshops.

RESULTS

We included 85 papers. Eight focused on Namaste Care and the remainder on other types of sensory interventions such as music therapy or massage. We identified three context-mechanism-outcome configurations which together provide an explanatory account of what needs to be in place for Namaste Care to work for people living with advanced dementia. This includes: providing structured access to social and physical stimulation, equipping care home staff to cope effectively with complex behaviours and variable responses, and providing a framework for person-centred care. A key overarching theme concerned the importance of activities that enabled the development of moments of connection for people with advanced dementia.

CONCLUSIONS

This realist review provides a coherent account of how Namaste Care, and other multisensory interventions might work. It provides practitioners and researchers with a framework to judge the feasibility and likely success of Namaste Care in long term settings. Key for staff and residents is that the intervention triggers feelings of familiarity, reassurance, engagement and connection.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42016047512.

[Effects of Music Therapy on the Care Burden of In-Home Caregivers and Physiological Parameters of Their In-Home Dementia Patients: A Randomized Controlled Trial]

OBJECTIVES

This study was conducted to explore the effects of classical Turkish music therapy on both the caregiver burden and physiological parameters of patients with dementia.

METHODS

The study was a randomized controlled trial. It was conducted with dementia patients (n = 75) and their caregivers who were registered at in-home care services of the General Secretariat of the Association of Public Hospitals in Ordu. The study sample consisted of 30 control and 30 music group patients and their caregivers who satisfied the inclusion criteria for the study conducted between April 2015 and April 2016. The primary outcome of the study was to measure the care burden of in-home caregivers, and the secondary outcome was to measure physiological parameters, including systolic and diastolic blood pressure, heart rate, and respiration rate in patients with dementia.

RESULTS

The mean scores of the post-test caregiver burden in the music group were found to be significantly lower than those of the control group (t = -4.478, p = 0.001). The differences in the post-test systolic and diastolic blood pressures between the patient groups were found to be statistically significant (t = -4.603, p = 0.001; t = -2.656, p = 0.010).

CONCLUSIONS

Classical Turkish music intervention in in-home dementia patients decreased the care burden of caregivers and the patients' blood pressures were brought under control. In parallel with these results, it is recommended that more studies to reveal the effects of classical Turkish music on care burden should be conducted.

Musical Electroacupuncture May Be a Better Choice than Electroacupuncture in a Mouse Model of Alzheimer's Disease

Objectives. To compare musical electroacupuncture and electroacupuncture in a mouse model of Alzheimer's disease. Methods. In this study, 7.5-month-old male senescence-accelerated mouse prone 8 (SAMP8) mice were used as an Alzheimer's disease animal model. In the normal control paradigm, 7.5-month-old male SAMR1 mice were used as the blank control group (N group). After 15 days of treatment, using Morris water maze test, micro-PET, and immunohistochemistry, the differences among the musical electroacupuncture (MEA), electroacupuncture (EA), Alzheimer's disease (AD), and normal (N) groups were assessed. Results. The Morris water maze test, micro-PET, and immunohistochemistry revealed that MEA and EA therapies could improve spatial learning and memory ability, glucose metabolism level in the brain, and Aβ amyloid content in the frontal lobe, compared with the AD group (P < 0.05). Moreover, MEA therapy performed better than EA treatment in decreasing amyloid-beta levels in the frontal lobe of mice with AD. Conclusion. MEA therapy may be superior to EA in treating Alzheimer's disease as demonstrated in SAMP8 mice.

Effects of response-related music stimulation versus general music stimulation on positive participation of patients with Alzheimer's disease

OBJECTIVE

Assessing the effects of response-related music stimulation versus general (response-unrelated) music stimulation on positive participation of 11 new patients with Alzheimer's disease.

METHOD

The patients were functioning in the severe and low-moderate ranges of the disease. Positive participation included behaviors such as, singing or rhythmic movements and smiles. Both music conditions relied on the display of music/song videos on a computer screen. In the response-related (active) condition, the patients used a simple hand response and a microswitch to determine music stimulation inputs. In the general (unrelated/passive) condition, music stimulation was automatically presented throughout the sessions.

RESULTS

Data showed that six of the 11 patients had higher levels of positive participation in the response-related stimulation condition. The remaining five patients did not have differences between the two conditions.

CONCLUSION

Based on this evidence and previous findings, one might consider the use of the active condition beneficial for daily programs.

Persons with Alzheimer's disease engage in leisure and mild physical activity with the support of technology-aided programs

Three studies were conducted to assess technology-aided programs to promote leisure engagement and mild physical activity in persons with Alzheimer's disease. Specifically, Study I assessed a program aimed at enabling three patients with mild or moderate Alzheimer's disease to choose among different music options and activate the preferred ones. Studies II and III were directed at patients in the low moderate or severe stages of the Alzheimer's disease who were no longer capable of ambulating and spent their time generally inactive, sitting in their wheelchairs. In particular, Study II used a program to help three patients exercise an arm-raising movement. Study III used a program to help three patients exercise a leg-foot movement. Each study was carried out according to a nonconcurrent multiple baseline design across patients. Results were very encouraging. The patients of Study I learned to choose and activate their preferred music pieces. The patients of Studies II and III enhanced their performance of the target movements and increased their indices of positive participation (e.g., smiles and verbalizations) during the sessions. The applicability of the programs in daily contexts and their implications for the patients involved are discussed.

Persons with moderate Alzheimer's disease use simple technology aids to manage daily activities and leisure occupation

Two studies assessed technology-aided programs to support performance of daily activities and selection/activation of music items with patients with moderate Alzheimer's disease. In Study I, four patients were presented with activity-related pictorial instructions via a computer fitted with inexpensive, commercial software. In Study II, four patients were (a) presented with different music options and (b) allowed to select and activate the preferred option via a microswitch response. Study I showed that each patient learned to perform the two activities available with percentages of correct responses exceeding 85 by the end of the intervention. Study II showed that all patients learned to choose and activate music options. Psychology students, employed in a social validation check, scored the patients' behavior within the program better than their behavior in a control situation. The relevance and usability of simplified pictorial-instruction programs and music choice programs for patients with moderate Alzheimer's disease were discussed.